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ICU care in India - Status and challenges

  • K J Somaiya medical college & hospital ,Ayurvihar , Sion ,mumbai 400022,India
© JAPI • VOL. 56 • APRIL 2008 221
ICU Care in India - Status and Challenges
ME Yeolekar*, S Mehta**
*Professor of Internal Medicine, Dean and Director (Medical
Education and Research); **Associate Professor of Medicine, Seth
G.S.Medical College & K.E.M.Hospital, Acharya Donde Marg,
Parel, Mumbai-12.
An intensive care unit (ICU) is dened as a specially
staffed, specialty equipped, separate section of a
hospital dedicated to the observation, care, and treatment
of patients with life threatening illnesses, injuries, or
complications from which recovery is possible. It provides
special expertise and facilities for the support of vital
function and utilizes the skill of medical nursing and other
staff experienced in the management of these problems.
The global history of ICU care dates back to the
polio epidemic in 1950s, when the specialty of critical
care was born. Simple ventilators or hand ventilation
enabled the survival of some patients. The technique
of controlled ventilation was then extended to patients
with drug overdose, tetanus, and chest trauma, with
resultant improvement in survival. The development of
effective ventilator and improved circulatory support in
post operative patients radically extended the surgical
possibilities. The ICUs then assumed the role in prevention
of irreversible organ failure. The majority of hospitals
(> 88%) in the United States have one or more ICUs,
constituting 5% or less of the total hospital beds. ICUs in the
United States consume 15% to 20% of the hospital budget,
amounting to 1% of GNP.1
India is a diverse country with different levels of health
care: primary, secondary and tertiary. The rst coronary
care unit in India was started in 1968 at the King Edward
VII Memorial Hospital, Mumbai. This unit was followed
by one at Breach Candy hospital in Mumbai, and later in
other large private hospitals of Mumbai and in other large
cities of India.2 Critical care units in the early 1970s, though
centralized, were designed and equipped chiey to offer
intensive care to patients with acute myocardial infarction
and other manifestations of ischaemic heart disease. There
was a poor concept of overall critical care or intensive
respiratory care. Ventilator support was primitive and was
generally offered as a terminal therapeutic approach. Many
of the ICUs were decient in good monitoring facilities and
were initially offered in a few designated room(s) within
a general ward of the hospital. The number of critical
care units caring for life-threatening illnesses other than
coronary heart disease slowly increased. In mid-1980s
there was a signicant improvement in the standard of
care, particularly evident in the larger teaching and private
hospitals in the cities of India. As a related professional
development, in 1993 the Indian Society of Critical Care
Medicine (ISCCM) was formed, which currently has
around two thousand members.3
The concept of respiratory care, including mechanical
ventilation was still underdeveloped. Initially, a volume-
cycled Beaver's ventilator and later a Bird's ventilator
were used. Critical care beds in the large public teaching
hospitals generally constitute 5-8% of the total bed
strength. At advanced centres in large cities, the ICU bed
strength varies between less than 5% of the total hospital
beds in majority of hospitals, to near 10% in selected few
hospitals. Large public hospitals (e.g., the All India Institute
of Medical Sciences, Delhi, and some corporate/chain
hospitals in the metropolitan cities/state-provincial capitals
of the country) have separate medical, surgical, paediatric,
cardiac, cardiothoracic, neurology, paediatric and neonatal
ICUs. Most hospitals have all/broad purpose ICUs or, at
most , medical, surgical, and coronary care units.
The number of ICU beds available is disproportionately
low, both in private as well as public hospitals. Obtaining a
bed in ICU is quite often difcult for critically ill patients.
Owing to shortage of ICU beds, only the most critical of
the deserving patients are provided ICU care, that could
contribute to high mortality inside the ICU as well as
outside the ICU (in the wards). There appears a strong need
to increase the ICU beds to at least 10% of total beds in all
hospitals; and even upto 15-20% in some leading public as
well as private tertiary care centres. Shortage of ICU beds
has slowed the pace of cadaver organ transplant program
adversely. In India, cadaveric renal transplantation
accounts for less than 1% of total renal transplantations.4
Shortage of ICU beds limits the protocols to be followed
for brain dead patients for organ harvesting. Success of
cadaver organ transplant program may become possible
by creating new and exclusive ICUs for brain dead patients
identified for organ harvesting, under the concerned
departments, e.g. nephrology.
