Critical care delivery across health care systems in low-income and low-middle-income country settings: A systematic review

Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce th...

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Vydané v:	Journal of global health Ročník 13; s. 04141
Hlavní autori:	Bartlett, Emily S, Lim, Andrew, Kivlehan, Sean, Losonczy, Lia I, Murthy, Srinivas, Lowsby, Richard, Papali, Alfred, Raees, Madiha, Seth, Bhavna, Cobb, Natalie, Brotherton, Jason, Dippenaar, Enrico, Nepal, Gaurav, Shrestha, Gentle S, Kuo, Shih-Chiang E, Skrabal, J Ryan, Davis, Margaret, Lay, Cappi, Yi, Sojung, Jaung, Michael, Chaffay, Brandon, Sefa, Nana, Yang, Marc LC, Stephens, P Andrew, Rashed, Amir, Benzoni, Nicole, Velasco, Bernadett, Adhikari, Neill KJ, Reynolds, Teri
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Scotland Edinburgh University Global Health Society 01.12.2023
Predmet:	Adult Age groups Aged Airway management Child Critical Care Critical Illness Delivery of Health Care Emergency medical care Geriatrics Global health Health care Hospitals Humans Illnesses Income Infant Medical personnel Medical students Nursing Patients Pediatrics Poverty Systematic review Ventilators United States > US
ISSN:	2047-2978, 2047-2986, 2047-2986
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Abstract	Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature. A search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020. A total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%). This review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings. PROSPERO CRD42019146802.
AbstractList	BackgroundPrior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature.MethodsA search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020.ResultsA total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%).ConclusionsThis review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings.RegistrationPROSPERO CRD42019146802. Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature.BackgroundPrior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature.A search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020.MethodsA search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020.A total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%).ResultsA total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%).This review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings.ConclusionsThis review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings.PROSPERO CRD42019146802.RegistrationPROSPERO CRD42019146802. Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature. A search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020. A total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%). This review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings. PROSPERO CRD42019146802.
ArticleNumber	04141
Author	Papali, Alfred Jaung, Michael Seth, Bhavna Reynolds, Teri Adhikari, Neill KJ Lay, Cappi Kivlehan, Sean Yang, Marc LC Shrestha, Gentle S Skrabal, J Ryan Nepal, Gaurav Benzoni, Nicole Raees, Madiha Chaffay, Brandon Dippenaar, Enrico Kuo, Shih-Chiang E Stephens, P Andrew Yi, Sojung Sefa, Nana Bartlett, Emily S Cobb, Natalie Losonczy, Lia I Lowsby, Richard Velasco, Bernadett Davis, Margaret Brotherton, Jason Lim, Andrew Rashed, Amir Murthy, Srinivas
Author_xml	– sequence: 1 givenname: Emily S surname: Bartlett fullname: Bartlett, Emily S organization: Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA – sequence: 2 givenname: Andrew surname: Lim fullname: Lim, Andrew organization: Section of Critical Care Medicine, Virginia Mason Franciscan Health, Seattle, Washington, USA – sequence: 3 givenname: Sean surname: Kivlehan fullname: Kivlehan, Sean organization: Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA, Harvard Humanitarian Initiative, Cambridge, Massachuesetts, USA – sequence: 4 givenname: Lia I surname: Losonczy fullname: Losonczy, Lia I organization: Department of Emergency Medicine, Department of Anaesthesia and Critical Care Medicine, George Washington University Medical Center, Washington, District of Columbia, USA – sequence: 5 givenname: Srinivas surname: Murthy fullname: Murthy, Srinivas organization: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada – sequence: 6 givenname: Richard surname: Lowsby fullname: Lowsby, Richard organization: Department of Critical Care Medicine, Department of Emergency Medicine, Mid Cheshire Hospitals National health Service Foundation Trust, Cheshire, UK – sequence: 7 givenname: Alfred surname: Papali fullname: Papali, Alfred organization: Pulmonary and Critical Care Medicine, Atrium Health, Pineville, North Carolina, USA – sequence: 8 givenname: Madiha surname: Raees fullname: Raees, Madiha organization: Division of Critical Care Medicine, Department of Anaesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA – sequence: 9 givenname: Bhavna surname: Seth fullname: Seth, Bhavna organization: Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA – sequence: 10 givenname: Natalie surname: Cobb fullname: Cobb, Natalie organization: Division of 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of Public Health, Baltimore, Maryland, USA – sequence: 16 givenname: J Ryan surname: Skrabal fullname: Skrabal, J Ryan organization: Department of Emergency Medicine, George Washington University, Washington, District of Columbia, USA – sequence: 17 givenname: Margaret surname: Davis fullname: Davis, Margaret organization: Department of Emergency Medicine, University of Washington, Seattle, Washington, USA – sequence: 18 givenname: Cappi surname: Lay fullname: Lay, Cappi organization: Department of Neurosurgery, Department of Emergency Medicine, The Mount Sinai Hospital, New York, New York, USA – sequence: 19 givenname: Sojung surname: Yi fullname: Yi, Sojung organization: Stanford University, Stanford, California, USA – sequence: 20 givenname: Michael surname: Jaung fullname: Jaung, Michael organization: Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA – sequence: 21 givenname: Brandon surname: Chaffay fullname: Chaffay, Brandon organization: Department of Emergency Medicine, George Washington University, Washington, District of Columbia, USA – sequence: 22 givenname: Nana surname: Sefa fullname: Sefa, Nana organization: Department of Emergency Medicine, Department of Critical Care, Medstar Washington Hospital Center, Washington, District of Columbia, USA – sequence: 23 givenname: Marc LC surname: Yang fullname: Yang, Marc LC organization: Accident and Emergency Medicine, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong – sequence: 24 givenname: P Andrew surname: Stephens fullname: Stephens, P Andrew organization: Department of Emergency Medicine, Intensive Care & Resuscitation, Cleveland Clinic Foundation, Cleveland, Ohio, USA – sequence: 25 givenname: Amir surname: Rashed fullname: Rashed, Amir organization: Albert Einstein College of Medicine, New York, New York, USA – sequence: 26 givenname: Nicole surname: Benzoni fullname: Benzoni, Nicole organization: Critical Care Medicine, Virginia Mason Franciscan Health, Silverdale, Washington, USA – sequence: 27 givenname: Bernadett surname: Velasco fullname: Velasco, Bernadett organization: Department of Emergency Medicine, East Avenue Medical Center, Quezon City, National Capital Region, Philippines – sequence: 28 givenname: Neill KJ surname: Adhikari fullname: Adhikari, Neill KJ organization: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada – sequence: 29 givenname: Teri surname: Reynolds fullname: Reynolds, Teri organization: Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
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Snippet	Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality... BackgroundPrior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of...
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SubjectTerms	Adult Age groups Aged Airway management Child Critical Care Critical Illness Delivery of Health Care Emergency medical care Geriatrics Global health Health care Hospitals Humans Illnesses Income Infant Medical personnel Medical students Nursing Patients Pediatrics Poverty Systematic review Ventilators
Title	Critical care delivery across health care systems in low-income and low-middle-income country settings: A systematic review
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