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

Jigeeshu V Divatia, Yatin Mehta, Deepak Govil, Kapil Zirpe, Pravin R Amin, Nagarajan Ramakrishnan, Farhad N Kapadia, Mrinal Sircar, Samir Sahu, Pradip Kumar Bhattacharya, Sheila Nainan Myatra, Srinivas Samavedam, Subhal Dixit, Rajesh Kumar Pande, Sujata N Mehta, Ramesh Venkataraman, Khusrav Bajan, Vivek Kumar, Rahul Harne, Leelavati Thakur, Darshana Rathod, Prachee Sathe, Sushma Gurav, Carol D'Silva, Shaik Arif Pasha, Subhash Kumar Todi, the INDICAPS-II investigators, Neeraj Kumar, Neeraj Kumar, Amarjeet Kumar, Dipak Kumar Agarwal, Sarat Kumar Behera, Susruta Bandyopadhyay, Rajarshi Roy, Samir Sahu, Rajeshree Nandy, Sushmita Basu, Subhash Kumar Todi, Saswati Sinha, Lawni Goswami, Manoj Kumar Singh, Jay Kothari, Vilas Kushare, Pravin Tajane, Banambar Ray, Sharmili Sinha, Saroj Pattnaik, Nagarajan Ramakrishnan, Ramesh Venkataraman, Reshma Tewari, Sujan Dey, Ruchira Khasne, Prasanna Kumar Mishra, Sampat Dash, Sandip Bhattacharyya, Vandana Sinha, Anup Jyoti Dutta, Praveen Kumar Koppula, Krishna Prabhakar Kasam, Basanth Kumar Rayani, Abhijit Sukumaran Nair, Jignesh Navinchandra Shah, Prashant Jedge, A Chakravarthi, Amol Hartalkar, Rajesh Kumar Pande, Abhishek Vishnu, Pravin R Amin, Sujata N Mehta, Kalpesh Bhoyar, Joanne Mascarenhas, Madhusudan R Jaju, Venkat Raman Kola, Hariprasad, T Mohan S Maharaj, Lakshmi Rani Takkellapati, Sunil T Pandya, M Kiran, Akshay Shrivastava, Pallavi Shrivastava, Pradip K Bhattacharya, Nimita Deora, Anand Sanghi, Abhishek Samprathi, Kishore Pichamuthu, Bhagyesh Shah, Shuchi Kaushik, Palepu B Gopal, Ch Balasubrahmanyam, Deepak Jeswani, Deepti Jeswani, Shruti Sharma, Gunchan Paul, Prasad Rajhans, Safal Sable, Chaitri Shah, J D Lakhani, Arpita Dwivedy, Priteema Chanana, Vaibhav Bhargava, Pramod Sarwa, Kishore Mangal, Yatendra Kumar Gupta, Vivek Nangia, Amina Mobashir, Mrinal Sircar, Saurabh Mehra, Arun Kumar, Amit Kumar Mandal, V K Thakur, Sandeep Patil, Bhushan Kinholkar, Neeta Bose, Dhara Tanna, Bhavik V Shah, Priyanka Khatri, Nishchil H Patel, Sanjoy Joseph George, Sanghamitra Mishra, Basanta Kumar Pati, Rajesh Chawla, Sudha Kansal, Atul Kumar Singh, Sulakshana, Leelavati Thakur, Shruti Tandan, Varun Deshmukh, Gyanendra Agrawal, Deepak Singhal, Narendra Rungta, Neena Rungta, Om Prakash Shrivastava, Satnam Singh, Vivek Kumar, Srinivasan Ramananthan, Dipak Aghara, Jayendra Aghara, Rajesh Mohan Shetty, Manjunath Thimmappa, Shantanu Belwal, Bhupesh Uniyal, Rekha Gupta, Mudit Garg, Yatin Mehta, Deepak Govil, Shaleen Bhatnagar, Chitra Mehta, Prashant Kumar, Tariq Ali, Rahul Harne, Payel Bose, Saurabh Debnath, Lalit Singh, Nipun Agrawal, Ajay A Bulle, Ajita Annachhatre, Yogesh Belapurkar, Kanwalpreet Sodhi, Harmanpreet Kaur, A S Ansari, Sourabh Phadtare, Ranjit Sousa, Minal Jariwala, Yuti Sheth, Gunjan Chanchalani, Harish Mallapura Maheshwarappa, B M Ramya, Sachin Gupta, Deeksha Singh Tomar, Utpal Sarma, Vipul Mishra, Sultana Teslima Begum, Ajit Deka, Sunitha Binu Varghese, Ajit Yadav, Shaik Arif Pasha, V Chittaranjan Naidu, Lakshmi Prasannam, Pankaj Patil, Farhad N Kapadia, Khusrav Bajan, Ajoy Krishna Sarkar, Diptimala Agarwal, Simant Kumar Jha, Shiv Kumar, Kapil Zirpe, Sushma Gurav, Prajakta Wankhede, Prachee Sathe, Prashant Sakhavalkar, T R Jadhav, Shilpa Kulkarni, Saurabh Shaha, Sanjith Saseedharan, Roopa Karanam, Promise Jain, Subhal Dixit, Priyanka Khalate, Nikhil Ajmera, Geetesh Mangal, A S Arunkumar, M S Kalaiselvan, A Mohana Rao, V Kuchela Babu, Vishal Sadatia, Tushar Patel, Abhishek Prajapati, Deepak S Sharma, Krutika Tandon, Nitinkumar B Agarwal, Basavraj Pujari, Sudhir Khunteta, Darshana Rathod, Ankur Bhavsar, N K Vinod, K V Bharath, Carol Dsilva, Bhuvana Krishna, Harjit Dumra, Mansi Dandnaik, Anand V Joshi, Nirmal Jaiswal, Shivam Chopra, Ranvir Singh Tyagi, Rakesh Kumar Tyagi, Milap Mashru, Jayeshkumar Dobariya, Jigeeshu V Divatia, Sheila Nainan Myatra, Atul P Kulkarni, Anjana Shrivastava, Amit Narkhede, Bharat Jagiasi, Pallavi Patekar, Shyam Sunder Tipparaju, Yalavarthy Swathi, Himansu Sekhar Mishra, N Srinivas, Srinivas