The care in Indian ICUs has evolved from cardiac to
multi-system diseases. Initial ICUs were Cardiac Care
Units, where deaths due to ventricular brillation could
be prevented by DC shock, and temporary transvenous
pacing could be done for heart blocks. In later years, the
scope of ICUs includes thrombolysis in acute myocardial
infarction (AMI), primary and rescue angioplasty, primary
coronary artery bypass surgery, congenital heart surgeries
in high risk underweight babies. Swan Ganz catheterization
has ensured better measurements of pulmonary capillary
wedge pressure and appropriate differentiations into
causes of dyspnoea predominantly cardiac or respiratory
and advanced precise interventions and mechanical
Conventionally, the ICUs are led/manned by respective
medical or surgical specialty e.g. coronary, respiratory,
medical, neurological, neurosurgical, general surgical,
222 © JAPI • VOL. 56 • APRIL 2008
anaesthesia, paediatric, neonatal, burns and dialysis units.
The newer generations of critical care physicians, popularly
known as `intensivists' undergo training to cater to multi-
specialty patients. The paediatric and neonatal ICUs have
come primarily from major teaching hospitals, and partly
in some hospitals in the private sector.5 The newest ICU
set up emerging in some advanced tertiary care hospitals
is the emergency or acute care units, located in the casualty
or emergency departments. These emergency intensive
care units cater to rst 24 hours of aggressive treatment,
monitoring and stabilization of diverse emergencies,
and seem to have signicantly reduced the mortality,
especially in patients with Acute Myocardial Infarction/
ACS, Cerebrovascular Stroke, Adult Respiratory Distress
Syndrome (ARDS) arising out of diverse aetiologies and
The ICU patients across the country show peculiar and
distinct trends. During monsoon, 70-80% of patients are
of infectious diseases (tropical febrile emergencies e.g.
malaria, leptospirosis, dengue). Lifestyle related metabolic
diseases and consequent critical situations are on the rise,
e.g. diabetes, cirrhosis, uraemia. Consistent with the general
demographic trends, 30-40% of patients in ICU are elderly,
with inherent features of difcult weaning, prolonged
stay and refractoriness to standard line of treatment.
Nosocomial infections due to multiple vascular accesses
and tubings, catheterisations are clinical entities of concern,
as are fungal infections in immunocompromised hosts such
as those with HIV/AIDS, uncontrolled Diabetes Mellitus
further accentuated by usage of potent antimicrobials.
The infrastructure and care in ICUs across the country
is varied. Advanced units with proper infrastructure are
available at teaching hospitals and major private hospitals.
On the other hand, small time set up units with just basic
`monitor only' facility are apparently numerous in nursing
homes and small hospitals, where ICUs exist in the most
elementary and somewhat crude situations. Monitoring,
certication and adherence to basic/dened norms is
obviously necessary.
Overall, there are few critical care units in the
country that are well equipped and have the expertise
to use modern, sophisticated technology to the patient's
advantage. Many units are poorly equipped for economic
reasons, and a few units are reasonably well equipped but
lack the comprehensive equipment and/or the expertise
to use it with efciency and discretion. The scenario is
slowly changing for the better in terms of technology and
The cost of ICU care in a tertiary care centre in India
(in 1991) was reported to be Rs. 3200 per patient ($167.70).
Stafng, intravenous uids, and drugs accounted for 75% of
the cost of ICU care, whereas 15% accounted for laboratory
investigations and 6.9% for disposables.2 The cost of ICU
care is rising steadily owing to costly equipments and
manpower in better ratios. However, the ICU care of high
quality is available in teaching hospital at highly subsidized
cost to the patients; though the ratio of nursing staff in
government hospitals tends to be sub-optimal.
