A national landscaping survey of critical care services in hospitals accredited for training in a lower-middle income country: Pakistan

Purpose: To describe the extent and variation of critical care services in Pakistan Materials and methods: A cross-sectional survey was conducted in all CCUs recognised for postgraduate training to determine administration, infrastructure, equipment, staffing, and training. Results: There were 220 CCUs registered for training, providing 2166 CCU beds and 1473 ventilators. Regional distribution of CCU beds per 100,000 population ranged from 1.0 in Sindh to none in Gilgit Baltistan (median 0.7). A senior clinician trained in critical care was available in 19 (12.1%) of units, giving a ratio of one trained intensivist for every 82 CCU beds and 0.009 trained intensivists per 100,000 population. One to one nurse to bed ratio during the day was available in 84 (53.5%) of units, dropping to 75 (47.8%) at night. Availability of 1:1 nursing also varied between provinces, ranging from 56.5% in Punjab compared to 0% in Azad Jamu Kashmir. All CCUs had basic infrastructure (electricity, running water, piped oxygen) and basic equipment (electronic monitoring and infusion pumps). Conclusion: Pakistan, a lower middle-income country has an established network of critical care facilities with access to basic equipment, but inequalities in its distribution. Investment in critical care training for doctors and nurses is needed.