Smarter, kinder, closer, how India’s open ICU model is changing critical care

Once cold, clinical, and cut off from families, India’s intensive care units (ICU) are being reimagined. Umesh Isalkar speaks to Dr Sameer Jog, senior intensivist at Deenanath Mangeshkar Hospital, Pune, about the shift to a more humane and inclusive approach to critical care

What’s the most significant shift in ICU care over the past two decades?
When I began practising, ICUs were almost off-limits to families. Communication was minimal, access was restricted, and it felt like a world run by machines. Today, Indian ICUs are far more inclusive and patient centric. Families are part of the discussion, counselling is routine, and visiting hours are more liberal. However, the most profound shift is not just in attitudes, but also in how we have adapted the Open ICU model to work for India.

How is it different from the closed ICU systems used in the West?A closed ICU, standard in most western hospitals, is a system where the moment a patient enters, their primary care shifts entirely to the intensivist — a specialist in critical care. The primary doctor (cardiologist, nephrologist or surgeon) steps back completely. While this ensures standardised ICU protocols and rapid decisions, it also disconnects the patient from the doctor who knows them best. India’s Open ICU model allows the patient’s primary doctor and the intensivist to work together. This respects our context, as doctor-patient relationships here are long-term and deeply personal. Many families trust their primary doctor more than a hospital system. The open model preserves that trust while still providing ICU-level expertise.

How does it aid patients’ families?
In traditional ICUs, families may feel isolated from the care process, especially when the doctor they trust is not involved. Critical decisions — like whether to intubate, perform a high-risk procedure, or shift to palliative care — are sometimes made without emotional context. In India, where doctors often serve generations, this disconnect can create confusion, distress, and even conflict. The Open ICU model reduces that tension, creating a shared decision-making environment that’s more transparent, culturally appropriate, and emotionally supportive.
What about concerns that it may lead to inconsistent care or conflict between specialists?
It’s a valid concern but, over time, we have developed protocol-driven systems that ensure safety while allowing flexibility. The intensivist ensures evidence-based critical care, while the primary physician brings continuity and context. When done right, it becomes a partnership, not a turf war.

How are tele-ICUs changing care, especially outside metro hospitals?
We’ve built hub-and-spoke systems where experienced intensivists in urban centres remotely guide doctors in smaller towns via video feeds and real-time data. They assist in ventilator adjustments, drug titration, and even code blue (emergency) situations. This model is saving lives where no intensivist is physically available without the patient needing to be shifted. It’s cost-effective, scalable, and immediate.
What are the major tech advances transforming Indian ICUs today?
The technological leap has been remarkable. We have gone from basic monitors to AI-driven early warning systems that predict patient deterioration hours in advance. Today, ventilators come with adaptive modes that intuitively sync with a patient’s natural breathing, offering precision support. ECMO systems, once limited to a few tertiary centres, now function as life-saving heart-lung machines for patients in severe cardiac or respiratory distress. Bedside diagnostics has become equally game changing. Intensivists can now perform ultrasounds and echocardiograms right at the bedside, cutting delays and enabling real-time clinical decisions. There are portable dialysis units and integrated monitoring dashboards that consolidate a patient’s vitals, lab trends, and medication infusions onto a single interface, improving decision-making speed and clarity during high-pressure situations.
Is there any use of AI?
AI-powered early warning systems are one of the most groundbreaking developments in critical care. These algorithms can detect subtle physiological changes and predict sepsis or a sudden drop in oxygen levels, often hours before visible clinical signs emerge. This gives ICU teams a vital window to intervene early, potentially preventing deterioration. AI systems are also used in enhanced diagnostics in radiology, ultrasound, and echocardiography.

You said ICU care also happens at home now. How does that work?
For patients who require prolonged critical care but are medically stable — such as after a stroke or major surgery — ICU-at-home services are now a viable option. These setups allow patients to recover in the comfort and familiarity of their own homes. This reduces hospital stays, lowers infection risk, and is especially valuable for elderly patients or those in the palliative stages.

Speaking of palliative care, how has that role evolved in ICUs?
End-of-life care was once a taboo subject in ICUs. Today, palliative care protocols are increasingly integrated into critical care practice, shifting focus from aggressive treatment to comfort, dignity, and emotional support for both the patient and the family. This shift does not signify giving up; rather, it ensures that patients are not subjected to unnecessary suffering when further medical intervention offers no real benefit. It allows for peaceful goodbyes, with families involved in the decision-making process, marking a vital step in making intensive care more humane.

Finally, what does the future hold?
The ICU of the future will be more connected, compassionate, and intelligent, with more prominent predictive algorithms and remote-guided care. The ICU journey here is no longer just about survival, but about surviving with dignity, trust, and care.