ArticlePloS one2017
Impact of a structured ICU training programme in resource-limited settings in Asia.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Interventions for improving critical care in low- and middle-income countries: a systematic review.Intensive care medicine · 2024Pooled it
- Challenges and strategies for the identification and correction of patient-ventilator asynchronies in daily practice: a scoping review.Acute and critical care · 2026Article
- A rapid evaluation of quality of sedation and ventilation care processes for critically ill patients in Vietnam.PloS one · 2026Article
- Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study.BMC health services research · 2023Article
- Impact of Telemedicine use on clinical care indicators of pediatric intensive care units: protocol for a cluster randomized clinical trial.Critical care science · 2023Article
- Core competencies in critical care for general medical practitioners in South Africa: A Delphi study.The Southern African journal of critical care : the official journal of the Critical Care Society · 2023Article
- The Malawi emergency and critical care survey: A cross-sectional national facility assessment.EClinicalMedicine · 2022Article
- Effectiveness of virtual training for medical officers and community health officers in the critical care management of COVID-19 patients in the intensive care unit.Indian journal of anaesthesia · 2021Article
- White Paper on Early Critical Care Services in Low Resource Settings.Annals of global health · 2021Article
- Improving nurses' knowledge of managing endotracheal tube cuff pressure in intensive care units: A quasi-experimental study.Health SA = SA Gesondheid · 2020Article
- Pakistan Registry of Intensive CarE (PRICE): Expanding a lower middle-income, clinician-designed critical care registry in South Asia.Journal of the Intensive Care Society · 2019Article
- Challenges experienced by health care professionals working in resource-poor intensive care settings in the Limpopo province of South Africa.Curationis · 2019Article
- Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka.BMJ global health · 2019Article
- Article
- Article
- Decision-making in the detection and management of patients with sepsis in resource-limited settings: the importance of clinical examination.Critical care (London, England) · 2018Article
- Observational
- Simplified prognostic model for critically ill patients in resource limited settings in South Asia.Critical care (London, England) · 2017Article
Corrections and comments
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Authors and funding
13 authors at 6 institutions in 6 countries.
Funding
Abstract
objectiveTo assess the impact on ICU performance of a modular training program in three resource-limited general adult ICUs in India, Bangladesh, and Nepal.
methodA modular ICU training programme was evaluated using performance indicators from June 2009 to June 2012 using an interrupted time series design with an 8 to 15 month pre-intervention and 18 to 24 month post-intervention period. ICU physicians and nurses trained in Europe and the USA provided training for ICU doctors and nurses. The training program consisted of six modules on basic intensive care practices of 2-3 weeks each over 20 months. The performance indicators consisting of ICU mortality, time to ICU discharge, rate at which patients were discharged alive from the ICU, discontinuation of mechanical ventilation or vasoactive drugs and duration of antibiotic use were extracted. Stepwise changes and changes in trends associated with the intervention were analysed.
resultsPre-Training ICU mortality in Rourkela (India), and Patan (Nepal) Chittagong (Bangladesh), was 28%, 41% and 62%, respectively, compared to 30%, 18% and 51% post-intervention. The intervention was associated with a stepwise reduction in cumulative incidence of in-ICU mortality in Chittagong (adjusted subdistribution hazard ratio [aSHR] (95% CI): 0.62 (0.40, 0.97), p = 0.03) and Patan (aSHR 0.16 (0.06, 0.41), p<0.001), but not in Rourkela (aSHR: 1.17 (0.75, 1.82), p = 0.49). The intervention was associated with earlier discontinuation of vasoactive drugs at Rourkela (adjusted hazard ratio for weekly change [aHR] 1.08 (1.03, 1.14), earlier discontinuation of mechanical ventilation in Chittagong (aHR 2.97 (1.24, 7.14), p = 0.02), and earlier ICU discharge in Patan (aHR 1.87 (1.02, 3.43), p = 0.04).
conclusionThis structured training program was associated with a decrease in ICU mortality in two of three sites and improvement of other performance indicators. A larger cluster randomised study assessing process outcomes and longer-term indicators is warranted.
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