Samavedam, Narmada Aluru, Jigeeshu V Divatia, Yatin Mehta, Deepak Govil, Kapil Zirpe, Pravin R Amin, Nagarajan Ramakrishnan, Farhad N Kapadia, Mrinal Sircar, Samir Sahu, Pradip Kumar Bhattacharya, Sheila Nainan Myatra, Srinivas Samavedam, Subhal Dixit, Rajesh Kumar Pande, Sujata N Mehta, Ramesh Venkataraman, Khusrav Bajan, Vivek Kumar, Rahul Harne, Leelavati Thakur, Darshana Rathod, Prachee Sathe, Sushma Gurav, Carol D'Silva, Shaik Arif Pasha, Subhash Kumar Todi, the INDICAPS-II investigators, Neeraj Kumar, Neeraj Kumar, Amarjeet Kumar, Dipak Kumar Agarwal, Sarat Kumar Behera, Susruta Bandyopadhyay, Rajarshi Roy, Samir Sahu, Rajeshree Nandy, Sushmita Basu, Subhash Kumar Todi, Saswati Sinha, Lawni Goswami, Manoj Kumar Singh, Jay Kothari, Vilas Kushare, Pravin Tajane, Banambar Ray, Sharmili Sinha, Saroj Pattnaik, Nagarajan Ramakrishnan, Ramesh Venkataraman, Reshma Tewari, Sujan Dey, Ruchira Khasne, Prasanna Kumar Mishra, Sampat Dash, Sandip Bhattacharyya, Vandana Sinha, Anup Jyoti Dutta, Praveen Kumar Koppula, Krishna Prabhakar Kasam, Basanth Kumar Rayani, Abhijit Sukumaran Nair, Jignesh Navinchandra Shah, Prashant Jedge, A Chakravarthi, Amol Hartalkar, Rajesh Kumar Pande, Abhishek Vishnu, Pravin R Amin, Sujata N Mehta, Kalpesh Bhoyar, Joanne Mascarenhas, Madhusudan R Jaju, Venkat Raman Kola, Hariprasad, T Mohan S Maharaj, Lakshmi Rani Takkellapati, Sunil T Pandya, M Kiran, Akshay Shrivastava, Pallavi Shrivastava, Pradip K Bhattacharya, Nimita Deora, Anand Sanghi, Abhishek Samprathi, Kishore Pichamuthu, Bhagyesh Shah, Shuchi Kaushik, Palepu B Gopal, Ch Balasubrahmanyam, Deepak Jeswani, Deepti Jeswani, Shruti Sharma, Gunchan Paul, Prasad Rajhans, Safal Sable, Chaitri Shah, J D Lakhani, Arpita Dwivedy, Priteema Chanana, Vaibhav Bhargava, Pramod Sarwa, Kishore Mangal, Yatendra Kumar Gupta, Vivek Nangia, Amina Mobashir, Mrinal Sircar, Saurabh Mehra, Arun Kumar, Amit Kumar Mandal, V K Thakur, Sandeep Patil, Bhushan Kinholkar, Neeta Bose, Dhara Tanna, Bhavik V Shah, Priyanka Khatri, Nishchil H Patel, Sanjoy Joseph George, Sanghamitra Mishra, Basanta Kumar Pati, Rajesh Chawla, Sudha Kansal, Atul Kumar Singh, Sulakshana, Leelavati Thakur, Shruti Tandan, Varun Deshmukh, Gyanendra Agrawal, Deepak Singhal, Narendra Rungta, Neena Rungta, Om Prakash Shrivastava, Satnam Singh, Vivek Kumar, Srinivasan Ramananthan, Dipak Aghara, Jayendra Aghara, Rajesh Mohan Shetty, Manjunath Thimmappa, Shantanu Belwal, Bhupesh Uniyal, Rekha Gupta, Mudit Garg, Yatin Mehta, Deepak Govil, Shaleen Bhatnagar, Chitra Mehta, Prashant Kumar, Tariq Ali, Rahul Harne, Payel Bose, Saurabh Debnath, Lalit Singh, Nipun Agrawal, Ajay A Bulle, Ajita Annachhatre, Yogesh Belapurkar, Kanwalpreet Sodhi, Harmanpreet Kaur, A S Ansari, Sourabh Phadtare, Ranjit Sousa, Minal Jariwala, Yuti Sheth, Gunjan Chanchalani, Harish Mallapura Maheshwarappa, B M Ramya, Sachin Gupta, Deeksha Singh Tomar, Utpal Sarma, Vipul Mishra, Sultana Teslima Begum, Ajit Deka, Sunitha Binu Varghese, Ajit Yadav, Shaik Arif Pasha, V Chittaranjan Naidu, Lakshmi Prasannam, Pankaj Patil, Farhad N Kapadia, Khusrav Bajan, Ajoy Krishna Sarkar, Diptimala Agarwal, Simant Kumar Jha, Shiv Kumar, Kapil Zirpe, Sushma Gurav, Prajakta Wankhede, Prachee Sathe, Prashant Sakhavalkar, T R Jadhav, Shilpa Kulkarni, Saurabh Shaha, Sanjith Saseedharan, Roopa Karanam, Promise Jain, Subhal Dixit, Priyanka Khalate, Nikhil Ajmera, Geetesh Mangal, A S Arunkumar, M S Kalaiselvan, A Mohana Rao, V Kuchela Babu, Vishal Sadatia, Tushar Patel, Abhishek Prajapati, Deepak S Sharma, Krutika Tandon, Nitinkumar B Agarwal, Basavraj Pujari, Sudhir Khunteta, Darshana Rathod, Ankur Bhavsar, N K Vinod, K V Bharath, Carol Dsilva, Bhuvana Krishna, Harjit Dumra, Mansi Dandnaik, Anand V Joshi, Nirmal Jaiswal, Shivam Chopra, Ranvir Singh Tyagi, Rakesh Kumar Tyagi, Milap Mashru, Jayeshkumar Dobariya, Jigeeshu V Divatia, Sheila Nainan Myatra, Atul P Kulkarni, Anjana Shrivastava, Amit Narkhede, Bharat Jagiasi, Pallavi Patekar, Shyam Sunder Tipparaju, Yalavarthy Swathi, Himansu Sekhar Mishra, N Srinivas, Srinivas Samavedam, Narmada Aluru

