Cargando…

Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study

BACKGROUND: We aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010–2011. METHODS: An observational, 4-day point prevalence study was perform...

Descripción completa

Detalles Bibliográficos
Autores principales: Divatia, Jigeeshu V, Mehta, Yatin, Govil, Deepak, Zirpe, Kapil, Amin, Pravin R, Ramakrishnan, Nagarajan, Kapadia, Farhad N, Sircar, Mrinal, Sahu, Samir, Bhattacharya, Pradip Kumar, Myatra, Sheila Nainan, Samavedam, Srinivas, Dixit, Subhal, Pande, Rajesh Kumar, Mehta, Sujata N, Venkataraman, Ramesh, Bajan, Khusrav, Kumar, Vivek, Harne, Rahul, Thakur, Leelavati, Rathod, Darshana, Sathe, Prachee, Gurav, Sushma, D'Silva, Carol, Pasha, Shaik Arif, Todi, Subhash Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Jaypee Brothers Medical Publishers 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8645819/
https://www.ncbi.nlm.nih.gov/pubmed/34916740
http://dx.doi.org/10.5005/jp-journals-10071-23965
_version_ 1784610388931772416
author Divatia, Jigeeshu V
Mehta, Yatin
Govil, Deepak
Zirpe, Kapil
Amin, Pravin R
Ramakrishnan, Nagarajan
Kapadia, Farhad N
Sircar, Mrinal
Sahu, Samir
Bhattacharya, Pradip Kumar
Myatra, Sheila Nainan
Samavedam, Srinivas
Dixit, Subhal
Pande, Rajesh Kumar
Mehta, Sujata N
Venkataraman, Ramesh
Bajan, Khusrav
Kumar, Vivek
Harne, Rahul
Thakur, Leelavati
Rathod, Darshana
Sathe, Prachee
Gurav, Sushma
D'Silva, Carol
Pasha, Shaik Arif
Todi, Subhash Kumar
author_facet Divatia, Jigeeshu V
Mehta, Yatin
Govil, Deepak
Zirpe, Kapil
Amin, Pravin R
Ramakrishnan, Nagarajan
Kapadia, Farhad N
Sircar, Mrinal
Sahu, Samir
Bhattacharya, Pradip Kumar
Myatra, Sheila Nainan
Samavedam, Srinivas
Dixit, Subhal
Pande, Rajesh Kumar
Mehta, Sujata N
Venkataraman, Ramesh
Bajan, Khusrav
Kumar, Vivek
Harne, Rahul
Thakur, Leelavati
Rathod, Darshana
Sathe, Prachee
Gurav, Sushma
D'Silva, Carol
Pasha, Shaik Arif
Todi, Subhash Kumar
author_sort Divatia, Jigeeshu V
collection PubMed
description BACKGROUND: We aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010–2011. METHODS: An observational, 4-day point prevalence study was performed between 2018 and 2019. ICU, patient characteristics, and interventions were recorded for 24 hours, and ICU outcomes till 30 days after the study day. Adherence to selected compliance measures was determined. Data were analyzed for 4,669 adult patients from 132 ICUs. RESULTS: On the study day, mean age, acute physiology and chronic health evaluation (APACHE II), and sequential organ failure assessment (SOFA) scores were 56.9 ± 17.41 years, 16.7 ± 9.8, and 4.4 ± 3.6, respectively. Moreover, 24% and 22.2% of patients received mechanical ventilation (MV) and vasopressors or inotropes (VIs), respectively. On the study days, 1,195 patients (25.6%) were infected and 1,368 patients (29.3%) had sepsis during their ICU stay. ICU mortality was 1,092 out of 4,669 (23.4%), including 737 deaths and 355 terminal discharges (TDs) from ICU. Compliance for process measures related to MV ranged between 62.7 and 85.3%, 11.2 and 47.4% for monitoring delirium, sedation, and analgesia, and 7.7 and 25.3% for inappropriate transfusion of blood products. Only 34.8% of ICUs routinely used capnography. Large hospitals with ≥500 beds, closed ICUs, the APACHE II and SOFA scores, medical admissions, the presence of cancer or cirrhosis of the liver, the presence of infection on the study day, and the need for MV or VIs were independent predictors of mortality. CONCLUSIONS: Hospital size and closed ICUs are independently associated with worse outcomes. The proportion of TDs remains high. There is a scope for improvements in processes of care. Registered at clinicaltrials.gov (NCT03631927). HOW TO CITE THIS ARTICLE: Divatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, et al. Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021;25(10):1093–1107.
format Online
Article
Text
id pubmed-8645819
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Jaypee Brothers Medical Publishers
record_format MEDLINE/PubMed
spelling pubmed-86458192021-12-15 Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study Divatia, Jigeeshu V Mehta, Yatin Govil, Deepak Zirpe, Kapil Amin, Pravin R Ramakrishnan, Nagarajan Kapadia, Farhad N Sircar, Mrinal Sahu, Samir Bhattacharya, Pradip Kumar Myatra, Sheila Nainan Samavedam, Srinivas Dixit, Subhal Pande, Rajesh Kumar Mehta, Sujata N Venkataraman, Ramesh Bajan, Khusrav Kumar, Vivek Harne, Rahul Thakur, Leelavati Rathod, Darshana Sathe, Prachee Gurav, Sushma D'Silva, Carol Pasha, Shaik Arif Todi, Subhash Kumar Indian J Crit Care Med Original Article BACKGROUND: We aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010–2011. METHODS: An observational, 4-day point prevalence study was performed between 2018 and 2019. ICU, patient characteristics, and interventions were recorded for 24 hours, and ICU outcomes till 30 days after the study day. Adherence to selected compliance measures was determined. Data