Challenges in the delivery of critical care in India during the COVID-19 pandemic

Vijayaraghavan, Bharath Kumar Tirupakuzhi; Myatra, Sheila Nainan; Mathew, Meghena; Lodh, Nirmalyo; Divatia, Jigeeshu Vasishtha; Hammond, Naomi; Jha, Vivekanand; Venkatesh, Balasubramanian

doi:10.1177/1751143720952590

Cited by 19 publications

(17 citation statements)

References 20 publications

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“…Nurses form the backbone of the healthcare system and constitute a significant part of the trained workforce; they play a pivotal role in the provision of public healthcare [4]. A study has revealed that the Indian healthcare system is facing a severe shortage of trained nursing workforce [5]. Crucially, this shortage has been further intensified by a large number of nurses contracting COVID-19 during this pandemic and 1 1…”

Section: Introductionmentioning

confidence: 99%

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Promoting Mental Health of Nurses During the Coronavirus Pandemic: Will the Rapid Deployment of Nurses' Training Programs During COVID-19 Improve Self-Efficacy and Reduce Anxiety?

Dharra¹,

Kumar²

2021

Cureus

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The nursing profession is extremely demanding and stressful. Nurses have been facing a tremendous amount of fear and anxiety during the ongoing coronavirus disease 2019 (COVID-19) pandemic. General self-efficacy is considered one of the most influential factors that can modify the impact of anxiety on nurses' mental health. In this study, we aimed to determine the predictors of self-efficacy and anxiety among nurses during the current COVID-19 pandemic. MethodsWe conducted a cross-sectional survey involving 368 nurses working in a tertiary care hospital. The General Self-Efficacy scale (GSE) and Generalized Anxiety Disorder Scale-7 (GAD-7) were used for assessing selfefficacy and anxiety. The chi-square test followed by bivariate and multivariable regression analyses was performed to identify the determinants of self-efficacy and anxiety. ResultsThe mean age of the nurses was 28.91 years (SD=3.68), with a mean working experience in the nursing field of 5.32 years (SD=2.48). The mean self-efficacy and anxiety scores were 32.19 (SD=4.53) and 3.82 (SD=2.87), respectively. Multivariable analysis showed that higher age (>30 years, p=.003), professional education acquired through a diploma course instead of a graduate degree (p<.001), and lack of training on handling COVID-19 patients (p=.003) were significant determinants of higher anxiety among nurses. Similarly, higher economic status (p=.001), sufficient COVID-19 training (p=.049), having family members tested positive for COVID-19 (p=.012), professional experience (≤5 years, p<0.001), and quarantine period (≤14 days, p=.002) were revealed to be independent determinants of a higher sense of self-efficacy among nurses during the COVID-19 pandemic. ConclusionReceiving adequate levels of training on COVID-19 plays a vital role in improving self-efficacy and reducing anxiety among nurses during the ongoing pandemic. Managing anxiety, increasing self-efficacy, and ensuring more exposure to COVID-19-related training may improve nurses' mental health and prepare them for fighting pandemics in a much better and more efficient manner.

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Section: Introductionmentioning

confidence: 99%

“…being forced quarantine as a result [5,6]. Studies from India [7] and Wuhan, China [8] have revealed that HCWs are often experiencing a great deal of anxiety, stress, and depression due to the current pandemic.…”

Section: Introductionmentioning

confidence: 99%

Promoting Mental Health of Nurses During the Coronavirus Pandemic: Will the Rapid Deployment of Nurses' Training Programs During COVID-19 Improve Self-Efficacy and Reduce Anxiety?

Dharra¹,

Kumar²

2021

Cureus

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“…The early rapid spread of the COVID-19 pandemic resulted in a shortage of mechanical ventilators and accessory components (e.g., humidifiers, circuits, etc.) in many regions throughout the world [ 2 – 5 ]. In response to these shortages, a global surge in development and production occurred, including repurposing non-medical device assembly lines to manufacture quickly designed ventilators (e.g., FORD, GM, Virgin, etc.)…”

