Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. May 9, 2022; 11(3): 169-177
Published online May 9, 2022. doi: 10.5492/wjccm.v11.i3.169
Critical care practices in the world: Results of the global intensive care unit need assessment survey 2020
Faisal A Nawaz, Neha Deo, Salim Surani, William Maynard, Martin L Gibbs, Rahul Kashyap
Faisal A Nawaz, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
Neha Deo, Department of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN 55905, United States
Salim Surani, Rahul Kashyap, Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
Salim Surani, Texas A&M University, College Station, TX 77843, United States
William Maynard, Rahul Kashyap, Internal Medicine, TriStar Centennial Medical Center, HCA Healthcare, Nashville, TN 37203, United States
Martin L Gibbs, Pulmonary and Critical Care, Tulane University School of Medicine, New Orleans, LA 70112, United States
Author contributions: Nawaz FA, Deo N and Kashyap R prepared the first draft of this manuscript and analyzed the results; Surani S, Maynard W, Gibbs ML and Kashyap R reviewed, edited, and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Mayo Clinic Institutional Review Board.
Informed consent statement: Informed consent was waived by the the Mayo Clinic Institutional Review Board.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FACP, FCCP, MD, MSc, Doctor, Professor, Critical Care Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States. srsurani@hotmail.com
Received: September 3, 2021
Peer-review started: September 3, 2021
First decision: December 2, 2021
Revised: December 11, 2021
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: May 9, 2022
Abstract
BACKGROUND

There is variability in intensive care unit (ICU) resources and staffing worldwide. This may reflect variation in practice and outcomes across all health systems.

AIM

To improve research and quality improvement measures administrative leaders can create long-term strategies by understanding the nature of ICU practices on a global scale.

METHODS

The Global ICU Needs Assessment Research Group was formed on the basis of diversified skill sets. We aimed to survey sites regarding ICU type, availability of staffing, and adherence to critical care protocols. An international survey ‘Global ICU Needs Assessment’ was created using Google Forms, and this was distributed from February 17th, 2020 till September 23rd, 2020. The survey was shared with ICU providers in 34 countries. Various approaches to motivating healthcare providers were implemented in securing submissions, including use of emails, phone calls, social media applications, and WhatsApp™. By completing this survey, providers gave their consent for research purposes. This study was deemed eligible for category-2 Institutional Review Board exempt status.

RESULTS

There were a total 121 adult/adult-pediatrics ICU responses from 34 countries in 76 cities. A majority of the ICUs were mixed medical-surgical [92 (76%)]. 108 (89%) were adult-only ICUs. Total 36 respondents (29.8%) were 31-40 years of age, with 79 (65%) male and 41 (35%) female participants. 89 were consultants (74%). A total of 71 (59%) respondents reported having a 24-h in-house intensivist. A total of 87 (72%) ICUs were reported to have either a 2:1 or ≥ 2:1 patient/nurse ratio. About 44% of the ICUs were open and 76% were mixed type (medical-surgical). Protocols followed regularly by the ICUs included sepsis care (82%), ventilator-associated pneumonia (79%); nutrition (76%), deep vein thrombosis prophylaxis (84%), stress ulcer prophylaxis (84%), and glycemic control (89%).

CONCLUSION

Based on the findings of this international, multi-dimensional, needs-assessment survey, there is a need for increased recruitment and staffing in critical care facilities, along with improved patient-to-nurse ratios. Future research is warranted in this field with focus on implementing appropriate health standards, protocols and resources for optimal efficiency in critical care worldwide.

Keywords: Intensive care unit, Critical care, Global, Survey, Intensive care unit survey, Intensive care unit needs

Core Tip: Intensive care unit (ICU) practices are variable across the world. Most common admitting diagnoses for ICUs worldwide are similar to Western reporting in literature. We aimed to survey sites regarding ICU type, availability of staffing, and adherence to critical care protocols. There is variable protocol penetration for processes of care in ICUs. Future research is warranted in this field with focus on implementing appropriate health standards, protocols and resources for optimal efficiency in critical care worldwide.