Improving ICU Care in Low and Middle Income Countries

Although intensive care units (ICUs) are increasingly available in low- and middle-income countries, case fatality rates remain high. Improving these outcomes will require evaluation of setting-specific factors adversely affecting performance and identification of investments and interventions to address them.

Our aim goes beyond addressing severe malaria only, and concerns all critical illness. We are systematically re-evaluating rich country-developed guidelines that are often not directly translatable to ICUs in resource-poor settings because of limited facilities and different causes of disease.

An important example is adult severe malaria as a cause of sepsis. We identified that following the liberal fluid management recommended for bacterial sepsis is dangerous in adults with severe malaria, and are carrying out research to define the optimal fluid management for these patients. Best practices for mechanical ventilation in these settings are also an important research topic. The Malaria Department has organized ICU training for several countries in the region with the aim to develop scalable and sustainable training programmes.

Through our PhD student Rashan Haniffa, we are involved in developing an ICU registry in Sri Lanka, which can serve as a template for other countries in Asia. The ability to measure ICU performance and changes over time after training or other interventions is crucial for improving care.