Critical care units in India face many challenges. Laws/
regulations by the government or the local and national
authorities that determine the standards or efcacy of
a critical care unit need to be in place. More organized
formal training for physicians or nurses in critical care is
necessary today, more than ever before. ICU care is poor or
nonexistent at district hospitals in rural India, which cater
to 80% of the population. Standard protocols and working
SOPs for the staff are both essential and crucial.
While the concept of the intensive care unit has gained
widespread acceptance amongst medical professionals,
hospital administrators and the general public, recognition
of the need and role for doctors specializing in intensive
care medicine, has lagged behind. Many large studies
world over suggest better outcomes in ICUs run by full time
dedicated intensivists.6 Consultant intensivists have been
demonstrated to improve outcomes in terms of morbidity,
mortality, length of stay and costs. Nursing staff have a
more specialized role to play in the ICU set up with a higher
nurse to patient ratio.
The future directions for developing high quality ICU
care in India include upgradation of ICUs, especially in the
less organized sector; increasing the ICU beds to 10-15%
of total hospital beds in public as well as private hospitals;
defining national or state norms for ICUs; regulating
and licensing of ICUs; accreditation from competent
government agency; training of ICU nurses and Intensive
care physicians; technology sharing with developed
countries, funding programs in collaboration with WHO,
ICMR, DBT, NGOs; use of information technology for
patient care, training and research. Setting up acute care
units in emergency departments greatly reduces the door
to intervention time and has the potential to revolutionize
the management of diverse emergencies both infectious
and non-infectious.
Manuscript assistance by Aditya M Yeolekar, House physician
Dept. of Chest Medicine, KEM Hospital, Parel, Mumbai 12.
1. Groeger JS, Strosberg MA, Guntupalli KG, et al. Descriptive analysis of
critical care units in the United State. Crit Care Med 1992;20:846-62.
2. Udwadia FE, Guntupalli KK, Vidyasagar D. Critical care in India. Critical
Care Clinics 1997;13:317-30.
3. Prayag S. ICUs worldwide : Critical care in India. Critical Care 2002;6:479-
4. Feroz A. Cadaveric renal transplantation: our experience at the Institute
of Kidney Diseases and Research Centre, Institute of Transplantation
Sciences, Ahmedabad. Transplant Proc 2007;39:721-2 (From NIH/NLM
5. Vidyasagar D, Singh M, Bhakoo ON, et al. Evolution of Neonatal and
Pediatric Critical Care in India. Critical Care Clinics 1997;13:331-47.
6. Besso J, Bhagwanjee S, Takezawa J, Prayag S, Moreno R. A Global view
of education and training in Critical Care Medicine. Critical Care Clinics
... The number of elderly COVID-19 cases and the increased death rates among them compared to the younger population are surfacing across the world. The odds of hospitalization and the requirement of ICU facilities for the elderly are very high, which further adds burdens to the already compromised system in India where 0.55 beds are available per 1,000 of the population (3). ICU care is also very low, which aggravates the situation (3). ...
... The odds of hospitalization and the requirement of ICU facilities for the elderly are very high, which further adds burdens to the already compromised system in India where 0.55 beds are available per 1,000 of the population (3). ICU care is also very low, which aggravates the situation (3). Data from other countries have shown that even though 20% of cases are elderly people, they account for 79% of deaths, since associated comorbidities like diabetes, hypertension, respiratory diseases, which are common in the older population, fan the flames (4-6). ...
... 1,2 Nevertheless, there is a need for solutions to bridge the gap between the demand for high-quality critical care and the shortage of qualified intensivists. 3,4 In India, critical care resources have been estimated at only 2.3 beds per 100 000 people 5 or 95 000 ICU beds 6 with~13 000 intensivists 7 for the Indian population. For context, Germany and Canada have 29.2 and 12.9 beds per 100 000 population, respectively, whereas amongst LMICs, Mongolia has 8.8 beds per 100 000 and Nepal has 2.8 beds per 100 000 population. 8 Cloudphysician Healthcare Private Limited (Bengaluru, India) developed a unique model of deployment and operations for tele-ICU care in India tailored to high-volume and lowresource settings during the COVID-19 pandemic. ...
