https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/182 Tue, 11 Apr 2017 16:21:02 +0000 This study was conducted to survey the facilities, bed strength, functional characteristics, manpower, operational practices and distribution of intensive care units in Bangladesh. Direct interview of consultants in charge of different Intensive Care Units (ICUs) in the city of Dhaka was conducted by a structured questionnaire. All Adult Intensive Care Units (ICUs) and Coronary Care Units (CCUs) with ventilator support in the city of Dhaka belonging to government and private sectors were included. Our survey showed that 90% of all Intensive Care Units in Bangladesh were located in the city of Dhaka. There were 40 Intensive Care Units in the city of Dhaka, of which 33 were ICUs and 7 CCUs with ventilator support (also considered as ICU). Only 4 (10%) ICUs were located in government hospitals. Rest of the ICUs was in private hospitals / clinics. Total number of ICU beds was 424 and total numbers of beds in these hospitals were 8824. So 4.8% of total hospital beds were provisioned for critical care. Among these only 240 beds (60%) had ventilator support. 27(68%) of the 40 ICUs were multidisciplinary, 7(18%) CCUs, 5(12%) cardiac surgery and 1(2%) neurology. 64% ICUs were run by anesthesiologists. 85% facilities were open units as opposed to 15% closed units. Nurse: bed ratio of 1:1 was seen in 15(42%) facilities. On duty doctor: patient ratio was variable and highest was 1:4 in 9 ICUs (27 %). ICUs in Bangladesh are mainly situated in the city of Dhaka and mostly in the private sector. The standards and management strategies vary greatly. Address for Correspondence: Mohammad Omar Faruq, Professor & Head of the Dept. of Critical Care Medicine, Room # 452(ICU), BIRDEM Hospital, Shahbagh, Dhaka,, Phone: 880-2-9661551-60/Ext 2399(Office), 01674999897(Cell), Fax: 880-2-9667812, E-mail: faruqmo@yahoo.com   Critical care medicine is the direct delivery of medical care by a physician to a critically ill or critically injured patient. Critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition. Care of these patients can take place anywhere in the inpatient hospital setting, although it typically occurs in the ICU. Critical care involves highly complex decision making to assess, manipulate, and support vital system functions, to treat single or multiple vital organ system failure, and/or to prevent further life-threatening deterioration of the patient’s condition.1 Intensive care is a known but neglected concept in Bangladesh. The first ICU in Bangladesh was established in the National Institute of Cardiovascular Diseases (NICVD) in 1980. Since then many ICUs have emerged. In Bangladesh there is no governing body like Bangladesh Medical and Dental Council (BMDC) that can scrutinize standards of such units. And there are no statistics regarding the number, bed strength, facilities, strength of medical and nursing staffs, and cost benefits of these ICUs, so that relevant recommendation regarding quality of management can be made. The objective of our study was to have an overall idea of intensive care facilities in Bangladesh. Methodology We prepared a structured questionnaire and visited the units. Then consultants in-charge of each ICU were interviewed except for 2 ICUs where we obtained information from the senior medical officers.   The first ICU in Bangladesh was established in 1980 at the National Institute of Cardiovascular Diseases (NICVD). Since then the number of ICUs have grown steadily but mostly in the city of Dhaka which is the capital (Fig 1). A total of 44 ICUs were identified in the country. Among them, 40 ICUs were situated in Dhaka city, remaining 4 ICUs were located in other districts of Bangladesh. Of the 40 ICUs of Dhaka, 7 were CCUs with ventilator support, 36 ICUs (90%) were in private hospitals, rest in government hospitals. Total beds in these study hospitals were 8828 and total number of ICU beds was 424 (4.8%). In 1980, there were only 28 ICU beds in Dhaka city. Since then the number of ICU beds have gradually increased (Fig 2).     Fig-2: Trend of number ICU beds in city of Dhaka Of all the hospitals studied, 25% hospitals had ³10% beds, and 27.5% hospitals had 5-9% beds dedicated to ICU. Total number of ventilators were 240 in 40 ICUs (i.e. 56.6% ICU beds had accompanying ventilators). 25% ICUs had a ventilator: bed ratio of 1:1. 6 (15%) ICUs were closed ICUs and 34 (85%) were open units. 9 facilities (27%) had on duty doctor: patient ratio of 1: 4. In 8 ICUs (24%), on duty doctor: patient ratio was 1:5. Only 4 ICU (12%) had ratio of 1:3. A nurse: bed ratio of 1:1 was seen in 15 (42%) units. 51% ICU doctors at 27 ICUs and 36% ICU nurses at 32 ICUs were cardio pulmonary resuscitation (CPR) trained. The remaining ICUs failed to furnish the information regarding CPR training of their duty doctors and nurses. Among supporting facilities, 19 hospitals had high dependency unit (HDU) support, 10 hospitals had dialysis units and 3 hospitals had CRRT (continuous renal replacement therapy) facilities and only one hospital had bed side routine hemodialysis facility. Population of Dhaka City Corporation is 5333571.4 So there was one ICU bed for aprox. 12579 residents of city of Dhaka. Discussion No ICU existed in Bangladesh before its independence in 1971 and in 1980 the first ICU was established. Since then the number of ICUs has been increasing steadily but almost all are concentrated in Dhaka city. Among all the ICUs, 90 % are in private sector. This is a major drawback in providing critical care facilities to the mass population as majority of them cannot afford the cost of private hospitals. As most of the ICUs are located in the city of Dhaka, this causes great difficulties in transporting patients from the peripheries of the country to the capital. 68% ICUs in Bangladesh provide mixed services, managing medical, surgical. gynecological and obstetrics patients. It is recommended that 25% of senior nursing staff should hold a formal qualification related to intensive care,7 and mandatory training of basic life support (BLS) is an important requirements for all critical care nurses.8 In our country there is no formal training in critical care nursing and according to our study only 36% nurses had BLS or CPR training.   Through this survey an attempt was made to assess the facilities, bed strength, spectrum of management, clinical skills available in the field of Intensive care in Bangladesh and areas where improvements need to be stressed. 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