The inadequacy of intensive care medicine in low-resource settings (LRS) has become significantly more visible after the COVID-19 pandemic. Recommendations for establishing medical critical care are scarce and rarely include expert clinicians from LRS. In December 2023, the National Association of Intensivists from Bosnia and Herzegovina organized a hybrid international conference on the topic of organizational structure of medical critical care in LRS. The conference proceedings and literature review informed expert statements across several domains. Following the conference, the statements were distributed via an online survey to conference participants and their wider professional network using a modified Delphi methodology. An agreement of ≥ 80% was required to reach a consensus on a statement. Out of the 48 invited clinicians, 43 agreed to participate. The study participants came from 20 countries and included clinician representatives from different base specialties and health authorities. After the two rounds, consensus was reached for 13 out of 16 statements across 3 domains: organizational structure, staffing, and education. The participants favored multispecialty medical intensive care units run by a medical team with formal intensive care training. Recognition and support by health care authorities was deemed critical and the panel underscored the important roles of professional organizations, clinician educators trained in high-income countries, and novel technologies such as tele-medicine and tele-education. Delphi process identified a set of consensus-based statements on how to create a sustainable patient-centered medical intensive care in LRS.

中文翻译：

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在资源匮乏地区建立医疗重症监护的共识声明：使用改良德尔菲法的国际研究


在 COVID-19 大流行之后，资源匮乏地区 (LRS) 重症监护医学的不足变得更加明显。建立医疗重症监护的建议很少，而且很少包括来自 LRS 的专家临床医生。 2023年12月，波斯尼亚和黑塞哥维那国家重症监护医师协会组织了一次混合国际会议，主题是LRS医疗重症监护的组织结构。会议记录和文献综述为多个领域的专家陈述提供了信息。会议结束后，使用修改后的德尔菲方法通过在线调查将这些声明分发给会议参与者及其更广泛的专业网络。需要≥80%的同意才能就声明达成共识。在 48 名受邀临床医生中，有 43 名同意参加。研究参与者来自 20 个国家，包括来自不同基地专业和卫生当局的临床医生代表。经过两轮讨论后，16 项声明中的 13 项达成了共识，涉及组织结构、人员配置和教育三个领域。参与者青睐由接受过正式重症监护培训的医疗团队运营的多专科医疗重症监护病房。卫生保健当局的认可和支持被认为至关重要，小组强调了专业组织、在高收入国家接受培训的临床医生教育工作者以及远程医疗和远程教育等新技术的重要作用。德尔福流程确定了一系列关于如何在 LRS 中创建可持续的以患者为中心的医疗重症监护的共识声明。