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

INDICAPS Study Investigators

Research output: Contribution to journalArticle

22 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)216-225
Number of pages10
JournalIndian Journal of Critical Care Medicine
Volume20
Issue number4
DOIs
Publication statusPublished - 01-04-2016

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Diagnosis-Related Groups
Critical Care
India
Intensive Care Units
APACHE
Organ Dysfunction Scores
Public Hospitals
Septic Shock
Artificial Respiration
Mortality
Sepsis
Hospital Mortality
Infection
Respiratory Insufficiency
Cross-Sectional Studies
Outcome Assessment (Health Care)
Anti-Bacterial Agents

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

@article{3a00606299c04b22bdfbec8518701531,
title = "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.",
author = "{INDICAPS Study Investigators} and Divatia, {Jigeeshu V.} and Amin, {Pravin R.} and Nagarajan Ramakrishnan and Kapadia, {Farhad N.} and Subhash Todi and Samir Sahu and Deepak Govil and Rajesh Chawla and Kulkarni, {Atul P.} and Srinivas Samavedam and Jani, {Charu K.} and Narendra Rungta and Samaddar, {Devi Prasad} and Sujata Mehta and Ramesh Venkataraman and Ashit Hegde and Bande, {B. D.} and Sanjay Dhanuka and Virendra Singh and Reshma Tewari and Kapil Zirpe and Prachee Sathe and Sivakumar, {M. N.} and Sudha Kansal and Sushma Gurav and Shilpa Kulkarni and Sumit Ray and Prasad Rajhans and Sanmay Choudhary and Trishala Singhvi and Kedar Toraskar and Rajesh Pande and Sachin Gupta and Rao, {S. Manimala} and Rash Kujore and {Kumar Mani}, Ashwin and Vandana Sinha and Amol Kulkarni and Moulick, {N. D.} and Chaitri Shah and Jitendra Lakhani and Myatra, {Sheila N.} and Mrinal Sircar and Shah, {Ritesh J.} and Singh, {D. K.} and Anitha Shenoy and Dubey, {Prakash K.} and Kalpesh Joshi and Singh, {A. K.} and Singh, {A. K.}",
year = "2016",
month = "4",
day = "1",
doi = "10.4103/0972-5229.180042",
language = "English",
volume = "20",
pages = "216--225",
journal = "Indian Journal of Critical Care Medicine",
issn = "0972-5229",
publisher = "E-Flow Medknow Publications",
number = "4",

}

Intensive Care in India : The Indian Intensive Care Case Mix and Practice Patterns Study. / INDICAPS Study Investigators.

In: Indian Journal of Critical Care Medicine, Vol. 20, No. 4, 01.04.2016, p. 216-225.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intensive Care in India

T2 - The Indian Intensive Care Case Mix and Practice Patterns Study

AU - INDICAPS Study Investigators

AU - Divatia, Jigeeshu V.

AU - Amin, Pravin R.

AU - Ramakrishnan, Nagarajan

AU - Kapadia, Farhad N.

AU - Todi, Subhash

AU - Sahu, Samir

AU - Govil, Deepak

AU - Chawla, Rajesh

AU - Kulkarni, Atul P.

AU - Samavedam, Srinivas

AU - Jani, Charu K.

AU - Rungta, Narendra

AU - Samaddar, Devi Prasad

AU - Mehta, Sujata

AU - Venkataraman, Ramesh

AU - Hegde, Ashit

AU - Bande, B. D.

AU - Dhanuka, Sanjay

AU - Singh, Virendra

AU - Tewari, Reshma

AU - Zirpe, Kapil

AU - Sathe, Prachee

AU - Sivakumar, M. N.

AU - Kansal, Sudha

AU - Gurav, Sushma

AU - Kulkarni, Shilpa

AU - Ray, Sumit

AU - Rajhans, Prasad

AU - Choudhary, Sanmay

AU - Singhvi, Trishala

AU - Toraskar, Kedar

AU - Pande, Rajesh

AU - Gupta, Sachin

AU - Rao, S. Manimala

AU - Kujore, Rash

AU - Kumar Mani, Ashwin

AU - Sinha, Vandana

AU - Kulkarni, Amol

AU - Moulick, N. D.

AU - Shah, Chaitri

AU - Lakhani, Jitendra

AU - Myatra, Sheila N.

AU - Sircar, Mrinal

AU - Shah, Ritesh J.

AU - Singh, D. K.

AU - Shenoy, Anitha

AU - Dubey, Prakash K.

AU - Joshi, Kalpesh

AU - Singh, A. K.

AU - Singh, A. K.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - 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.

AB - 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.

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DO - 10.4103/0972-5229.180042

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