Critical Care in Resource-Restricted Settings

Intensive care medicine in rural sub‐Saharan Africa

“…As the ICU is the only facility in the study hospital where critically ill patients are cared for, and because the study hospital is the only inpatient facility in the region, our study population is likely to represent the true spectrum of critical illness for a large rural sub‐Saharan African region. Furthermore, the virtual absence of financial barriers preventing patients from entering the ICU, which may be the case in other ICUs in low‐income countries , eliminates an important selection bias from this study. On the other hand, as ICU admission occurred after individual judgement of the patient's mortality risk by the attending physician, the anaesthetist and anaesthetic officer, it is likely that some patients who would have been admitted to an ICU in a high‐income setting were not admitted to the study ICU, and were thus not included in the database.…”

“…The main reason for this observation is that the study ICU cares for all critically ill patients of the hospital, including neonatal, paediatric and adult cases. Given the lack of specific neonatal and paediatric ICU facilities in low‐income settings , caring for critically ill patients of all age groups may be a frequent challenge for ICU staff in sub‐Saharan Africa . When analysing only patients aged > 18 years, the portion of patients > 60 years remained small (14.7%).…”

“…Over the past two decades, there has been an increased focus on the state of intensive care medicine in middle‐ and low‐income countries . At present, it is recognised that intensive care medicine is a young, underdeveloped and under‐resourced medical specialty in many of these areas . Lack of trained staff, equipment and supply materials represent major challenges.…”

Acute respiratory distress syndrome—a worldwide economic perspective

“…Of note, no patient was enrolled from low-income countries, which probably reflects the limited availability of ICUs in resource-limited settings (4).…”

Management of sepsis in resource poor countries: cutting your coat according to your cloth

“…Due to lack of antimicrobial stewardship programs, multidrug resistant organisms causing sepsis are quite common in resource poor settings. 21 As the ICU capacities and level of care might vary widely even in the resource limited settings, recommendations for management based on availability of diagnostic facilities and training of medical personnel may be reasonable. 22,23 Easily available bedside tools like point-of-care ultrasonography can be a valuable adjunct to facilitate management of these patients.…”