title: Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study.
abstract: OBJECTIVE
  To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs).
  
  
  METHODS
  An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs.
  
  
  RESULTS
  On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality.
  
  
  CONCLUSIONS
  The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.
authors.affiliation: Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India.
authors.forename: Jigeeshu V
authors.initials: JV
authors.lastname: Divatia
authors.affiliation: Department of Medicine and Critical Care, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
authors.forename: Pravin R
authors.initials: PR
authors.lastname: Amin
authors.affiliation: Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Ramakrishnan
authors.affiliation: Department of Medicine and Critical Care, P D Hinduja National Hospital, Mumbai, India.
authors.forename: Farhad N
authors.initials: FN
authors.lastname: Kapadia
authors.affiliation: Department of Critical Care Medicine, AMRI Hospitals Dhakuria, Kolkata, West Bengal, India.
authors.forename: Subhash
authors.initials: S
authors.lastname: Todi
authors.affiliation: Department of Critical Care and Pulmonology, AMRI Hospitals, Bhubaneswar, Odisha, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Sahu
authors.affiliation: Institute of Anesthesia and Critical Care, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Govil
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chawla
authors.affiliation: Division of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India.
authors.forename: Atul P
authors.initials: AP
authors.lastname: Kulkarni
authors.affiliation: Department of Critical Care Medicine, Century Super Speciality Hospital, Banjara Hills, Hyderabad, Telangana, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Samavedam
authors.affiliation: Department of Critical Care Medicine, Saifee Hospital, Mumbai, India.
authors.forename: Charu K
authors.initials: CK
authors.lastname: Jani
authors.affiliation: Department of Critical Care Medicine, Jeevan Rekha Critical Care and Trauma Hospital, Jaipur, Rajasthan, India.
authors.forename: Narendra
authors.initials: N
authors.lastname: Rungta
authors.affiliation: Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India.
authors.forename: Devi Prasad
authors.initials: DP
authors.lastname: Samaddar
authors.affiliation: Department of Medicine and Critical Care, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Venkataraman
authors.affiliation: Department of Medicine and Critical Care, P D Hinduja National Hospital, Mumbai, India.
authors.forename: Ashit
authors.initials: A
authors.lastname: Hegde
authors.affiliation: Department of Critical Care, KEM Hospital, Pune, Maharashtra, India.
authors.forename: B D
authors.initials: BD
authors.lastname: Bande
authors.affiliation: Department of Critical Care Medicine, Greater Kailash Hospital, Indore, Madhya Pradesh, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dhanuka
authors.affiliation: Department of Pulmonology, Asthma Bhawan, Jaipur, Rajasthan, India.
authors.forename: Virendra
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Critical Care Medicine, Artemis Health Institute, Gurgaon, Haryana, India.
authors.forename: Reshma
authors.initials: R
authors.lastname: Tewari
authors.affiliation: Department of Critical Care Medicine, Ruby Hall Clinic, Pune, Maharashtra, India.
authors.forename: Kapil
authors.initials: K
authors.lastname: Zirpe
authors.affiliation: Department of Critical Care Medicine, Ruby Hall Clinic, Pune, Maharashtra, India.
authors.forename: Prachee
authors.initials: P
authors.lastname: Sathe
keywords: Adult; India; case-mix; intensive care; practice