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

Autor:	Bartlett ES; Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA., Lim A; Section of Critical Care Medicine, Virginia Mason Franciscan Health, Seattle, Washington, USA., Kivlehan S; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Harvard Humanitarian Initiative, Cambridge, Massachuesetts, USA., Losonczy LI; Department of Emergency Medicine, Department of Anaesthesia and Critical Care Medicine, George Washington University Medical Center, Washington, District of Columbia, USA., Murthy S; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada., Lowsby R; Department of Critical Care Medicine, Department of Emergency Medicine, Mid Cheshire Hospitals National health Service Foundation Trust, Cheshire, UK., Papali A; Pulmonary and Critical Care Medicine, Atrium Health, Pineville, North Carolina, USA., Raees M; Division of Critical Care Medicine, Department of Anaesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Seth B; Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA., Cobb N; Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA., Brotherton J; Department of Internal Medicine and Paediatrics, Africa Inland Church Kijabe Hospital, Kijabe Kenya.; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Dippenaar E; University of Cape Town, Cape Town, South Africa., Nepal G; Ministry of Health and Population, Kathmandu, Nepal., Shrestha GS; Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal., Kuo SE; The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA., Skrabal JR; Department of Emergency Medicine, George Washington University, Washington, District of Columbia, USA., Davis M; Department of Emergency Medicine, University of Washington, Seattle, Washington, USA., Lay C; Department of Neurosurgery, Department of Emergency Medicine, The Mount Sinai Hospital, New York, New York, USA., Yi S; Stanford University, Stanford, California, USA., Jaung M; Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA., Chaffay B; Department of Emergency Medicine, George Washington University, Washington, District of Columbia, USA., Sefa N; Department of Emergency Medicine, Department of Critical Care, Medstar Washington Hospital Center, Washington, District of Columbia, USA., Yang ML; Accident and Emergency Medicine, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong., Stephens PA; Department of Emergency Medicine, Intensive Care & Resuscitation, Cleveland Clinic Foundation, Cleveland, Ohio, USA., Rashed A; Albert Einstein College of Medicine, New York, New York, USA., Benzoni N; Critical Care Medicine, Virginia Mason Franciscan Health, Silverdale, Washington, USA., Velasco B; Department of Emergency Medicine, East Avenue Medical Center, Quezon City, National Capital Region, Philippines., Adhikari NK; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada., Reynolds T; Department of Integrated Health Services, World Health Organization, Geneva, Switzerland.
Jazyk:	angličtina
Zdroj:	Journal of global health [J Glob Health] 2023 Dec 01; Vol. 13, pp. 04141. Date of Electronic Publication: 2023 Dec 01.
DOI:	10.7189/jogh.13.04141
Abstrakt:	Background: 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. Methods: 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. Results: 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%). Conclusions: 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. Registration: PROSPERO CRD42019146802. Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare the following activities and relationships: NA has served as a consultant to the World Health Organization (WHO) regarding guidelines for COVID-19 and serves as a member of a WHO Technical Advisory Group for Integrated Clinical Care. NC reports receipt of the United States National Heart, Lung, and Blood Institute training grant: T32HL007287. ED serves as the director of the Emergency Care Society of South Africa. SK has received grants or contracts from the WHO for work as a consultant to the WHO Clinical Services and Systems Program, from International Medical Corps as a program lead for trauma care training in Ukraine and from CARE as a program lead to provide emergency care training in India as well as payments for travel and presentations at the annual conference of the American College of Emergency Physicians. He also holds unpaid positions as a member of the editorial advisory board of EMS World, president of the Global Emergency Medicine Academy of the Society for Academic Emergency Medicine and as the standards lead for the Critical Care in Emergency Medicine Interest Group of the International Federation for Emergency Medicine. CL reports royalties from UptoDate.com for an article on management of respiratory failure in patients with elevated ICP and payment for legal review from Dansker and Aspromonte Associates, James Newman P.C. and McEldrew Purtell Law Associates, and support from the Mount Sinai Institute of Critical Care Medicine for travel. SM reports receipt of grants from the Canadian Institutes of Health Research. MR has received the McGrevin Post-Doctoral Grant to fund an educational project in Malawi. (Copyright © 2023 by the Journal of Global Health. All rights reserved.)
Databáze:	MEDLINE
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