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. 2021 Oct;25(10):1093-1107.
doi: 10.5005/jp-journals-10071-23965.

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

Jigeeshu V Divatia  1 , Yatin Mehta  2 , Deepak Govil  2 , Kapil Zirpe  3 , Pravin R Amin  4 , Nagarajan Ramakrishnan  5 , Farhad N Kapadia  6 , Mrinal Sircar  7 , Samir Sahu  8 , Pradip Kumar Bhattacharya  9 , Sheila Nainan Myatra  1 , Srinivas Samavedam  10 , Subhal Dixit  11 , Rajesh Kumar Pande  12 , Sujata N Mehta  13 , Ramesh Venkataraman  14 , Khusrav Bajan  6 , Vivek Kumar  15 , Rahul Harne  2 , Leelavati Thakur  16 , Darshana Rathod  17 , Prachee Sathe  18 , Sushma Gurav  19 , Carol D'Silva  20 , Shaik Arif Pasha  21 , Subhash Kumar Todi  22 ; the INDICAPS-II investigators
Collaborators, Affiliations

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

Jigeeshu V Divatia et al. Indian J Crit Care Med. 2021 Oct.

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).

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.

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

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Conflict of interest statement

Source of support: This study was funded by the Indian Society of Critical Care Medicine Conflict of interest: None

Figures

Figs 1A and B
Figs 1A and B
(A) APACHE II score on the study day; (B) Number of organ failures on the study day and ICU nonsurvivors
Fig. 2
Fig. 2
Predicted vs actual hospital mortality for 1,819 patients
See this image and copyright information in PMC

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