Critical care in resource-poor settings: Lessons learned and future directions*

Riviello, Elisabeth D.; Letchford, Stephen; Achieng, Loice; Newton, Mark

doi:10.1097/ccm.0b013e318206d6d5

Cited by 154 publications

(141 citation statements)

References 44 publications

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“…Obviously, the timely and protocolized goal directed therapy or standardized care in the patients with severe sepsis and septic shock can significantly improve 8,18 patient outcome. The problems attributable to significant lack of knowledge and deficiency of trained health care professionals can be overcome by training the health care professionals dealing with the patients with sepsis about the evidence based and resource-appropriate management 17,19 strategies. The local professional societies and government authorities should make policies to regularly train the health care professionals about recognition and effective early m a n a ge m e nt o f s e ps i s .…”

Section: Methodology Resultsmentioning

confidence: 99%

Understanding of Severe Sepsis and Septic Shock Among Emergency Department and Intensive Care Unit Medical Officers in a Developing Country Nepal: A Survey Study

Shrestha

Parajuli

Acharya

et al. 2017

Birat J. Health Sci.

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KEY WORDS IntroductionSevere sepsis and septic shock is a major cause of morbidity and mortality. The burden is higher and the outcome is dismal in the low and middle income countries. ObjectiveThis study aims to evaluate the knowledge about severe sepsis and septic shock among the medical officers of emergency department and intensive care unit in Nepal. It is a cross-sectional survey study. MethodologyThe medical officers working in emergency department and intensive care unit were asked to fill up the survey questionnaire, which contained the questions related to the demographics of the participant, about the knowledge of sepsis and the hindrances behind the effective management of septic patients. The percentage of correct answers for each question and average correct response for all the questions were analyzed. ResultsSeventy medical officers from twenty-four hospitals across the country were enrolled in the study. Among them, 39 were working in the emergency department and 31 were working in the intensive care unit. For the individual questions, the percentage of correct answers varied from 8.57% to 82.86% (average 48.16%). As per the response of the participants, lack of knowledge about sepsis and management guidelines, lack of experience for management of sepsis and lack of investigation facilities were considered to be the major barriers for effective management of septic patients. ConclusionsKnowledge and understanding about severe sepsis and septic shock among the medical officers of emergency department and intensive care unit in Nepal is sub-optimal. To improve the outcome of septic patients, efforts should be made to increase the understanding among these first-line health care workers by implementing regular and mandatory training programs. Knowledge, medical officer, septic shock, severe sepsis Affiliation:1.

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Section: Methodology Resultsmentioning

confidence: 99%

Understanding of Severe Sepsis and Septic Shock Among Emergency Department and Intensive Care Unit Medical Officers in a Developing Country Nepal: A Survey Study

Shrestha

Parajuli

Acharya

et al. 2017

Birat J. Health Sci.

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“…In a recent review, critical care improvement as a fundamental aspect of healthcare in the developing world has been emphasised [2]. In their article, Riviello and co-authors correctly underlined that the intensive care setting must be separate from the concept of "expensive" intensive care; instead, it must be thought in terms of "appropriate" intensive care, thus strictly related to the site of intervention.…”

Section: Introductionmentioning

confidence: 99%

Challenges of Improving Intensive Care Medicine in Eritrea: Impact of an Italian Cooperative Project of Educational and Clinical Support

Anichini¹,

Zagli²,

Goitom³

et al. 2013

OJAnes

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Intensive care in Africa is available only in teaching or referral hospitals. Here we report the experience of a multidisciplinary collaboration between physicians and nurses of the Emergency Department (First Aid and Intensive Care Unit) of a tertiary referral hospital (Careggi Teaching Hospital, Florence, IT) and physicians and nurses of Orotta National referral Hospital in Asmara, Eritrea. The project was aimed at performing clinical assistance and training on the job to the local staff to improve the standard of care in the local Emergency Department. The duration of the project was initially planned to be 30 months, but unfortunately it was interrupted after 18 months because of lack of funds. The Italian staff was composed of two physicians and two nurses per period. To monitor local ICU activity, a retrospective survey of 36 months was performed. During the 36 months of data collection, 1169 patients were admitted to the ICU. Intra-ICU mortality rate resulted comparable before, during, and after Italian presence. On the contrary, the 28-day mortality resulted significantly lower bo th during and after the Italian stay. After project interruption, the Italian staff maintained contact with the Eritrean ICU personnel, who were invited to attend the Italian ICU for one month per year, and collected information about Orotta ICU activities.

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“…Basic laboratory equipment such as electrolyte, blood gas and chemistry analyzers with reliable results and good turnaround time (TAT) will raise the level of care in a given hospital setting. 9 Sadly, many critically ill patients of varying underlying conditions die of the effects of fluid and dyselectrolytaemias in the developing countries due to inadequate diagnosis and management. 9,10 Indeed the dire state of acute care in developing countries has been highlighted in several articles in spite of increasing deaths and burden of critical illness in countries.…”

Section: Introductionmentioning

confidence: 99%

“…9 Sadly, many critically ill patients of varying underlying conditions die of the effects of fluid and dyselectrolytaemias in the developing countries due to inadequate diagnosis and management. 9,10 Indeed the dire state of acute care in developing countries has been highlighted in several articles in spite of increasing deaths and burden of critical illness in countries. [11][12][13] Diagnostic support has been identified as crucial for effective critical care.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic challenges in critical care management of fluid and electrolyte disturbances in a poor-resource setting: a survey of critical care doctors

et al. 2017

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Background: To determine the challenges in diagnostic support for adequate fluid and electrolyte (F/E) management in a poor-resource critical care setting.Methods: This cross-sectional survey was conducted between March and May 2017 in one hundred and four (104) doctors practicing in four tertiary hospitals in North-central Nigeria. These doctors were currently working in Accidents and Emergency Units (A/E), Intensive care Units (ICU) and Children Emergency Units and have worked for at least two months prior to the study. They were given a structured questionnaire to fill and return. The questionnaire among other things, addressed laboratory-related factors that affect management of F/E disturbances.Results: Unavailability of some laboratory tests, inaccuracy of laboratory results, incomplete test results and delay in obtaining results, hampered F/E management in critical care according to more than 75% of the surveyed doctors. About sixty percent of the doctors reported a turnaround time (TAT) of ≥3 hours for electrolytes and most emergency biochemical tests (except urine dipstick and Blood gases). Also ≤25% of doctors responded that electrolytes and most emergency biochemical tests (except urine dipstick and Blood gases) were offered in the ICU/Emergency unit laboratories. Ten percent or less of doctors reported that electrolytes and the emergency biochemical test were available by Point of care testing (POCT).Conclusions: There is an urgent need for the managers of healthcare in LMICs to establish functional laboratories in ICUs, explore the use of POCT and build capacity for diagnostic critical care.

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Critical care in resource-poor settings: Lessons learned and future directions*

Cited by 154 publications

References 44 publications

Understanding of Severe Sepsis and Septic Shock Among Emergency Department and Intensive Care Unit Medical Officers in a Developing Country Nepal: A Survey Study

Understanding of Severe Sepsis and Septic Shock Among Emergency Department and Intensive Care Unit Medical Officers in a Developing Country Nepal: A Survey Study

Challenges of Improving Intensive Care Medicine in Eritrea: Impact of an Italian Cooperative Project of Educational and Clinical Support

Diagnostic challenges in critical care management of fluid and electrolyte disturbances in a poor-resource setting: a survey of critical care doctors

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