title: A survey on critical care resources and practices in low- and middle-income countries.
abstract: BACKGROUND
  Timely and appropriate care is the key to achieving good outcomes in acutely ill patients, but the effectiveness of critical care may be limited in resource-limited settings.
  
  
  OBJECTIVE
  This study sought to understand how to implement best practices in intensive care units (ICU) in low- and middle-income countries (LMIC) and to develop a point-of-care training and decision-support tool.
  
  
  METHODS
  An internationally representative group of clinicians performed a 22-item capacity-and-needs assessment survey in a convenience sample of 13 ICU in Eastern Europe (4), Asia (4), Latin America (3), and Africa (2), between April and July 2012. Two ICU were from low-income, 2 from low-middle-income, and 9 from upper-middle-income countries. Clinician respondents were asked about bed capacity, patient characteristics, human resources, available medications and equipment, access to education, and processes of care.
  
  
  RESULTS
  Thirteen clinicians from each of 13 hospitals (1 per ICU) responded. Surveyed hospitals had median of 560 (interquartile range [IQR]: 232, 1,200) beds. ICU had a median of 9 (IQR: 7, 12) beds and treated 40 (IQR: 20, 67) patients per month. Many ICU had ≥ 1 staff member with some formal critical care training (n = 9, 69%) or who completed Fundamental Critical Care Support (n = 7, 54%) or Advanced Cardiac Life Support (n = 9, 69%) courses. Only 2 ICU (15%) used any kind of checklists for acute resuscitation. Ten (77%) ICU listed lack of trained staff as the most important barrier to improving the care and outcomes of critically ill patients.
  
  
  CONCLUSIONS
  In a convenience sample of 13 ICU from LMIC, specialty-trained staff and standardized processes of care such as checklists are frequently lacking. ICU needs-assessment evaluations should be expanded in LMIC as a global priority, with the goal of creating and evaluating context-appropriate checklists for ICU best practices.
authors: Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia. Electronic address: kojicic.marija@gmail.com.
authors: Marija
authors: M
authors: Vukoja
authors: Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors: Elisabeth
authors: E
authors: Riviello
authors: Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
authors: Srdjan
authors: S
authors: Gavrilovic
authors: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
authors: Neill K J
authors: NK
authors: Adhikari
authors: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Rahul
authors: R
authors: Kashyap
authors: Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
authors: Satish
authors: S
authors: Bhagwanjee
authors: Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Ognjen
authors: O
authors: Gajic
authors: Department of Anesthesiology and Reanimation, Gulhane Military Medical Faculty, Ankara, Turkey.
authors: Oguz
authors: O
authors: Kilickaya
mesh_terms: D003422:Critical Care; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006295:Health Resources; D006801:Humans; D007182:Income; D007362:Intensive Care Units; D011203:Poverty; D010818:Practice Patterns, Physicians'