title: Structure, Organization, and Delivery of Critical Care in Asian ICUs.
abstract: Despite being the epicenter of recent pandemics, little is known about critical care in Asia. Our objective was to describe the structure, organization, and delivery in Asian ICUs.
  
  
  
  A web-based survey with the following domains: hospital organizational characteristics, ICU organizational characteristics, staffing, procedures and therapies available in the ICU and written protocols and policies.
  
  
  
  ICUs from 20 Asian countries from April 2013 to January 2014. Countries were divided into low-, middle-, and high-income based on the 2011 World Bank Classification.
  
  
  
  ICU directors or representatives.
  
  
  
  Of 672 representatives, 335 (50%) responded. The average number of hospital beds was 973 (SE of the mean [SEM], 271) with 9% (SEM, 3%) being ICU beds. In the index ICUs, the average number of beds was 21 (SEM, 3), of single rooms 8 (SEM, 2), of negative-pressure rooms 3 (SEM, 1), and of board-certified intensivists 7 (SEM, 3). Most ICUs (65%) functioned as closed units. The nurse-to-patient ratio was 1:1 or 1:2 in most ICUs (84%). On multivariable analysis, single rooms were less likely in low-income countries (p = 0.01) and nonreferral hospitals (p = 0.01); negative-pressure rooms were less likely in private hospitals (p = 0.03) and low-income countries (p = 0.005); 1:1 nurse-to-patient ratio was lower in private hospitals (p = 0.005); board-certified intensivists were less common in low-income countries (p < 0.0001) and closed ICUs were less likely in private (p = 0.02) and smaller hospitals (p < 0.001).
  
  
  
  This survey highlights considerable variation in critical care structure, organization, and delivery in Asia, which was related to hospital funding source and size, and country income. The lack of single and negative-pressure rooms in many Asian ICUs should be addressed before any future pandemic of severe respiratory illness.
authors.affiliation: 1Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.2Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Singapore.3Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.4Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China.5Department of Critical Care Medicine, Birdem General Hospital, Ibrahim Medical College, Dhaka, Bangladesh.6Emergency and Critical Care Medicine, University of Tokushima Graduate School, Tokushima, Japan.7Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, and Chang Gung University of Science and Technology, Kaohsiung, Taiwan.8Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, Hong Kong, China.9Intensive Care Department, Dubai Hospital, Dubai, United Arab Emirates.10Intensive Care Department, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.11Department of Critical Care Medicine, Sunnybrook Health Science Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.forename: Mohammad Omar
authors.initials: MO
authors.lastname: Faruq
authors.forename: Masaji
authors.initials: M
authors.lastname: Nishimura
authors.forename: Wen-Feng
authors.initials: WF
authors.lastname: Fang
authors.forename: Charles
authors.initials: C
authors.lastname: Gomersall
authors.forename: Hussain N
authors.initials: HN
authors.lastname: Al Rahma
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.forename: Hasan M
authors.initials: HM
authors.lastname: Al-Dorzi
authors.forename: Fahad M
authors.initials: FM
authors.lastname: Al-Hameed
authors.forename: Neill K J
authors.initials: NK
authors.lastname: Adhikari
authors.forename: Musharaf
authors.initials: M
authors.lastname: Sadat
mesh_terms: D001208:Asia; D002985:Clinical Protocols; D003422:Critical Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D006302:Health Services Research; D006742:Hospital Bed Capacity; D007362:Intensive Care Units / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D057766:Policy