Critical Care in Resource-Restricted Settings

In many low-and middle-income countries, with improved public health services like sanitation and immunization, the relative contribution of curative care for critically ill patients to overall health and life expectancy has increased considerably.The importance of intensive care facilities as a global good was emphasized by recent epidemics in which survival was highly dependent on adequate critical care.Examples include the SARS coronavirus (2002-2003), avian influenza H5N1 (2004 and onward), pandemic influenza A(H1N1) ( 2009), the MERS coronavirus (2012 and onward), and Ebola virus disease (2014-2015).An important impediment for capacity planning in resource-restricted settings is the limited data on critical care usage and capacity. 1 However, basic intensive care facilities are becoming increasingly available in developing countries.For example, the number of intensive care unit (ICU) beds in Sri Lanka, a lower-to middle-income country, is now 2.5 per 100 000 inhabitants, compared with 3.5 ICU beds per 100 000 in the United Kingdom and 20 per 100 000 in the United States. 2 In low-income countries, such as Bangladesh, with 0.3 ICU beds per 100 000 population, availability of intensive care is more limited and often only accessible to those members of society who can afford private hospitals.Beyond the quantity of ICU beds, there may also be concerns about the quality of care, as suggested by higher than expected ICU case fatality rates in low-and middle-income countries.Strategies to improve the quality of ICU care in these settings require consideration of disease-specific and setting-specific factors and careful evaluation of the best way to adapt and deploy quality improvement initiatives.Intensive care units in resourcerestricted settings have to function with important limitations.

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