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Divatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, Kapadia FN, Sircar M, Sahu S, Bhattacharya PK, Myatra SN, Samavedam S, Dixit S, Pande RK, Mehta SN, Venkataraman R, Bajan K, Kumar V, Harne R, Thakur L, Rathod D, Sathe P, Gurav S, D'Silva C, Pasha SA, Todi SK. Intensive Care in India in 2018-2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021; 25:1093-1107. [PMID: 34916740 PMCID: PMC8645819 DOI: 10.5005/jp-journals-10071-23965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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.
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Affiliation(s)
- Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Yatin Mehta
- Medanta Institute of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Deepak Govil
- Medanta Institute of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Kapil Zirpe
- Neurotrauma and Stroke Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Pravin R Amin
- Department of Critical Care Medicine, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | | | - Farhad N Kapadia
- Department of Intensive Care Medicine, PD Hinduja Hospital and MRC, Mumbai, Maharashtra, India
| | - Mrinal Sircar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Samir Sahu
- Department of Critical Care and Pulmonology, AMRI Hospitals, Bhubaneswar, Odisha, India
| | - Pradip Kumar Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care Medicine, Virinchi Hospital, Hyderabad, Telangana, India
| | - Subhal Dixit
- Department of Critical Care, Sanjeevan Hospital, Pune, Maharashtra, India
| | - Rajesh Kumar Pande
- Department of Critical Care Medicine, BLK Super Speciality Hospital, Delhi, India
| | - Sujata N Mehta
- Department of Medicine and Critical Care, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Ramesh Venkataraman
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Khusrav Bajan
- Department of Intensive Care Medicine, PD Hinduja Hospital and MRC, Mumbai, Maharashtra, India
| | - Vivek Kumar
- Critical Care and Emergency Medical Services, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rahul Harne
- Medanta Institute of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Leelavati Thakur
- Department of Critical Care, IQ City Medical College and Narayana Multispecialty Hospital, Durgapur, West Bengal, India
| | - Darshana Rathod
- Department of Critical Care, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Prachee Sathe
- Department of Critical Care Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sushma Gurav
- Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Carol D'Silva
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Shaik Arif Pasha
- Department of Critical Care Medicine, NRI Medical College, Guntur, Andhra Pradesh, India
| | - Subhash Kumar Todi
- Department of Critical Care Medicine, AMRI Dhakuria Hospital, Kolkata, West Bengal, India
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Agarwal MB, Shah S, Vishwanathan C, Rajadhyaksha G, Bhave AA, Dube SR, Billa V, Malkan G, Bajan K. Thyroid dysfunction in multi-transfused iron loaded thalassemia patients. Indian Pediatr 1992; 29:997-102. [PMID: 1459722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Seventy-two transfusion-dependent iron loaded thalassemia patients were investigated for thyroid dysfunction by estimating circulating thyroid hormones (T4 and T3) and basal thyroid stimulating hormone (TSH). They were also evaluated for their liver function (biochemically) and iron overload by estimating serum ferritin. Thyroid failure (hypothyroidism) was documented in 14 patients (19.4%). In all, 3 groups were seen, i.e. Group 1: Normal T4, T3, TSH (58 patients: 80.6%); Group 2: Compensated hypothyroidism characterized by normal T4, T3 and raised TSH (9 patients: 12.5%); Group 3: Decompensated hypothyroidism characterized by decreased T4 and increased TSH (5 patients: 6.9%). Interestingly, impaired thyroid function could not be correlated with age, amount of blood transfused, liver dysfunction or degree of iron overload. It is postulated that an inter-play between chronic hypoxia, liver dysfunction and iron overload may be responsible for the thyroid damage.
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Affiliation(s)
- M B Agarwal
- Department of Hematology, L.T.M.G. Hospital, Sion, Bombay
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