... It becomes difficult to obtain an ICU bed for many of the deserving critically ill patients. [6] Hence, there is a considerable interest in interventions including early tracheostomy which can shorten the duration of mechanical ventilation (MV) and ICU stay, potentially leading to better utilization of scarce resources. ...
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Background and Aims: Tracheostomy is a commonly performed procedure in critically ill patients because patients requiring chronic mechanical ventilation (MV) are rising by as much as 5.5% per year. The controversy on likely benefits of early versus late tracheostomy is ongoing. We aimed to study the impact of early versus late tracheostomy on patient outcomes. Material and Methods: A retrospective observational study was performed in intensive care unit (ICU) patients who underwent tracheostomy in a 31-bedded multispeciality ICU of a 350-bedded tertiary care hospital, over a period of 1 year. Data collected included the age, sex, APACHE II score, indication for tracheostomy, timing of procedure, whether surgical or percutaneous, any complication, MV days, ICU stay, and patient outcome. Patients were divided into two groups for statistical comparison: early ≤7 days and late >7 days of MV. Results: A total of 102 patients underwent tracheostomy over the study period, of which 19 were excluded because of inadequate data and exclusion criteria. Of the 83 study patients, 60 had percutaneous, while 23 had surgical tracheostomy. About 51 (61.45%) had early, while 32 (38.55%) had late tracheostomy. On statistical analysis, there was a significant difference in MV days (5 vs 12.5 days, P = 0.002), ICU stay (10 vs 16 days, P = 0.004), mortality (21.6% vs 43.8%, P = 0.032), and decannulation rate (29.41% vs 6.25%, P = 0.009). No difference was observed in hospital stay or complication rates. Conclusion: Early tracheostomy is associated with both morbidity and mortality benefits. Patients requiring MV should be given an option of early tracheostomy.
... An ICU is defined as a specially staffed, equipped, separate section of a hospital dedicated to the observation, care and treatment of patients with life threatening illness, injuries, or complications from which recovery is possible. The global history of ICU care goes back to the polio epidemic In India the ICU beds are just 5% in the leading hospitals out of total beds which needs to be raised upto 10% of the total beds (Yeolekar and Mehta, 2008). ...
The shutdown of almost all economic activities to inhibit the spread of COVID-19 occurred in early 2020 in India including Punjab and had serious implications for Punjab agriculture as wheat harvesting was just going to start faced with immediate shortages of labour and machinery and posing challenges for effective procurement. A few months after the wheat harvesting, sowing/transplantation of kharif crops such as cotton, maize and paddy required multiple times more labour force and posed serious challenges to farmers across the state. This paper provides a preliminary assessment of the adaptations strategies of Punjab farmers under such situation. The assessment is based on telephonic/personal survey of 120 farmers under the auspices of the TIGRRESS (Transforming India's Green Revolution by Research and Empowerment for Sustainable food Supplies of University of Cambridge, UK) Project, a collaborative and interdisciplinary programme designed to improve the sustainability of India’s agriculture. Despite considerable challenges, farmers adopted different strategies to address labour shortages and marketing challenges as influenced by their holding size, financial resources and access to local information networks. Marginal and small farmers increased the use of family labour, while medium and large farmers showed an increased use of machinery. The medium and large farmers who showed higher dependence on machinery were inclined to diversify their cropping pattern in kharif season.
... Findings on the challenges that the respondents encountered in palliative care units was done in relation to the programs that was offered at the palliative care facilities established that majority of the respondents experienced challenges of being isolated and lacking finances respectively. The findings draw a similarity with the findings by Yeolekar & Mehta, (2008) which was conducted on challenges in a palliative care unit and identified pain and symptom control, psychological and spiritual support and identification of alternative sites as key challenges. ...
