Improving outcomes for the critically ill in developing countries: what is next?

Critical care is a complicated, high risk, resource-dependent environment. Developing countries face common barriers to delivering quality emergent care due to the lack of supplies, coordination, infrastructure, technology, and human resources (e.g., competency-based education, multi-disciplinary staff and access to the most recent literature).(1) More importantly, the capacity to provide care for critically ill patients in intensive care units (ICUs) of low-income countries is unknown. Most developing countries lack published data on ICU capacity.(2) Importantly, a previous observational study aimed to assess the worldwide burden of critical illness, but only an insignificant sample (2 of 730 centers) of ICUs in low-income countries was taken into account.(3) Poor access to material resources and skilled personal pose a significant barrier to care improvement. Indeed, severity-of-illness-adjusted mortality is inversely related to gross national income.(3) Nevertheless, a recent survey performed by the CERTAIN (Checklist for Early Recognition and Treatment of Acute Illness and INjury; www.icertain.org) Investigators network in 15 ICUs from 11 lowand middle-income countries showed that 77% of ICUs singled out lack of protocols and trained staff, which are the most important barriers to improving the care and outcomes of critically ill patients as opposed to cost-dependent variables, such as equipment or supplies.(1) Basic resources, such as standardized supportive care and trained personnel have been cited as instrumental in changing the outcomes for catastrophic/challenging diseases, such as the Ebola virus disease in resource-limited settings.(4)