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VOLUME 25 , ISSUE 10 ( October, 2021 ) > List of Articles

Original Article

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

Yatin Mehta, Pravin R Amin, Samir Sahu, Pradip Kumar Bhattacharya, Rajesh Kumar Pande, Sujata N Mehta, Khusrav Bajan, Vivek Kumar, Rahul Harne, Leelavati Thakur, Darshana Rathod, Prachee Sathe, Sushma Gurav, Carol D'Silva, the INDICAPS-II investigators

Keywords : Adult, Health care, India, Intensive care units, Mortality, Patients, Process assessment

Citation Information : Mehta Y, Amin PR, Sahu S, Bhattacharya PK, Pande RK, Mehta SN, Bajan K, Kumar V, Harne R, Thakur L, Rathod D, Sathe P, Gurav S, D'Silva C, the INDICAPS-II investigators. 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.

DOI: 10.5005/jp-journals-10071-23965

License: CC BY-NC 4.0

Published Online: 21-06-2022

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

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).


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  1. Divatia JV, Amin PR, Ramakrishnan N, Kapadia FN, Todi S, Sahu S, et al. Intensive care in India: The Indian intensive care case mix and practice patterns study. Indian J Crit Care Med 2016;20(4):216–225. DOI: 10.4103/0972-5229.180042.
  2. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619–1636. DOI: 10.1378/chest.100.6.1619.
  3. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818–829.
  4. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286(14):1754–1758. DOI: 10.1001/jama.286.14.1754.
  5. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  6. Mani RK. End-of-life care in India. Intensive Care Med 2006;32: 1066–1068. DOI: 10.1007/s00134-006-0185-7.
  7. Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018;46(9):e825–e873. DOI: 10.1097/CCM.0000000000003299.
  8. Aruna Ramachandra Shanbaug vs the Union of India & Ors. WRIT Petition (CRIMINAL) No. 115 of 2009 (Supreme Court of India Proceedings); 2009.
  9. Ramakrishnan N, Ranganathan L, Abraham BK, Rajagopalan S, Venkataraman R. What happens to patients discharged against medical advice? Indian J Crit Care Med 2018;22(8):580–584. DOI: 10.4103/ijccm.IJCCM_101_18.
  10. Brilli RJ, Spevetz A, Branson RD, Campbell GM, Cohen H, Dasta JF, et al. Critical care delivery in the intensive care unit: Defining clinical roles and the best practice model. Crit Care Med 2001;29(10):2007–2019. DOI: 10.1097/00003246-200110000-00026.
  11. Critical care delivery in intensive care units in India: defining the functions, roles and responsibilities of a consultant intensivist: recommendations of the Indian Society of Critical Care Medicine Committee on defining the functions, roles and responsibilities of a consultant intensivist. Available from: https://isccm.org/pdf/ISCCM%20Intensivist%20guidelines.pdf [Last cited on June 07, 2021].
  12. Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, et al. Indian Society of Critical Care Medicine experts committee consensus statement on ICU planning and designing, 2020. Indian J Crit Care Med 2020;24(Suppl. 1):S43–S60. DOI: 10.5005/jp-journals-10071-G23185.
  13. Checkley W, Martin GS, Brown SM, Chang SY, Dabbagh O, Fremont RD, et al. Structure, process, and annual ICU mortality across 69 centers: United States critical illness and injury trials group critical illness outcomes study. Crit Care Med 2014;42(2):344–356. DOI: 10.1097/CCM.0b013e3182a275d7.
  14. Kashyap R, Vashistha K, Saini C, Dutt T, Raman D, Bansal V, et al. Critical care practice in India: results of the intensive care unit need assessment survey (ININ2018). World J Crit Care Med 2020;9(2):31–42. DOI: 10.5492/wjccm.v9.i2.31.
  15. Kartik M, Gopal PBN, Amte R. Quality indicators compliance survey in Indian intensive care units. Indian J Crit Care Med 2017;21(4):187–191. DOI: 10.4103/ijccm.IJCCM_164_15.
  16. Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, Danis M. Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med 2008;148(11): 801–809. DOI: 10.7326/0003-4819-148-11-200806030-00002.
  17. Sakr Y, Moreira CL, Rhodes A, Ferguson ND, Kleinpell R, Pickkers P, et al. The impact of hospital and ICU organizational factors on outcome in critically ill patients: results from the extended prevalence of infection in intensive care study. Crit Care Med 2015;43(3):519–526. DOI: 10.1097/CCM.0000000000000754. PMID: 25479111.
  18. Vincent JL, Sakr Y, Singer M, Martin-Loeches I, Machado FR, Marshall JC, et al. Prevalence and Outcomes of infection among patients in intensive care units in 2017. JAMA 2020;323(15):1478–1487. DOI: 10.1001/jama.2020.2717. PMID: 32207816; PMCID: PMC7093816.
  19. Cook TM, Woodall N, Harper J, Benger J; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth 2011;106(5):632–642. DOI: 10.1093/bja/aer059.
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