were analyzed for 4,669 adult patients from 132 ICUs. RESULTS: On the study day, mean age, acute physiology and chronic health evaluation (APACHE II), and sequential organ failure assessment (SOFA) scores were 56.9 ± 17.41 years, 16.7 ± 9.8, and 4.4 ± 3.6, respectively. Moreover, 24% and 22.2% of patients received mechanical ventilation (MV) and vasopressors or inotropes (VIs), respectively. On the study days, 1,195 patients (25.6%) were infected and 1,368 patients (29.3%) had sepsis during their ICU stay. ICU mortality was 1,092 out of 4,669 (23.4%), including 737 deaths and 355 terminal discharges (TDs) from ICU. Compliance for process measures related to MV ranged between 62.7 and 85.3%, 11.2 and 47.4% for monitoring delirium, sedation, and analgesia, and 7.7 and 25.3% for inappropriate transfusion of blood products. Only 34.8% of ICUs routinely used capnography. Large hospitals with ≥500 beds, closed ICUs, the APACHE II and SOFA scores, medical admissions, the presence of cancer or cirrhosis of the liver, the presence of infection on the study day, and the need for MV or VIs were independent predictors of mortality. CONCLUSIONS: Hospital size and closed ICUs are independently associated with worse outcomes. The proportion of TDs remains high. There is a scope for improvements in processes of care. Registered at clinicaltrials.gov (NCT03631927). HOW TO CITE THIS ARTICLE: Divatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, et al. Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021;25(10):1093–1107. Jaypee Brothers Medical Publishers 2021-10 /pmc/articles/PMC8645819/ /pubmed/34916740 http://dx.doi.org/10.5005/jp-journals-10071-23965 Text en Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd. https://creativecommons.org/licenses/by-nc/4.0/© The Author(s). 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Article
Divatia, Jigeeshu V
Mehta, Yatin
Govil, Deepak
Zirpe, Kapil
Amin, Pravin R
Ramakrishnan, Nagarajan
Kapadia, Farhad N
Sircar, Mrinal
Sahu, Samir
Bhattacharya, Pradip Kumar
Myatra, Sheila Nainan
Samavedam, Srinivas
Dixit, Subhal
Pande, Rajesh Kumar
Mehta, Sujata N
Venkataraman, Ramesh
Bajan, Khusrav
Kumar, Vivek
Harne, Rahul
Thakur, Leelavati
Rathod, Darshana
Sathe, Prachee
Gurav, Sushma
D'Silva, Carol
Pasha, Shaik Arif
Todi, Subhash Kumar
Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study
title Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study
title_full Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study
title_fullStr Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study
title_full_unstemmed Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study
title_short Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study
title_sort intensive care in india in 2018–2019: the second indian intensive care case mix and practice patterns study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8645819/
https://www.ncbi.nlm.nih.gov/pubmed/34916740
http://dx.doi.org/10.5005/jp-journals-10071-23965
work_keys_str_mv AT divatiajigeeshuv intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT mehtayatin intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT govildeepak intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT zirpekapil intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT aminpravinr intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT ramakrishnannagarajan intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT kapadiafarhadn intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT sircarmrinal intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT sahusamir intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT bhattacharyapradipkumar intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT myatrasheilanainan intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT samavedamsrinivas intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT dixitsubhal intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT panderajeshkumar intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT mehtasujatan intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT venkataramanramesh intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT bajankhusrav intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT kumarvivek intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT harnerahul intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT thakurleelavati intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT rathoddarshana intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT satheprachee intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT guravsushma intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT dsilvacarol intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT pashashaikarif intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT todisubhashkumar intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy
AT intensivecareinindiain20182019thesecondindianintensivecarecasemixandpracticepatternsstudy