Dengue is a mosquito-borne systemic viral infection with variety of clinical presentation, ranging from mild febrile illness to severe and fatal disease. A patient presented with history of fever and abdominal pain, and later developed shock. From clinical and epidemiological features, he was diagnosed as a patient of severe dengue, later confirmed by laboratory investigations. In dengue, shock can result from plasma leakage, and abdominal pain may be a feature of acalculous cholecystitis or pancreatitis, recognised presentations of dengue and usually managed conservatively. But high index of suspicion persuaded abdominal imaging, revealing a potentially fatal complication of dengue- spontaneous splenic rupture. Aggressive resuscitation and early surgery saved the patient. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14373 Bangladesh Crit Care J March 2013; 1: 59-62
Background : This study is a sub analysis of data submitted on behalf of Bangladesh to an international study (2013-2014) involving Asian ICUs and merits comparison with prior study done in Bangladesh in 2007 which had similar objective. Objective : To assess structure, organization and delivery of ICU care in ICUs of Bangladesh with attention to hospital organizational characteristics, ICU organizational characteristics, staffing etc. Method : Prospective cohort study involving ICUs of 51 hospitals of Bangladesh done in 2013-2014. The hospitals in our study were divided into three groups : clinics/hospitals less than 50 beds (n =18), clinics/hospitals more than 50 beds(n=24) and Govt. hospitals/academic hospitals/ medical colleges hospitals (n=9). Results : Most respondent hospitals were from Dhaka (77.4%). Only 17.6% hospitals were university affiliated. The average number of hospital beds were 225. The average number of ICU beds were 14. 19.6 % hospitals had infection control committees. Basic life support training was required for doctors and nurses in 31.4 % and 27.5 % hospitals respectively. Small clinics/ hospitals (less than 50 bed capacity [n=18]) had significantly less government funding (p < 0.0001), were less attached to university hospital (p < 0.0001), had fewer referral centers (p < 0.001), had less total hospital beds (p < 0.004) and were less in case of ICU beds : hospital beds percentage (p < 0.003). 28 ICUs had no single room. Govt. hospitals/academic hospitals/Medical colleges had relatively more ICU beds .(12.33% - p < 0.004). 60.8% ICUs were operated as open units. Open units were more likely present in hospitals/clinics more than 50 beds. Multivariable analysis showed that the presence of 1:1 nursing staff was much lower in private hospitals. Funding sources and types of hospitals were independently associated with lower percentage of ICU beds (p < 0.002) and (p < 0.0001) respectfully. University affiliations was more likely associated with closed ICU (p < 0.002). Presence of MD CCM qualified intensivists are more in government funded hospitals (p < 0.003) than those of private hospitals Conclusions : Our study demonstrates considerable variation in the organization and staffing among Bangladeshi ICUs. Compared to 2007 study it shows increased trend in number of closed units( 39% vs 15%) and percentage of ICU beds relative to number of hospital beds (6.5% vs 4.8%) . Bangladesh Crit Care J March 2019; 7(1): 3-11
Objective: To assess compliance of Intensive Care Units (ICUs) of Bangladesh to the components of resuscitation & management bundles of Surviving Sepsis Campaign (SSC). Secondary objective was to assess the impact of compliance on mortality and to determine how its compliance & mortality compared with other Asian and Western countries. Design: Prospective Cohort study. Setting: 14 ICUs of Bangladesh. Participants: 65 adult patients with severe sepsis admitted into these ICUs in July 2009. The organizational characteristics of the participating centers, the patients baseline characteristics, the achievement of target within the resuscitation & management bundle & outcome data were recorded. Outcome: Compliance with the Surviving Sepsis Campaigns resuscitation (6 hrs) & management (24 hrs) bundles. Results: Hospital mortality in ICU patients of Bangladesh suffering from severe sepsis was 49·2%. It was significantly higher than countries reported. Compliance to entire components of both resuscitation & management bundles were reported to be zero in ICUs of Bangladesh. Compliance of individual components of the bundles did not predict improved survival. Conclusion: In ICUs of Bangladesh, high mortality of severe sepsis and failure of compliance of SSC bundle guidelines to have positive impact on survival were presumably attributed to delayed diagnosis, poor adherence to & delayed application of SSC guidelines on sepsis bundles. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14359 Bangladesh Crit Care J March 2013; 1: 8-17
DOI: http://dx.doi.org/10.3329/bccj.v1i1.14357 Bangladesh Crit Care J March 2013; 1: 1-2
Background : This study is a sub analysis of data submitted on behalf of Bangladesh in an International study ( ACME 2012) involving physicians working in Asian ICUs. Objective : To describe attitude of physicians of ICUs of Bangladesh toward withholding and withdrawal of life sustaining treatments in end of life care, to assess factors associated with these observations and to compare the findings especially with those of physicians of low – middle income Asian ICUs. Method : Self-administered pre-set structured and scenario based survey conducted among 101 physicians working in 38 ICUs of Bangladesh. Results : For patients with no real chance of recovering a meaningful life, 20 of 101 respondents reported that they almost always or often withheld life-sustaining treatments and 18 of 101 respondents almost always or often withdrew life-sustaining treatments.44 respondents in our study reported that they almost always or often withheld life sustaining treatments whereas 10 respondents almost always or often withdrew life sustaining treatments. 72% of all our respondents would implement DNR orders. In Bangladesh, religion (Islam) does not influence decision of complying with DNR order requested by family. Our study showed 71% of physicians were more likely to “do everything” if a patient with hypoxic-ischaemic encephalopathy developed septic shock. In our study, physicians were more ready to withdraw vasopressors and hemo dialysis than enteral feeding and intravenous fluids. Physicians from Bangladesh generally perceived more legal risk with limitation of life sustaining treatments because of lack of legislation for such practices. When it comes to limit aggressive lifesaving treatments, Bangladeshi physicians were less likely accede to families request to withdraw them on financial ground. Conclusion : Like physicians of low-middle income countries of Asia, Bangladeshi ICU physicians’ self-reported practice of limiting life sustaining treatments, role of families and surrogates and perception of legal rights were significantly different than physicians of high income countries of Asia. However unlike physicians from other low income Asian countries, physicians from Bangladesh were less likely to accede to families request to withdraw life sustaining treatments on financial ground. Bangladesh Crit Care J September 2019; 7(2): 66-72
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