Current Challenges in the Management of Sepsis in ICUs in Resource-Poor Settings and Suggestions for the Future
Year: 2019
Type: book-chapter
Abstract: Sepsis is a major cause of critical illness worldwide, especially in resource-poor settings. Intensive care units (ICUs) in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. The aim of this review is to describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics, and research aspects of sepsis. We restricted this manuscript to the ICU setting although we are aware that many sepsis patients in LMICs are treated outside an ICU. Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can be more important than the host response. There are differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in resource-rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and important differences in resources. Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.
Source: Springer eBooks
Authors: Marcus J. Schultz, Martin W. Dünser, Arjen M. Dondorp, Neill K. J. Adhikari, Shivakumar Iyer, Arthur Kwizera, Yoel Lubell, Alfred Papali, Luigi Pisani, Elisabeth D. Riviello, Derek C. Angus, Luciano C. Azevedo, Timothy Baker, Janet V. Diaz, Emir Festic, Rashan Haniffa, Randeep Jawa, Shevin T. Jacob, Niranjan Kissoon, Rakesh Lodha, Ignacio Martin-Loeches, Ganbold Lundeg, David Misango, Mervyn Mer, Sanjib Mohanty, Srinivas Murthy, Ndidiamaka Musa, Jane Nakibuuka, Ary Serpa Neto, NT Hoang Mai, Binh Nguyen Thien, Rajyabardhan Pattnaik, Jason Phua, Jacobus Preller, Pedro Povoa, Suchitra Ranjit, Daniel Talmor, Jonarthan Thevanayagam, C. Louise Thwaites
Institutions: Mahidol University, Johannes Kepler University of Linz, Sunnybrook Health Science Centre, University of Toronto, Bharati Vidyapeeth (Deemed to be University), Mulago Hospital, Amsterdam UMC Location University of Amsterdam, University of Amsterdam, University of Maryland, Baltimore, Beth Israel Deaconess Medical Center, Harvard University, University of Pittsburgh, Hospital Sírio-Libanês, Karolinska Institutet, California Pacific Medical Center, Mayo Clinic in Florida, Stony Brook University Hospital, Liverpool School of Tropical Medicine, BC Children's Hospital, All India Institute of Medical Sciences, St. James's Hospital, Mongolian National University of Medical Sciences, Aga Khan University Hospital Nairobi, Aga Khan University Nairobi, University of the Witwatersrand, Johannesburg Hospital, Ispat General Hospital, Seattle Children's Hospital, University of Washington, Hospital Israelita Albert Einstein, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, National University Hospital, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, University of Lisbon, Centro Hospitalar de Lisboa Ocidental, Universidade Nova de Lisboa, Apollo Hospitals, University of Oxford
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W3009380144