Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jun 5, 2020; 9(2): 31-42
Published online Jun 5, 2020. doi: 10.5492/wjccm.v9.i2.31
Critical care practice in India: Results of the intensive care unit need assessment survey (ININ2018)
Rahul Kashyap, Kirtivardhan Vashistha, Chetan Saini, Taru Dutt, Dileep Raman, Vikas Bansal, Harpreet Singh, Geeta Bhandari, Nagarajan Ramakrishnan, Harshit Seth, Divya Sharma, Premkumar Seshadri, Mradul Kumar Daga, Mohan Gurjar, Yash Javeri, Salim Surani, Joseph Varon, ININ-2018 Investigators Team
Rahul Kashyap, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, United States
Kirtivardhan Vashistha, Department of Infectious Disease, Mayo Clinic, Rochester, MN 55905, United States
Kirtivardhan Vashistha, Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, United States
Chetan Saini, Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States
Chetan Saini, Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 14061, United States
Taru Dutt, Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States and Department of Psychiatry, Hennepin County Medical Center, Minneapolis, MN 55415, United States
Dileep Raman, Department of Medicine, Cloud Physician Healthcare, Bangalore 560038, India
Vikas Bansal, Department of Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
Harpreet Singh, Department of Internal Medicine, Maulana Azad Medical College & Associated Hospitals, New Delhi, Delhi 110002, India
Geeta Bhandari, Department of Anesthesiology, Government Medical College, Haldwani, Nainital 263129, India
Nagarajan Ramakrishnan, Department of Critical Care Medicine, Apollo Hospitals, Chennai 600006, India
Harshit Seth, Department of Hospitalist Medicine, Allegany Clinic, Allegany Health Network, Pittsburgh, PA 15222, United States
Divya Sharma, Premkumar Seshadri, Department of Medicine, MAAGF Healthcare, Chennai 600024, India
Mradul Kumar Daga, Department of Internal Medicine and Center for Occupational and Environment Health, Maulana Azad Medical College, New Delhi, Delhi 110002, India
Mohan Gurjar, Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
Yash Javeri, Department of Critical Care Medicine, Regency Super Speciality Hospital, Lucknow 208005, India
Yash Javeri, Nayati Healthcare, New Delhi, Delhi 110065, India
Salim Surani, Department of Pulmonary and Critical Care Medicine, Texas A&M University, College Station, TX 77843, United States
Joseph Varon, Department of Critical Care, United Memorial Medical Center, Houston, TX 77091, United States
Author contributions: All listed authors provided intellectual contribution and made critical revisions of this paper; Kashyap R, Ramakrishnan N, Daga MK, Seshadri P and Javeri Y contributed to study conception and design; All co-authors contributed to data acquisition; Vashistha K, Saini C and Kashyap R contributed to data analysis; Surani S and Varon J contributed to data interpretation and critical edits; all authors approved the final version of the manuscript.
Institutional review board statement: This study was deemed eligible for category-2 Institutional Review Board exempt status from Mayo Clinic IRB, Mayo Clinic, Rochester, MN, 55905, United States.
Informed consent statement: Informed consent was waived by IRB, as it being a survey and no human subject was involved.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
STROBE statement: We have read the Strobe statement and prepared checklist and the manuscript accordingly.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rahul Kashyap, MBBS, MBA, Assistant Professor, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. kashyap.rahul@mayo.edu
Received: December 7, 2019
Peer-review started: December 7, 2019
First decision: January 28, 2020
Revised: April 27, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: June 5, 2020
Abstract
BACKGROUND

A diverse country like India may have variable intensive care units (ICUs) practices at state and city levels.

AIM

To gain insight into clinical services and processes of care in ICUs in India, this would help plan for potential educational and quality improvement interventions.

METHODS

The Indian ICU needs assessment research group of diverse-skilled individuals was formed. A pan- India survey "Indian National ICU Needs" assessment (ININ 2018-I) was designed on google forms and deployed from July 23rd-August 25th, 2018. The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories (UTs). In addition to emails and phone calls, social medial applications-WhatsApp™, Facebook™ and LinkedIn™ were used to remind and motivate providers. By completing and submitting the survey, providers gave their consent for research purposes. This study was deemed eligible for category-2 Institutional Review Board exempt status.

RESULTS

There were total 134 adult/adult-pediatrics ICU responses from 24 (83% out of 29) states, and two (28% out of 7) UTs in 61 cities. They had median (IQR) 16 (10-25) beds and most, were mixed medical-surgical, 111(83%), with 108(81%) being adult-only ICUs. Representative responders were young, median (IQR), 38 (32-44) years age and majority, n = 108 (81%) were males. The consultants were, n = 101 (75%). A total of 77 (57%) reported to have 24 h in-house intensivist. A total of 68 (51%) ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio. More than 80% of the ICUs were open, and mixed type. Protocols followed regularly by the ICUs included sepsis care, ventilator- associated pneumonia (83% each); nutrition (82%), deep vein thrombosis prophylaxis (87%), stress ulcer prophylaxis (88%) and glycemic control (92%). Digital infrastructure was found to be poor, with only 46 % of the ICUs reporting high-speed internet availability.

CONCLUSION

In this large, national, semi-structured, need-assessment survey, the need for improved manpower including; in-house intensivists, and decreasing patient-to-nurse ratios was evident. Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized. Additionally, subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols.

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

Core tip: Intensive care unit (ICU) practices are variable in a vast country like India. Most common admitting diagnosis for ICU is similar to Western reporting in literature. There is variable protocol penetration for processes of care in ICU.