Studying current status of intensive care services in Sri Lanka.

OBJECTIVE

To describe intensive care unit (ICU) facilities in Sri Lanka; to describe the pattern of admissions, case-mix and mortality; compare patient outcome against the various types of ICUs; and determine the adequacy and standards of training received by medical and nursing staff.

MATERIALS AND METHODS

Observational study of multidisciplinary (general) and adult speciality ICUs in government sector hospitals.

RESULTS

Hospitals studied had 1 ICU bed per 100 hospital beds. Each bed catered to 70-90 patients over a year. Death rates were comparable in each level of hospital/ICU despite differences in resource allocation. Fifty to 60% of patients had their original problems related to medicine, while only 35% - 45% were surgical. Thirty two percent of medical patients and 15% of surgical patients died. More than 90% of ICUs had a multi-monitor for each bed. Seventy seven percent of ICUs had one or more ventilators for each bed. Arterial blood gas (ABG) facilities were available in 83% of ICUs. There were serious inadequacies in the availability of facilities of 24 hour physiotherapy (available only in 36.7%), 24 hour in hospital Ultra Sonography (22.4%), electrolyte analyser in ICU (54.2%), haemodialysis / continuous renal replacement therapy (HD/CRRT) (41.7%), and Echocardiography. Medical Officers' training was anaesthetics dominated as opposed to a multidisciplinary training. There was a severe shortage of critical care trained nurses.

CONCLUSIONS

Only limited evolution has taken place in intensive care over the past 5 years. The reasons for higher death rates in medical patients should be investigated further. Moving towards a multidisciplinary approach for training and provision of care for ICU patients is recommended.