Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study

Abstract

Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs).

Patients and methods: An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs.

Results: On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality.

Conclusions: The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

Keywords: Adult; India; case-mix; intensive care; practice.

Figure 1

Distribution of Acute Physiology and Chronic Health Evaluation II scores (number of patients in vertical bars on the Y1 axis) and mortality rate (solid line on the Y2 axis)

Figure 2

Distribution of organ failures (number of patients in vertical bars on the Y1 axis) and mortality rate (solid line on the Y2 axis)

Figure 3

Observed mortality (solid line) versus Acute Physiology and Chronic Health Evaluation II Predicted mortality (dashed line) on the Y2 axis in 1627 patients. Horizontal bars denote number of patients (Y1 axis)