Mortality in mechanically ventilated patients in middle-income countries: a call for action

Duarte, Péricles Almeida Delfino; Réa-Neto, Álvaro

doi:10.1016/s2214-109x(21)00522-2

Cited by 2 publications

(2 citation statements)

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“…A research agenda should focus on identifying and measuring factors that determine critical care outcomes. Commentators have advocated for a multifaceted approach (clinical processes, unit structure and staffing, resources, barriers, disease type and severity, sociodemographic information, and other context-specific variables) [29,30], which our data supports. This can be accomplished through the repeated administration of the MECC Survey instrument, potentially supplemented with process observation and patient-level data, including outcomes.…”

Section: Significance/future Directionssupporting

confidence: 67%

“…Similarly, a pooled analysis of four large observational studies found 50% higher mechanical ventilation mortality in middle-income countries compared to HICs, despite similar rates of low volume ventilation [5]. Translating quality clinical processes into good patient outcomes requires characterizing context-specific barriers [29]. In our study, personnel and training were the most common barriers related to mechanical ventilation.…”

Section: Family Engagement and Empowermentmentioning

confidence: 55%

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Critical Care Units in Malawi: A Cross-Sectional Study

Sonenthal

Kasomekera

Connolly

et al. 2023

agh

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Background: The global burden of critical illness falls disproportionately outside high-income countries. Despite younger patient populations with similar or lower disease severity, critical illness outcomes are poor outside high-income countries. A lack of data limits attempts to understand and address the drivers of critical care outcomes outside high-income countries. Objectives: We aim to characterize the organization, available resources, and service capacity of public sector critical care units in Malawi and identify barriers to improving care. Methods: We conducted a secondary analysis of the Malawi Emergency and Critical Care Survey, a cross-sectional study performed from January to February 2020 at all four central hospitals and a simple random sample of nine out of 24 public sector district hospitals in Malawi, a predominantly rural, low-income country of 19.6 million in southern Africa. Data from critical care units were used to characterize resources, processes, and barriers to care. Findings: There were four HDUs and four ICUs across the 13 hospitals in the Malawi Emergency and Critical Care Survey sample. The median critical care beds per 1,000,000 catchment was 1.4 (IQR: 0.9 to 6.7). Absent equipment was the most common barrier in HDUs (46% [95% CI: 32% to 60%]). Stockouts was the most common barriers in ICUs (48% [CI: 38% to 58%]). ICUs had a median 3.0 (range: 2 to 8) functional ventilators per unit and reported an ability to perform several quality mechanical ventilation interventions. Conclusions: Although significant gaps exist, Malawian critical care units report the ability to perform several complex clinical processes. Our results highlight regional inequalities in access to care and support the use of process-oriented questions to assess critical care capacity. Future efforts should focus on basic critical care capacity outside of urban areas and quantify the impact of context-specific variables on critical care mortality.

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Section: Significance/future Directionssupporting

confidence: 67%

Section: Family Engagement and Empowermentmentioning

confidence: 55%