https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/212 Sun, 07 May 2017 12:35:21 +0000 In general it is the most expensive, technologically advanced and resource intensive area of medical care. In the year 2000 in USA, the estimated expenditure for critical care medicine was arround $ 55 billion accounting for 0.5% of GDP and 13% of national health care expenditure.2 For Bangladesh we have no statistics to assess the share of critical care services in the overall health care cost of our country. The first ICU in Bangladesh was established in 1980 at National Institute of Cardiovascular Disease (NICVD). A study4 conducted in 2007 by the Department of CCM, BIRDEM General Hospital found total number of ICU beds to be 424 in 40 ICUs of Bangladesh, of which 80% were located in the city of Dhaka. 68% of ICUs were run by anesthesiologists who lacked proper training & qualifications in CCM. Only 15% ICUs were run by primary care Intensivists in the set up of closed ICUs as opposed to open ICUs which were more common. Several earlier studies5-6 showed that care provided by Intensivists in the set up of closed ICUs provided better outcomes and were more cost effective. In North America, CCM and in Europe, Intensive Care Medicine have been recognized as independent speciality over last 3-4 decades. In Bangladesh although relatively new, CCM is now being increasingly recognised as an important medical speciality. The first postgraduate MD course in CCM was introduced in 2007 by the University of Dhaka. Departments of CCM, BIRDEM General Hospital and Dhaka Medical College Hospital offer the same course and both the institutions together admit only 14 postgraduate students per year. But Bangladesh should by now have at least 600 postgraduate qualified Intensivists or critical care medicine specialists and atleast 5000 allocated ICU beds,7 for a total of 75000 general hospital beds.8 The other issue is the rapidly growing but poorly managed private ICUs rendering unethical standards of care. This has resulted in inappropriately high cost, increased mortality and poor outcomes of critically ill patients. Bangladesh Medical & Dental Council (BM&DC) in spite of its limitation of manpower should play a major role in enforcing operational registration for all these ICUs.   Mohammad Omar Faruq Ibrahim Medical College & BIRDEM General Hospital   1.   Ewart GW, Marcus L, Gaba MM et al. The critical 2.   Halpern NA, Pastores SM, Guerenstein RJ. Critical Care Medicine in USA 1985-2000, an analysis of bed numbers, use and costs. Critical Care Medicine 2004; 32(6): 1254-1259. 4.   Faruq MO, Ahsan ASMA, Fatema K, Ahmed F et al. An audit of Intensive Care Services in Bangladesh. Ibrahim Medical College Journal 2010; 4(1): 13-16. 6.   Hanson CW 3rd, Deutschman CS, Anderson Hl 3rd et al. Effects of an organized critical care service on outcomes and resource utilization: a cohort study. Critical Care Medicine 1999; 27(2): 270-4. 8.   Bangladesh Bureau of Statistics. Statistical pocket book of Bangladesh 2009; 2010: p 375. 2026 Ibrahim Medical College. All rights reserved.