With great interest, I read the study published in Intensive Care Medicine by Wagstaff et al. [
1]. The study aimed to systematically review the typology, impact, quality of evidence, barriers, and facilitators to implementation of quality improvement (QI) interventions for adult critical care in low- and middle-income countries (LMICs). The authors highlight interesting facts from their study. The sixty three percent of the included studies in their systematic review were observational or quasi-experimental study designs, while only 5% were randomized controlled trials. Moreover, 80% of the included studies had moderate to high risk of bias. The challenges of delivering critical care services in countries with low- and middle incomes have been brought to our attention by this review paper, given the limited or low nature of availability of resources across such settings. …