Abstract

Background: We aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010-2011.

Methods: An observational, 4-day point prevalence study was performed between 2018 and 2019. ICU, patient characteristics, and interventions were recorded for 24 hours, and ICU outcomes till 30 days after the study day. Adherence to selected compliance measures was determined. Data were analyzed for 4,669 adult patients from 132 ICUs.

Results: On the study day, mean age, acute physiology and chronic health evaluation (APACHE II), and sequential organ failure assessment (SOFA) scores were 56.9 ± 17.41 years, 16.7 ± 9.8, and 4.4 ± 3.6, respectively. Moreover, 24% and 22.2% of patients received mechanical ventilation (MV) and vasopressors or inotropes (VIs), respectively. On the study days, 1,195 patients (25.6%) were infected and 1,368 patients (29.3%) had sepsis during their ICU stay. ICU mortality was 1,092 out of 4,669 (23.4%), including 737 deaths and 355 terminal discharges (TDs) from ICU. Compliance for process measures related to MV ranged between 62.7 and 85.3%, 11.2 and 47.4% for monitoring delirium, sedation, and analgesia, and 7.7 and 25.3% for inappropriate transfusion of blood products. Only 34.8% of ICUs routinely used capnography. Large hospitals with ≥500 beds, closed ICUs, the APACHE II and SOFA scores, medical admissions, the presence of cancer or cirrhosis of the liver, the presence of infection on the study day, and the need for MV or VIs were independent predictors of mortality.

Conclusions: Hospital size and closed ICUs are independently associated with worse outcomes. The proportion of TDs remains high. There is a scope for improvements in processes of care.Registered at clinicaltrials.gov (NCT03631927).

How to cite this article: Divatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, et al. Intensive Care in India in 2018-2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021;25(10):1093-1107.

Keywords: Adult; Health care; India; Intensive care units; Mortality; Patients; Process assessment.

Conflict of interest statement

Source of support: This study was funded by the Indian Society of Critical Care Medicine Conflict of interest: None

Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.

Figures

Figs 1A and B
Figs 1A and B
(A) APACHE II score on the study day; (B) Number of organ failures on the study day and ICU nonsurvivors
Fig. 2
Fig. 2
Predicted vs actual hospital mortality for 1,819 patients

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