Latif Asad, Atiq Huba, Zaki Mareeha, Hussain Syeda A, Ghayas Ammarah, Shafiq Omer, Daudpota Ali A, Abbas Qalab, Ariff Shabina, Asghar Muhammad A, Khan Muhammad F, Khan Muhammad H, Rashid Naveed, Sabeen Amber, Sohaib Muhammad, Ullah Hameed, Munir Tahir, Hassan Mohammad M, Sami Kiran, Amin Syed K, Samad Zainab, Haider Adil
Department of Anaesthesiology, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi74800, Pakistan.
Dean's Office, Medical College, Aga Khan University, Karachi, Pakistan.
Bull World Health Organ. 2025 Feb 1;103(2):90-98. doi: 10.2471/BLT.23.290926. Epub 2024 Dec 4.
To develop a tele-intensive care service providing peer-to-peer teleconsultation for physicians in remote and resource-constrained health-care settings for treatment of critically ill patients, and to evaluate the outcomes of the service.
The Aga Khan University started the coronavirus disease 2019 (COVID-19) tele-intensive care unit in 2020. A central command centre used two-way audiovisual technology to connect experienced intensive care specialists to clinical teams in remote hospital settings. The service, always available, used messaging applications and telephone calls. Coverage was later extended to other medical, neonatal, paediatric and surgical patients requiring critical care.
Between June 2020 and December 2023, the service provided 6014 teleconsultations to manage 1907 patients in 109 medical facilities, mostly in Pakistan and also Afghanistan, Kenya and United Republic of Tanzania. Of the 1907 patients, 652 (34.4%) had COVID-19 and 1244 (65.6%) had other illnesses. The mean duration of teleconsultations was 14.5 min. Of 581 patients for whom outcome data were available, 204 (35.1%) died. Multivariate multinomial logistic regression showed the odds of death decreased with increased number of consultations (> 3) per patient (adjusted odds ratio (aOR): 0.28; 95% confidence interval, CI: 0.16-0.48), and increased number of recommendations (≥ 5) per consultation (aOR: 3.09; 95% CI: 1.08-8.84).
Our tele-intensive care service helped manage critically ill patients in regions where intensive care had not previously been available. While research on the clinical impact of this model is needed, decision-makers should consider its use to increase provision of critical care in remote and resource-constrained health-care settings.
开发一种远程重症监护服务，为偏远及资源有限的医疗环境中的医生提供点对点远程会诊，以治疗重症患者，并评估该服务的效果。
阿迦汗大学于2020年启动了2019冠状病毒病（COVID-19）远程重症监护病房。一个中央指挥中心利用双向视听技术，将经验丰富的重症监护专家与偏远医院的临床团队连接起来。该服务随时可用，使用信息应用程序和电话。后来，服务范围扩大到其他需要重症监护的内科、新生儿、儿科和外科患者。
在2020年6月至2023年12月期间，该服务提供了6014次远程会诊，为109个医疗机构的1907名患者提供管理，这些医疗机构大多位于巴基斯坦，也包括阿富汗、肯尼亚和坦桑尼亚联合共和国。在这1907名患者中，652名（34.4%）患有COVID-19，1244名（65.6%）患有其他疾病。远程会诊的平均时长为14.5分钟。在有结局数据的581名患者中，204名（35.1%）死亡。多变量多项逻辑回归显示，每位患者会诊次数增加（>3次），死亡几率降低（调整优势比（aOR）：0.28；95%置信区间，CI：0.16 - 0.48），每次会诊建议数量增加（≥5条），死亡几率增加（aOR：3.09；95%CI：1.08 - 8.84）。
我们的远程重症监护服务有助于在以前没有重症监护服务的地区管理重症患者。虽然需要对该模式的临床影响进行研究，但决策者应考虑采用该服务，以增加偏远及资源有限的医疗环境中重症监护服务的提供。