Section: Introductionmentioning

confidence: 99%

Data automated bag breathing unit for COVID-19 ventilator shortages

Gruslova

Katta

Cabe

et al. 2021

ICMx

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Background The COVID-19 pandemic has caused a global mechanical ventilator shortage for treatment of severe acute respiratory failure. Development of novel breathing devices has been proposed as a low cost, rapid solution when full-featured ventilators are unavailable. Here we report the design, bench testing and preclinical results for an 'Automated Bag Breathing Unit' (ABBU). Output parameters were validated with mechanical test lungs followed by animal model testing. Results The ABBU design uses a programmable motor-driven wheel assembled for adult resuscitation bag-valve compression. ABBU can control tidal volume (200–800 ml), respiratory rate (10–40 bpm), inspiratory time (0.5–1.5 s), assist pressure sensing (− 1 to − 20 cm H2O), manual PEEP valve (0–20 cm H2O). All set values are displayed on an LCD screen. Bench testing with lung simulators (Michigan 1600, SmartLung 2000) yielded consistent tidal volume delivery at compliances of 20, 40 and 70 (mL/cm H2O). The delivered fraction of inspired oxygen (FiO2) decreased with increasing minute ventilation (VE), from 98 to 47% when VE was increased from 4 to 16 L/min using a fixed oxygen flow source of 5 L/min. ABBU was tested in Berkshire pigs (n = 6, weight of 50.8 ± 2.6 kg) utilizing normal lung model and saline lavage induced lung injury. Arterial blood gases were measured following changes in tidal volume (200–800 ml), respiratory rate (10–40 bpm), and PEEP (5–20 cm H2O) at baseline and after lung lavage. Physiological levels of PaCO2 (≤ 40 mm Hg [5.3 kPa]) were achieved in all animals at baseline and following lavage injury. PaO2 increased in lavage injured lungs in response to incremental PEEP (5–20 cm H2O) (p < 0.01). At fixed low oxygen flow rates (5 L/min), delivered FiO2 decreased with increased VE. Conclusions ABBU provides oxygenation and ventilation across a range of parameter settings that may potentially provide a low-cost solution to ventilator shortages. A clinical trial is necessary to establish safety and efficacy in adult patients with diverse etiologies of respiratory failure.

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“…Even in non-pandemic times, India has a limited supply of critical care capacity with bed availability estimated at 2.6 per 100,000 population compared with much higher capacity in most high-income countries, for example 12.9 ICU beds per 100,000 population in Canada 3 , and other LMICs in the region, for example 11.7 beds per 100,000 population in Mongolia 4 . Other well-described challenges to the delivery of critical care in India include the limited number of beds with capacity for oxygen delivery, ventilators, and importantly, healthcare professionals 5 . All these challenges are further amplified by the disparities in distribution of these resources between urban and rural India 6 and between the public and private sector.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based analysis from India

et al. 2021

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Background: Coronavirus disease 2019 (COVID-19) has been responsible for over 3.4 million deaths globally and over 25 million cases in India. As part of the response, India imposed a nation-wide lockdown and prioritized COVID-19 care in hospitals and intensive care units (ICUs). Leveraging data from the Indian Registry of IntenSive care, we sought to understand the impact of the COVID-19 pandemic on critical care service utilization, case-mix, and clinical outcomes in non-COVID ICUs. Methods: We included all consecutive patients admitted between 1st October 2019 and 27th September 2020. Data were extracted from the registry database and included patients admitted to the non-COVID or general ICUs at each of the sites. Outcomes included measures of resource-availability, utilisation, case-mix, acuity, and demand for ICU beds. We used a Mann-Whitney test to compare the pre-pandemic period (October 2019 - February 2020) to the pandemic period (March-September 2020). In addition, we also compared the period of intense lockdown (March-May 31st 2020) with the pre-pandemic period. Results: There were 3424 patient encounters in the pre-pandemic period and 3524 encounters in the pandemic period. Comparing these periods, weekly admissions declined (median [Q1 Q3] 160 [145,168] to 113 [98.5,134]; p=0.00002); unit turnover declined (median [Q1 Q3] 12.1 [11.32,13] to 8.58 [7.24,10], p<0.00001), and APACHE II score increased (median [Q1 Q3] 19 [19,20] to 21 [20,22] ; p<0.00001). Unadjusted ICU mortality increased (9.3% to 11.7%, p=0.01519) and the length of ICU stay was similar (median [Q1 Q3] 2.11 [2, 2] vs. 2.24 [2, 3] days; p=0.15096). Conclusion: Our registry-based analysis of the impact of COVID-19 on non-COVID critical care demonstrates significant disruptions to healthcare utilization during the pandemic and an increase in the severity of illness.

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Challenges in the delivery of critical care in India during the COVID-19 pandemic

Cited by 19 publications

References 20 publications

Promoting Mental Health of Nurses During the Coronavirus Pandemic: Will the Rapid Deployment of Nurses' Training Programs During COVID-19 Improve Self-Efficacy and Reduce Anxiety?

Promoting Mental Health of Nurses During the Coronavirus Pandemic: Will the Rapid Deployment of Nurses' Training Programs During COVID-19 Improve Self-Efficacy and Reduce Anxiety?

Data automated bag breathing unit for COVID-19 ventilator shortages

Impact of COVID-19 on non-COVID intensive care unit service utilization, case mix and outcomes: A registry-based analysis from India

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