Levaraging a cloud-based intensive care registry in a lower-middle income country to enable high-quality critical care research

India, a lower-middle-income country, has made significant economic progress over the past two decades. As a result, the nation has witnessed major improvements in healthcare infrastructure and resources, particularly in large urban centers. However, a clear and persistent gap remains between advances in clinical service delivery and the corresponding growth in research output. The overarching objective of this thesis was to demonstrate the potential of a cloud-based registry—and its associated infrastructure—to enable high-quality critical care research in the Indian context. Using a scoping review methodology, we identified the barriers to conducting research in low- and lower-middle-income countries. Subsequently, drawing on data from the Indian Registry of IntenSive Care (IRIS), we explored a series of research questions to illustrate the registry’s ability to facilitate high-quality research. Given the limited information available on the influence of baseline patient characteristics on outcomes, our central research theme examined the association between the characteristics: frailty; persistent critical illness; and sex, on clinical outcomes. In the general discussion, we reflect on the implications of our findings in relation to the specific research questions, as well as the barriers mitigated by the registry ecosystem. We also discuss the strengths and limitations of our approach and outline future directions, including integrating electronic medical records and artificial intelligence technologies to enhance data collection and analysis; advancing recommendations for registry-embedded critical care research to democratize research in India; and developing sustainable funding models to ensure the long-term viability of the registry.