Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study

Background and aim While intensive care unit (ICU) mortality rates in India are higher when compared to countries with more resources, fewer patients with clinically futile conditions are subjected to limitation of life-sustaining treatments or given access to palliative care. Although a few surveys and audits have been conducted exploring this phenomenon, the qualitative perspectives of ICU physicians regarding end-of-life care (EOLC) and the quality of dying are yet to be explored. Methods There are 22 eligible consultant-level ICU physicians working in multidisciplinary ICUs were purposively recruited and interviewed. The study data was analyzed using reflexive thematic analysis (RTA) with a critical realist perspective, and the study findings were interpreted using the lens of the semiotic theory that facilitated the development of themes. Results About four themes were generated. Intensive care unit physicians perceived the quality of dying as respecting patients’ and families’ choices, fulfilling their needs, providing continued care beyond death, and ensuring family satisfaction. To achieve this, the EOLC process must encompass timely decision-making, communication, treatment guidelines, visitation rights, and trust-building. The contextual challenges were legal concerns, decision-making complexities, cost-related issues, and managing expectations. To improve care, ICU physicians suggested amplifying patient and family voices, building therapeutic relationships, mitigating conflicts, enhancing palliative care services, and training ICU providers in EOLC. Conclusion Effective management of critically ill patients with life-limiting illnesses in ICUs requires a holistic approach that considers the complex interplay between the EOLC process, its desired outcome, the quality of dying, care context, and the process of meaning-making by ICU physicians. How to cite this article Iyer S, Sonawane RN, Shah J, Salins N. Semiotics of ICU Physicians’ Views on End-of-life Care and Quality of Dying in a Critical Care Setting: A Qualitative Study. Indian J Crit Care Med 2024;28(5):424–435.

Section: Discussionmentioning

confidence: 99%

“… 8 Most of the limitations of support decisions in India culminated in a terminal discharge against medical advice (DAMA) or left against medical advice (LAMA), as suggested by the point prevalence Indian study INDICAPS II. 9 …”

Section: Introductionmentioning

confidence: 99%

Semiotics of ICU Physicians’ Views on End-of-life Care and Quality of Dying in a Critical Care Setting: A Qualitative Study

Shah,

Iyer,

Sonawane

et al. 2024

“…This data contradicts western literature which favors a closed ICU structure in order to achieve better outcomes. On the contrary, the INDICAPS-II 4 study indicated that having a closed ICU structure was an independent predictor of mortality, wherein the closed ICU was defined as one in which, only the ICU team doctors wrote the final orders for the patient. A third model, the hybrid model or mandatory consult model is in which all patients admitted to the ICU are seen by the primary consultant and the ICU team, with both having the privilege to write orders.…”

Section: R Ole Of I Ntensive C ...mentioning

confidence: 99%

Patient Safety in Intensive Care Unit: What can We Do Better?

Ambulkar¹,

Kulkarni²,

Patil³

2023

A bstract Patient safety is an important step in providing high-quality health care. Every intensive care unit (ICU) is unique and its needs would be different; it is thus necessary to build a safety culture based on local and cultural characteristics. Various measures such as regular training, the use of bundles of care, and a blame-free environment can promote patient safety in ICUs. These measures are simple to implement even in resource-limiting settings and can go a long way in improving patient outcomes in our country. How to cite this article Patil SJ, Ambulkar R, Kulkarni AP. Patient Safety in Intensive Care Unit: What can We Do Better? Indian J Crit Care Med 2023;27(3):163–165.

“…CO and SVV monitoring remained low even in this second survey which happened after a gap of ~8 years. 6 …”

Section: Introductionmentioning

confidence: 99%

ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill

Pichamuthu¹,

Venkataraman²,

Govil³

et al. 2022

Self Cite

Hemodynamic assessment along with continuous monitoring and appropriate therapy forms an integral part of management of critically ill patients with acute circulatory failure. In India, the infrastructure in ICUs varies from very basic facilities in smaller towns and semi-urban areas, to world-class, cutting-edge technology in corporate hospitals, in metropolitan cities. Surveys and studies from India suggest a wide variation in clinical practices due to possible lack of awareness, expertise, high costs, and lack of availability of advanced hemodynamic monitoring devices. We, therefore, on behalf of the Indian Society of Critical Care Medicine (ISCCM), formulated these evidence-based guidelines for optimal use of various hemodynamic monitoring modalities keeping in mind the resource-limited settings and the specific needs of our patients. When enough evidence was not forthcoming, we have made recommendations after achieving consensus amongst members. Careful integration of clinical assessment and critical information obtained from laboratory data and monitoring devices should help in improving outcomes of our patients. How to cite this article Kulkarni AP, Govil D, Samavedam S, Srinivasan S, Ramasubban S, Venkataraman R, et al . ISCCM Guidelines for Hemodynamic Monitoring in the Critically Ill. Indian J Crit Care Med 2022;26(S2):S66–S76.