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The large global burden of critical illness is particularly felt by the 84% of the world’s population that lives in low- or middle-income countries (LMICs). Limited intensive care unit (ICU) capacity puts critically ill patients in LMICs at serious risk. Quality ICU care should be an affordable global goal.

© MORU 2019, Nicky Almasy
Summary of published results showing the improved performance and reduction in mortality of a large ICU training effort by the MORU ICU team in India, Bangladesh and Nepal.

 Achieving quality intensive care unit in resource-limited settings requires:

  • Quality ICUs in public hospitals
  • Subsidised/ social health insurance schemes
  • Assessment of drivers of ICU performance, quality improvement projects and training
  • Adaptation of guidelines from high-income setting
  • Research: low cost tools, setting/ disease specific interventions

The Malaria & Critical Illness Department’s work on critical illness includes the development and roll out of an electronic intensive care unit (ICU) registry as a starting point for quality improvement projects aiming to improve patient outcomes. This has been piloted successfully in Sri Lanka and Pakistan. We now plan to establish a large Asian ICU network with the aim to expand implementation of the registry and quality improvement activities, and to test new interventions.

The department has set up and is running in Lao PDR and Sri Lanka studies on improving ICU training in low and middle-income countries (LMICs).

Sepsis guidelines from high-income settings are often not applicable to resource-limited settings because of differences in human and material resources and causes of sepsis. To address this, Arjen Dondorp, Head of Malaria and Critical Illness (MORU), coordinated with honorary MORU member Marcus Schultz, Professor of Intensive Care Medicine in Amsterdam, and Martin Dünser, an intensivist from Austria, to publish Sepsis Management in Resource-limited Settings, which critically evaluates the “surviving sepsis campaign” guidelines and adapts these for hospitals in resource-limited settings with constraints in human and material resources and examines the different causes of sepsis in the tropical world.

With support from Wellcome, Malaria & Critical Illness plans include:

  • Understanding the contributors to intensive care performance in LMICs
  • Developing sustainable training models to improve ICU care in LMICs
  • Developing and implementing setting adapted ICU registries in LMICs
  • The role of lung ultrasound in ICU in LMICs
  • Probiotics to prevent ventilator associated pneumonia in LMICs
  • Optimising mechanical ventilation strategies in LMICs
  • Translating ICU guidelines developed in HIC to LMIC settings