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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 3, Kapil Zirpe 4, Pravin R Amin 5, Nagarajan Ramakrishnan 6, Farhad N Kapadia 7, Mrinal Sircar 8, Samir Sahu 9, Pradip Kumar Bhattacharya 10, Sheila Nainan Myatra 11, Srinivas Samavedam 12, Subhal Dixit 13, Rajesh Kumar Pande 14, Sujata N Mehta 15, Ramesh Venkataraman 16, Khusrav Bajan 17, Vivek Kumar 18, Rahul Harne 19, Leelavati Thakur 20, Darshana Rathod 21, Prachee Sathe 22, Sushma Gurav 23, Carol D'Silva 24, Shaik Arif Pasha 25, Subhash Kumar Todi 26; the INDICAPS-II investigators 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.
