The practice of intensive care in Latin America: a survey of academic intensivists

Critical Care. 2018;22(1):1-11 DOI 10.1186/s13054-018-1956-6

 

Journal Homepage

Journal Title: Critical Care

ISSN: 1364-8535 (Print); 1466-609X (Online)

Publisher: BMC

LCC Subject Category: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS


Ricardo Castro (Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Catolica de Chile)

Nicolas Nin (Hospital Español)

Fernando Ríos (Servicio de Terapia Intensiva. Hospital Alejandro Posadas)

Leyla Alegría (Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Catolica de Chile)

Elisa Estenssoro (Servicio de Terapia Intensiva, Hospital Interzonal de Agudos General San Martin de La Plata)

Gastón Murias (Clinica Bazterrica and Clinica Santa Isabel, Billinghurst 2072 (esquina Juncal))

Gilberto Friedman (Departamento de Medicina Interna - Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre)

Manuel Jibaja (Escuela de Medicina, Universidad Internacional del Ecuador, Unidad de Cuidados Intensivos, Hospital Eugenio Espejo)

Gustavo Ospina-Tascon (Department of Intensive Care Medicine, Fundación Valle del Lili - Universidad ICESI, Cali)

Javier Hurtado (Hospital Español)

María del Carmen Marín (Unidad de Cuidados Intensivos, Hospital Regional 1 Octubre, ISSSTE)

Flavia R. Machado (Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo)

Alexandre Biasi Cavalcanti (Research Institute HCor, Hospital do Coração)

Arnaldo Dubin (Catedra de Farmacología, Facultad de Ciencias Médicas, Universidad Nacional de La Plata)

Luciano Azevedo (Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo)

Maurizio Cecconi (St. George’s University Hospitals NHS Foundation Trust)

Jan Bakker (Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center)

Glenn Hernandez (Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Catolica de Chile)

On behalf of the Latin-American Intensive Care Network - LIVEN (www.redliven.org)

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 14 weeks

 

Abstract | Full Text

Abstract Background Intensive care medicine is a relatively young discipline that has rapidly grown into a full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, life-threatening diseases. Several factors may influence their performance, including age, training, experience, workload, and socioeconomic context. The aim of this study was to examine individual- and work-related aspects of the Latin American intensivist workforce, mainly with academic appointments, which might influence the quality of care provided. In consequence, we conducted a cross-sectional study of intensivists at public and private academic and nonacademic Latin American intensive care units (ICUs) through a web-based electronic survey submitted by email. Questions about personal aspects, work-related topics, and general clinical workflow were incorporated. Results Our study comprised 735 survey respondents (53% return rate) with the following country-specific breakdown: Brazil (29%); Argentina (19%); Chile (17%); Uruguay (12%); Ecuador (9%); Mexico (7%); Colombia (5%); and Bolivia, Peru, Guatemala, and Paraguay combined (2%). Latin American intensivists were predominantly male (68%) young adults (median age, 40 [IQR, 35–48] years) with a median clinical ICU experience of 10 (IQR, 5–20) years. The median weekly workload was 60 (IQR, 47–70) h. ICU formal training was between 2 and 4 years. Only 63% of academic ICUs performed multidisciplinary rounds. Most intensivists (85%) reported adequate conditions to manage patients with septic shock in their units. Unsatisfactory conditions were attributed to insufficient technology (11%), laboratory support (5%), imaging resources (5%), and drug shortages (5%). Seventy percent of intensivists participated in research, and 54% read scientific studies regularly, whereas 32% read no more than one scientific study per month. Research grants and pharmaceutical sponsorship are unusual funding sources in Latin America. Although Latin American intensivists are mostly unsatisfied with their income (81%), only a minority (27%) considered changing to another specialty before retirement. Conclusions Latin American intensivists constitute a predominantly young adult workforce, mostly formally trained, have a high workload, and most are interested in research. They are under important limitations owing to resource constraints and overt dissatisfaction. Latin America may be representative of other world areas with similar challenges for intensivists. Specific initiatives aimed at addressing these situations need to be devised to improve the quality of critical care delivery in Latin America.