Critical care service delivery across healthcare systems in low-income and low-middle-income countries: protocol for a systematic review

Andrew George Lim; Sean Kivlehan; Lia Ilona Losonczy; Srinivas Murthy; Enrico Dippenaar; Richard Lowsby; Marc Li Chuan L C Yang; Michael S Jaung; P Andrew Stephens; Nicole Benzoni; Nana Sefa; Emily Suzanne Bartlett; Brandon Alexander Chaffay; Naeha Haridasa; Bernadett Pua Velasco; Sojung Yi; Caitlin A Contag; Amir Lotfy Rashed; Patrick McCarville; Paul D Sonenthal; Nebiyu Shukur; Abdelouahab Bellou; Carl Mickman; Adhiti Ghatak-Roy; Allison Ferreira; Neill Kj Adhikari; Teri Reynolds

doi:10.1136/bmjopen-2020-048423

Critical care service delivery across healthcare systems in low-income and low-middle-income countries: protocol for a systematic review

BMJ Open. 2021 Aug 30;11(8):e048423. doi: 10.1136/bmjopen-2020-048423.

Authors

Andrew George Lim^{1

2}, Sean Kivlehan^{3

4}, Lia Ilona Losonczy⁵, Srinivas Murthy⁶, Enrico Dippenaar⁷, Richard Lowsby⁸, Marc Li Chuan L C Yang⁹, Michael S Jaung¹⁰, P Andrew Stephens¹¹, Nicole Benzoni¹², Nana Sefa¹³, Emily Suzanne Bartlett¹⁴, Brandon Alexander Chaffay¹⁵, Naeha Haridasa¹⁶, Bernadett Pua Velasco¹⁷, Sojung Yi¹⁸, Caitlin A Contag¹⁹, Amir Lotfy Rashed²⁰, Patrick McCarville¹⁵, Paul D Sonenthal^{21

22}, Nebiyu Shukur¹⁵, Abdelouahab Bellou²³, Carl Mickman²⁴, Adhiti Ghatak-Roy²⁵, Allison Ferreira²⁶, Neill Kj Adhikari^#²⁷, Teri Reynolds^#²⁸

Affiliations

¹ Section of Critical Care Medicine, Virginia Mason Medical Center, Seattle, Washington, USA [email protected].
² Division of Critical Care Medicine, Stanford University, Stanford, California, USA.
³ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴ Department of Emergency Medicine, Harvard University, Cambridge, Massachusetts, USA.
⁵ Department of Emergency Medicine, Department of Anaesthesia & Critical Care Medicine, The George Washington University Medical Center, Washington, District of Columbia, USA.
⁶ Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
⁷ Emergency Medicine Research Group, Anglia Ruskin University, Chelmsford, Essex, UK.
⁸ Department of Critical Care Medicine, Department of Emergency Medicine, Mid Cheshire Hospitals NHS Foundation Trust, Cheshire, Cheshire, UK.
⁹ Accident and Emergency Medicine, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong.
¹⁰ Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
¹¹ Department of Emergency Medicine, Intensive Care & Resuscitation, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
¹² Division of Pulmonary & Critical Care Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.
¹³ Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
¹⁴ Department of Emergency Medicine, University of Washington, Seattle, Washington, USA.
¹⁵ Department of Emergency Medicine, The George Washington University Hospital, Washington, District of Columbia, USA.
¹⁶ The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
¹⁷ Department of Emergency Medicine, East Avenue Medical Center, Quezon City, National Capital Region, Philippines.
¹⁸ Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA.
¹⁹ Department of Medicine, Stanford University, Palo Alto, California, USA.
²⁰ Department of Emergency Medicine, Jacobi Medical Center, Bronx, New York, USA.
²¹ Division of Pulmonary & Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²² Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
²³ Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
²⁴ Department of Emergency Medicine, Mount Sinai Hospital, New York, New York, USA.
²⁵ Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
²⁶ Department of Emergency Medicine, University of California Los Angeles, Los Angeles, California, USA.
²⁷ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
²⁸ World Health Organization, Geneva, GE, Switzerland.

^# Contributed equally.

Abstract

Introduction: Critical care in low-income and low-middle income countries (LLMICs) is an underdeveloped component of the healthcare system. Given the increasing growth in demand for critical care services in LLMICs, understanding the current capacity to provide critical care is imperative to inform policy on service expansion. Thus, our aim is to describe the provision of critical care in LLMICs with respect to patients, providers, location of care and services and interventions delivered.

Methods and analysis: We will search PubMed/MEDLINE, Web of Science and EMBASE for full-text original research articles available in English describing critical care services that specify the location of service delivery and describe patients and interventions. We will restrict our review to populations from LLMICs (using 2016 World Bank classifications) and published from 1 January 2008 to 1 January 2020. Two-reviewer agreement will be required for both title/abstract and full text review stages, and rate of agreement will be calculated for each stage. We will extract data regarding the location of critical care service delivery, the training of the healthcare professionals providing services, and the illnesses treated according to classification by the WHO Universal Health Coverage Compendium.

Ethics and dissemination: Reviewed and exempted by the Stanford University Office for Human Subjects Research and IRB on 20 May 2020. The results of this review will be disseminated through scholarly publication and presentation at regional and international conferences. This review is designed to inform broader WHO, International Federation for Emergency Medicine and partner efforts to strengthen critical care globally.

Prospero registration number: CRD42019146802.

Keywords: accident & emergency medicine; adult intensive & critical care; international health services; neonatal intensive & critical care; organisation of health services; paediatric intensive & critical care.

MeSH terms

Critical Care
Delivery of Health Care*
Developing Countries*
Humans
Poverty
Review Literature as Topic

Grants and funding

001/WHO_/World Health Organization/International