Anesthesiology and Critical Care Response to COVID-19 in Resource-Limited Settings

Shrestha, Gentle Sunder; Lamsal, Ritesh; Tiwari, Pradip Kumar; Acharya, Subhash Prasad

doi:10.1016/j.anclin.2021.02.004

Cited by 6 publications

(8 citation statements)

References 23 publications

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“…Another study reported a lack of infrastructure, such as a central pipeline for oxygen, in most of the government-funded hospitals in Nepal. As recommended by the World Health Organization (WHO), there should be 2.3 doctors per 1000 persons; however, this study reported that only 1 doctor was available per 1000 persons in Nepal [82]. The limited number of ICU units in various countries of Southeast Asia is presented in Figure 1 (yellow).…”

Section: Resource Constraints About High Population and Limitations O...mentioning

confidence: 78%

Sepsis Management in Southeast Asia: A Review and Clinical Experience

Mehta

Paul

Rabbani

et al. 2022

JCM

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Sepsis is a life-threatening condition that causes a global health burden associated with high mortality and morbidity. Often life-threatening, sepsis can be caused by bacteria, viruses, parasites or fungi. Sepsis management primarily focuses on source control and early broad-spectrum antibiotics, plus organ function support. Comprehensive changes in the way we manage sepsis patients include early identification, infective focus identification and immediate treatment with antimicrobial therapy, appropriate supportive care and hemodynamic optimization. Despite all efforts of clinical and experimental research over thirty years, the capacity to positively influence the outcome of the disease remains limited. This can be due to limited studies available on sepsis in developing countries, especially in Southeast Asia. This review summarizes the progress made in the diagnosis and time associated with sepsis, colistin resistance and chloramphenicol boon, antibiotic abuse, resource constraints and association of sepsis with COVID-19 in Southeast Asia. A personalized approach and innovative therapeutic alternatives such as CytoSorb® are highlighted as potential options for the treatment of patients with sepsis in Southeast Asia.

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Section: Resource Constraints About High Population and Limitations O...mentioning

confidence: 78%

Sepsis Management in Southeast Asia: A Review and Clinical Experience

Mehta

Paul

Rabbani

et al. 2022

JCM

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“…This is possibly the result of the general trend of nonoperative management for acute appendicitis in recent years, 15 in conjunction with the reduction in health care resources during the pandemic that led the medical teams to pursue less burdensome solutions for common clinical situations. 16 …”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of SARS-CoV-2 vaccine-related acute appendicitis

Quint

Kukeev

Hazan

et al. 2023

cjs

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Background: In a large nationwide mass vaccination setting, the SARS-CoV-2 vaccine was recently linked to myocarditis, lymphadenopathy, herpes zoster infection and appendicitis. We aimed to examine the characteristics and management of SARS-CoV-2 vaccine-related acute appendicitis. Methods: We performed a retrospective cohort study in a large tertiary medical centre in Israel. All patients presenting with acute appendicitis within 21 days of receiving their SARS-CoV-2 vaccination (PCVAA group) were compared with patients who presented with acute appendicitis not related to the vaccination (N-PCVAA group). Results: We reviewed the records of 421 patients with acute appendicitis from December 2020 to September 2021; 38 (9%) patients presented with acute appendicitis within 21 days of receiving their SARS-CoV-2 vaccination. Patients in the PCVAA group were older than those in the N-PCVAA group (mean 41 ± 19 yr v. 33 ± 15 yr, respectively, p = 0.008), with male predominance. More patients were managed nonsurgically during the pandemic than before the pandemic (24% v. 18%, p = 0.03). Conclusion: With the exception of older age, the clinical characteristics of patients presenting with acute appendicitis within 21 days of receiving the SARS-CoV-2 vaccination did not differ from those of patients who presented with acute appendicitis not related to the vaccination. This finding suggests that vaccine-related acute appendicitis is similar to “classic” acute appendicitis.

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“…There is disagreement on the rationale principle behind the just allocation during the crisis [24][25][26][27][28]. A requirement of strengthened national guidance for the protocol and policy for ICU triaging [29] was highlighted. To conduct a deeper assessment, ICU triage frameworks for the South Asian countries were revisited.…”

Section: Theme 2: Disagreements On the (Ethical) Frameworkmentioning

confidence: 99%

Setting Up a Just and Fair ICU Triage Process during a Pandemic: A Systematic Review

Chakraborty,

Achour

2024

Healthcare

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Introduction: Triage is a dynamic and complex decision-making process to determine fair access to medical care in mass casualty situations. Triage takes place through healthcare settings including Intensive Care Units (ICUs). Triage governing principles have been subject to ethical debates for a long time specifically with the recent global pandemic of COVID-19. This study aims to revisit the ethical principles guiding patient prioritisation during recent COVID-19 disaster triage in the Indian subcontinent and attempts to look for principles with consideration of social justice. Methods: Key electronic databases such as WHO, EMBASE, and DOAJ were used to access published literature relating to ICU triage in the Indian subcontinent. Literature on and from 2015–2022 were included in this study. The SPICE framework was used to identify the literature. The Inclusion criteria were as follows: Literature with ethical connotations focusing on India and neighbouring countries, and in an ICU setting during pandemics. The Exclusion criteria were as follows: Literature focusing on other countries, without ethical foundations, hospital admissions, and non-COVID-19 ICU admissions. The PRISMA standard was applied to screen the appropriate literature. The BOOLEAN operator “OR” was used to enhance the literature search. Finally, six papers were found suitable for this study and thus were included in the literature review. Additionally, for the second time, the frequency of certain ethical phrases was reassessed in the plans and guidelines to check the changed awareness of ethical pandemic planning, if any. A thematic analysis was applied to analyse the data and generate findings and new knowledge. Results: The findings highlight gaps in knowledge around ICU triaging in the region which indicates the scope of better ethical pandemic preparation at the regional level. The findings show that there is a debate between researchers on prioritisation from available resources and ethical perspectives and principles associated with fair access to healthcare even during pandemic times. The literature also highlights enhancing the regional capacity and building equitable approaches to reduce existing health inequities and the need of the social justice framework for ICU triaging during a pandemic. Conclusions: ICU triaging in five South Asian neighbour nations was studied for the presence of a guided ethical framework. Additionally, for the second time, certain ethical phrases were reassessed in the plans and guidelines; however, usage of those terms was found to be significantly low. The discussion shows that the plans and guidelines have the scope to improve ethical ICU triaging in these countries and in the specific region. After analysing different ethical guidelines, this study emphasises that there is a need for a just and fair framework, specifically a social justice framework in ICU triage in the subcontinent to address the underlying health inequities.

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Anesthesiology and Critical Care Response to COVID-19 in Resource-Limited Settings

Cited by 6 publications

References 23 publications

Sepsis Management in Southeast Asia: A Review and Clinical Experience

Sepsis Management in Southeast Asia: A Review and Clinical Experience

Clinical characteristics of SARS-CoV-2 vaccine-related acute appendicitis

Setting Up a Just and Fair ICU Triage Process during a Pandemic: A Systematic Review

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