Aim: To investigate critical care resourcing and the clinical management of sepsis in lower-middle income, upper-middle income and high income countries across the Asia Pacific region.
Background: Sepsis is a time-critical complex condition that requires evidence-based care delivered by appropriate levels of well trained, qualified and experienced staff supported by proactive organisational and quality processes, sophisticated technologies and reliable infrastructure. In 2017, the estimated sepsis incidence in the Asia Pacific region ranged from 120 to 200 per 100,000 population in Australia and New Zealand to 2500 to 3400 per 100,000 population in India. Currently, there is limited information on the organisational structures, human resources, clinical standards, laboratory support and the therapeutic options available in the Asia Pacific region to treat sepsis.
Method: Prospective electronic survey.
Results: Representatives of 59 hospitals from 15 countries responded. Provision of critical care and the management of sepsis varied considerably between lower-middle income, upper-middle income and high income countries. Specific differences include nurse to patient ratios and availability of allied health services.
Conventional organ support modalities such as mechanical ventilation and non-invasive ventilation were commonly available. Even advanced life support like extracorporeal membrane oxygenation was available in at least 60% of surveyed ICUs. However, in contrast, essential monitoring devices including EtCO2 were not universally available.
Lower-middle income countries had considerably lower provisions for isolation and surge capacity to support pandemic and disaster management, though basic personal protective equipment was widely available.
A majority of ICUs used the Surviving Sepsis Campaign guidelines or the adapted version for lower-middle income countries, though only 21% of ICUs in lower-middle income countries used the adapted version. While essential antimicrobials were accessible across most ICUs, availability of reserve antibiotics was limited.
Conclusion: The disparities identified in this survey inform healthcare workers and health services, policy makers and governments on the priorities for action to improve the delivery of critical care and sepsis outcomes in this region.
Keywords: critical care, disaster, resources, sepsis
PNS23 Setting Health Priorities in Low-Income and Middle-Income Countries in the ASIA-Pacific Region: The Case of Papua New Guinea