Purpose: This study sought to establish challenges among cancer patients that may influence recovery outcomes in palliative care units in Nairobi and Nyeri Counties. Methodology: The study adopted a correlation research design. The target population were the cancer patients, attending treatment at the three palliative care units in Nairobi and Nyeri Counties. Systematic random sampling technique was used in the study to obtain a sample of 96 participants. Semi structured questionnaires were used to collect data. Data was analyzed using both descriptive and inferential statistics, namely Pearson Moment Correlation Coefficient(r). Findings: Result showed that, majority of the respondents indicated participating in the programs available at the palliative care institutions, which included; group psychotherapy (91.7%), spiritual support (91.7%) and programs on coping skills (91.7). Others (22.6%) participated in programs such as performing chorals, knitting and board games. The results also showed that 82.1% and 78.6% of the respondents noted that they experienced challenges of being isolated and lacking finances respectively. 50% of the respondents had a challenge in coping with the condition, while 2.4% experienced challenges in adhering to drugs .These findings were not unusual considering that most of the patients were newly diagnosed with cancer and for some respondent’s metastasis had set in. Unique contribution to theory, practice and policy Patients facing challenges receiving palliative care could adopt group psychotherapy, including cognitive-behavioral, informational, non-behavioral, social support, and using unusual treatments such as music and art therapy to curb cancer. Administrators and medical staff in the palliative care units should create awareness and encourage the attending patients to source for a health insurance cover e.g. National Health Insurance Fund (NHIF) to cater for the cancer disease both outpatient and incase of hospitalization. This will ease the financial burden of cancer on the patient, family and community.
... 4 Yeolekar et al. mention that in the monsoon months, almost 80% of ICU beds in public hospitals may be occupied by patients with tropical infections. 5 Tropical infections are common in the geographic regions of the world that are close to the equator because they have a warmer climate with less seasonal variation in temperatures, higher rainfall, and greater coverage of land by vegetation, 6 all of which favor the multiplication of insects like mosquitos, ticks, mites and flies which are vectors for several tropical infections. 7 Some pathogens survive only in such warm, humid environments. ...
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How to cite this article: Karnad DR, Amin P. An Approach to a Patient with Tropical Infection in the Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2):S118-S121.
In the glimpses of history, Punjab faced many epidemics during nineteenth and twentieth centuries. Presently state is facing a pandemic Covid-19 which is a global disease and it has affected all the developed and less developed nations. The Covid-19 has revealed the weaknesses in efficiency and equity of the public and private health care services. The public health sector with limited infrastructure and manpower is trying to treat the corona patients of vulnerable section of society. It seems the socialised medicine system is the only hope to cop up with disasters in future and it should be strengthened.
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Introduction: Mortality rate is always very high in Intensive Care Units (ICU) even with the best possible set ups, we should try to cater the need of the society according to the disease burden so that better care can be provided. Aim: To estimate the prevalence of various medical disease mortality profile of critically ill patients admitted in Medical Intensive Care Unit (MICU) of our institution. Materials and Methods: This was a retrospective observational study done at MICU of Bundelkhand Medical College and Hospital Sagar, Madhya Pradesh, India for a duration of one year (1st January 2019 to 31st December 2019). Data was retrieved from Medical Records Department (MRD) and total data of 349 deaths were registered. Disease was classified based upon ICD 10 (International Statistical classification of Diseases and related health problems) Score. Results: A total of 349 deaths occurred in MICU during the period of one year at the institution, out of which male deaths were 55.9% and female deaths were 44.1%. MICU deaths occurred in higher numbers in males with male: female ratio of 1.2:1. This difference in ratio of male and female mortality was not statistically significant (p-value >0.05). Mean age of males at time of death was 58.4±16.3 years whereas mean age of females were 55.2±19.7 years. This difference in mortality with age and gender was not statistically significant (p-value >0.05). In present study, most common systemic causes of mortality were cardiovascular (29.8%), followed by respiratory (17.5%), renal (16.5%) and cerebrovascular diseases (13.8%). Mortality was documented in 276 (79%) individuals within duration of seven days of admission, whereas mortality in 46 (13.1%) and 27 (7.7%) cases were documented within 8 to 14 days and >14 days, respectively. The present study documented no statistically significant association between length of stay and age of patients (p-value >0.05). Conclusion: Cardiovascular diseases are the most common causes leading to mortality especially in elderly male patients. Also, higher number of deaths is reported within seven days of admission signifying severity of illness at the time of admission.
