Global Critical Care: Moving Forward in Resource-Limited Settings.

Janet V Diaz,Juliana C Ferreira,Alfred Papali,Neill K J Adhikari,Elisabeth D Riviello

doi:10.5334/aogh.2413

Abstract

Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and institutional obstacles to implementation of life-saving interventions. Potential solutions include the development of common definitions for intensive care unit (ICU), intensivist, and intensive care to create a universal ICU organization framework; development of educational programs for capacity building of health care professionals working in resource-limited settings; global prioritization of epidemiologic and clinical research in resource-limited settings to conduct timely and ethical studies in response to emerging threats; adaptation of international guidelines to promote implementation of evidence-based care; and strengthening of health systems that integrates these interventions. This manuscript reviews the field of global critical care, barriers to safe high-quality care, and potential solutions to existing challenges. We also suggest a roadmap for improving the treatment of critically ill patients in resource-limited settings.

Highlights

Critical care is an important component of health care systems around the world (Figure 1)
The task force proposed a three-tiered system of categorizing intensive care unit (ICU) into: 1) level 1 units, capable of providing oxygen, noninvasive monitoring, and more intensive n ursing care than a regular ward; 2) level 2 units, which have shortterm ability of providing invasive monitoring and basic life support; and 3) level 3 units, capable of providing the full spectrum of monitoring and life support technologies, serving as a regional resource for the care of critically ill patients, and playing an active role in research and education [1]
A cluster randomized trial in 118 Brazilian ICUs compared routine care to a another multi-faceted Quality improvement (QI) strategy that included a daily checklist, goal setting during multidisciplinary rounds, and clinician prompting for 11 care processes and found no effect on mortality and variable impact on processes of care [88]

Summary

Introduction

Critical care is an important component of health care systems around the world (Figure 1). Caring for critically ill patients in resource-rich settings typically involves treatment in intensive care units (ICUs) staffed with highly specialized health care professionals, systematic monitoring and use of high-cost technology [1]. These components are not always available in resource-limited settings [2, 3], where the burden of disease is greater [4], outcomes are poorer [5, 6], and local characteristics require context-specific approaches to the organization of critical care services. Health care professionals from resource-rich and resource-limited settings should take a global perspective on critical care for both ethical and practical reasons. VaccinaƟon, nutriƟon, family planning, pre-natal care, outpaƟent care of children and adults, disease prevenƟon

CriƟcal Care

Burden of Disease

Early Recognition and Treatment of Critical Illnesses

Quality Improvement and Behavior Change

Conclusions