Critical care nursing and medicine have evolved significantly over the past few decades. Critical care in India began the major urban hospitals and has not yet become established in rural health care facilities. The formation of Indian critical care nursing and medical societies led to emerging regular conferences, updates, continuing nursing and medical education, workshops, and training programs for the further training of nurses and doctors. Future challenges include development of guidelines and consolidation of research activities on the outcome of patients with critical illness. This article describes the organization and practice of critical care nursing in India.
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Critical care practices in India have evolved significantly over the past decade. Critical care initially began as a service in major hospitals, but with the formation of the Indian Society of Critical Care Medicine the development of this speciality has been very rapid. Regular conferences, updates, continuing medical education programmes and workshops have emerged, and postdoctoral training programmes have been developed. Scientific publications have begun to appear and in spite of the diverse problems and standards, meaningful speciality-related activities have begun. Future challenges include the development of guidelines, the consolidation of training activities and research on the outcome of critical tropical problems.
To gather data about available technology, staffing, administrative policies, and bed capacities of ICUs in the United States. On January 15, 1991, survey instruments were mailed to the administrators of 4,233 hospitals to gather information from the medical director of the institutions' respective ICUs for the purpose of developing a database on ICUs in the United States. The sampling frame for this study was based on all American Hospital Association (AHA) hospitals that stated they have ICUs. Census questionnaires solicited information on types of hospitals, types of ICUs, number of ICU beds open and closed, technology available to the unit, organizational structure and management of the ICU, as well as the staffing and certification of unit personnel. Data were obtained on 32,850 ICU beds with 25,871 patients from 2,876 separate ICUs in 1,706 hospitals in the United States. Census responses came from units in all sizes of hospitals within all ten census regions in the country, all states, and all types of hospital sponsorship (federal, state, and local government, private nonprofit and private for profit). The census response rate was 40% of the AHA hospitals that stated that they have ICUs, with specific ICU data on 38.7% of the nation's ICUs. The number of ICUs per hospital increases with overall hospital size. The smallest hospitals (less than 100 beds) usually had only one ICU. As hospital size increased, the single, all inclusive medical/surgical/coronary care units diminished, and in hospitals with greater than 300 beds, specialization of units became prevalent. In absolute terms, hospitals had the following number of ICUs: 1.04 +/- 0.20 (less than or equal to 100 beds); 1.30 +/- 0.65 (101 to 300 beds); 2.37 +/- 1.58 (301 to 500 beds); and 3.34 +/- 2.21 (greater than 500 beds). ICU beds averaged, nationally, 8.09% of hospital-licensed beds with a median of 6.98%. Generally, medical units, pediatric units, coronary care units (CCUs), and medical/surgical/CCUs reported an average of 10 beds per unit. Neonatal units averaged 21 beds, and surgical units averaged 12 beds. The average ICU size, nationally, was 11.7 +/- 7.8 beds per unit. Available technology within hospitals and individual units was increased as hospital size increased; surgical units tended to have more available technology than other unit types. A wide range of organizational arrangements within hospitals determines where the ICU appears in an organizational chart and to whom unit management is accountable. Thirty-six percent of the units were located organizationally within the hospital's department of medicine, while 23% were considered "free standing," having no departmental affiliation. Although units must have a medical director, the perception as to whether this director supervises the day-to-day operation was different in larger vs. smaller hospitals. In hospitals with less than or equal to 100 beds, 72% of the units were perceived to be supervised by the medical director, whereas in larger hospitals (greater than 500 beds), 81% of units were supervised. Study results indicated that medical directors in pediatric, neonatal, and burn units most often were perceived to supervise the unit. Presently, 63% of all ICUs responding are directed by an internist. The next largest group to direct ICUs were surgeons, followed by pediatricians. Pediatrician involvement tended to be exclusive in pediatric and neonatal units. Surgeons directed most surgical and neurologic units and were involved in 21% of mixed medical/surgical units. Internists predominated in medical units and in CCUs, as well as in combined medical/surgical/CCUs. Direction by anesthesiologists, although relatively infrequent, predominated in the surgical unit. Critical care medicine certification of the medical director and attending staff of the ICU increased as hospital size increased, although only 44% of all units stated that thei
During the last decade, the disciplines of neonatal and pediatric critical care have rapidly progressed in India. The growth of Neonatal Intensive Care has paced the growth of Pediatric Critical Care. The substantial growth of discipline and the positive improvements in neonatal outcomes are the results of the concerted efforts of the National Neonatal Forum and commitment of expatriate physicians residing in the United States. This article provides the background information regarding perinatal, neonatal, and infant mortalities in India. It also describes the maternal child health care delivery system in the Indian subcontinent.
India is a vast democracy of nearly one billion people. Before the British rule ended in 1947, the life span of an Indian was a mere 21 years. Within a short span of 50 years, it increased to an impressive 63 years, largely due to public health measures initiated by the government. This created a pool of more than 300 million middle class Indians who could afford the benefits of modern and specialized care when needed. Critical care medicine, as practiced in the West, is still confined to large Metropolitan areas. A large pool of expatriate Indian physicians from all over the world are helping bridge the resource gap between the West and India by transfer of technology and providing appropriate training to physicians and paramedical personnel. This article describes the history and current status of development of critical care medicine in India.
The Educational Committee of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) performed a survey in various countries and reviewed data from the Cobatrice study and from surveys of the Pan-American and Iberic Federation of Societies of Intensive and Critical Care Medicine to characterize current structures and processes in education in intensive care medicine to determine the potential for convergence to a common competency-based training program, and to a common competency certification in most countries around the world, guided by the local scientific societies and the WFSICCM. Training in critical care medicine sponsored by the WFSICCM should provide a competency approach that permits diversity of training methods while creating a common outcome: doctors with a universal set of knowledge, skills, and attitudes essential for a specialist in intensive care medicine.
In a developing country such as India, cadaveric renal transplantation accounts for only less than 1% of total renal transplantations. The reasons for such a low rate of cadaveric transplantation are many, ranging from lack of awareness to socioeconomic reasons. Our institute conducted a statewide public awareness program and initiated an intercity organ harvesting program. This doubled the cadaveric renal transplantations in the last 2 years. We performed 38 cadaveric transplantations among 190 renal transplantations in the last year (August 2005 to July 2006). We retrieved kidneys from 21 donors, of whom 9 were outside our city. From 21 donors we transplanted 38 recipients; out of whom 3 received dual kidneys and one kidney was discarded. The Mean age of the donors was 41.4 +/- 18.2 years with a mean cold ischemia time of 6.9 +/- 3.8 hours. Sixty-eight percent had delayed graft function. At the last follow-up, which was 190 +/- 98 days, patient survival rate was 90%: 4 patients died, including 2 due to bacterial sepsis and 2 due to cytomegalovirus (CMV) disease. The Graft survival rate was 85%, and the death-censored graft survival rate was 90%. Mean serum creatinine value at the last follow-up was 1.2 +/- 0.3 mg%. There were 5 episodes of acute rejection in 31 patients during first 3 months (16% acute rejection rate). The increase in cadaveric transplantations was associated with satisfactory patient and graft survival despite the high incidence of delayed graft function.
Descriptive analysis of critical care units in the United State
  • Js Groeger
  • Ma Strosberg
  • Kg Guntupalli
Groeger JS, Strosberg MA, Guntupalli KG, et al. Descriptive analysis of critical care units in the United State. Crit Care Med 1992;20:846-62.
Descriptive analysis of critical care units in the United State
  • J S Groeger
  • M A Strosberg
  • K G Guntupalli
Groeger JS, Strosberg MA, Guntupalli KG, et al. Descriptive analysis of critical care units in the United State. Crit Care Med 1992;20:846-62.