Improving outcomes for the critically ill in developing countries: what is next?

Kashyap, Rahul; Hache-Marliere, Manuel; Gavrilovic, Srdjan; Gajić, Ognjen

doi:10.5935/0103-507x.20150054

Cited by 7 publications

(6 citation statements)

References 15 publications

(22 reference statements)

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“…(1,4,5) The lack of reliable data on resource availability from LMICs is also noteworthy. (6) Although some information is available, (7-10) these studies are largely single-center descriptions or questionnaire-based surveys without random sampling, which might induce selection bias.…”

Section: Introductionmentioning

confidence: 99%

Availability of resources to treat sepsis in Brazil: a random sample of Brazilian institutions

Taniguchi¹,

Azevedo²,

Bozza³

et al. 2019

Revista Brasileira De Terapia Intensiva

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Objective To characterize resource availability from a nationally representative random sample of intensive care units in Brazil. Methods A structured online survey of participating units in the Sepsis PREvalence Assessment Database (SPREAD) study, a nationwide 1-day point prevalence survey to assess the burden of sepsis in Brazil, was sent to the medical director of each unit. Results A representative sample of 277 of the 317 invited units responded to the resources survey. Most of the hospitals had fewer than 500 beds (94.6%) with a median of 14 beds in the intensive care unit. Providing care for public-insured patients was the main source of income in two-thirds of the surveyed units. Own microbiology laboratory was not available for 26.8% of the surveyed intensive care units, and 10.5% did not always have access to blood cultures. Broad spectrum antibiotics were not always available in 10.5% of surveyed units, and 21.3% could not always measure lactate within three hours. Those institutions with a high resource availability (158 units, 57%) were usually larger and preferentially served patients from the private health system compared to institutions without high resource availability. Otherwise, those without high resource availability did not always have broad-spectrum antibiotics (24.4%), vasopressors (4.2%) or crystalloids (7.6%). Conclusion Our study indicates that a relevant number of units cannot perform basic monitoring and therapeutic interventions in septic patients. Our results highlight major opportunities for improvement to adhere to simple but effective interventions in Brazil.

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Section: Introductionmentioning

confidence: 99%

Availability of resources to treat sepsis in Brazil: a random sample of Brazilian institutions

Taniguchi¹,

Azevedo²,

Bozza³

et al. 2019

Revista Brasileira De Terapia Intensiva

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“…The CERTAIN initiative mentioned previously uses electronic checklist and decision support tools to facilitate the best practices during admission/resuscitation and daily management of critically ill patients. 63,70 As in all fields of skill development, the risk to institutions and potential benefit to trainees in critical care is that trainees can use newly acquired skills to move to the more desirable urban areas and/or higher paying posts. 60…”

Section: Personnel and Trainingmentioning

confidence: 99%

Maternal critical care in resource-limited settings. Narrative review

Vasco

Pandya²,

Dyk

et al. 2019

International Journal of Obstetric Anesthesia

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Maternal critical care reflects interdisciplinary care in any hospital area according to the severity of illness of the pregnant woman. The admission rate to intensive care units is below 1% (0.08-0.76%) of deliveries in high-income countries, and ranges from 0.13% to 4.6% in low-and middle-income countries. Mortality in these patients is high and varies from 0% to 4.9% of admissions in highincome countries, and from 2% to 43.6% in low-and middle-income countries. Obstetric haemorrhage, sepsis, preeclampsia, human immunodeficiency virus complications and tropical diseases are the main reasons for intensive care unit admission in low middle-income countries. Bedside assessment tools, such as early warning scores, may help to identify critically ill patients and those at risk of deterioration. There is a lack of uniformity in definitions, identification and treatment of critically ill pregnant patients, especially in resourcelimited settings. Our aims were to (i) propose a more practical definition of maternal critical care, (ii) discuss maternal mortality in the setting of limited accessibility of critical care units, (iii) provide some accessible tools to improve identification of obstetric patients who may become critically ill, and (iv) confront challenges in providing maternal critical care in resource-limited settings. To improve maternal critical care, training programmes should embrace modern technological educational aids and incorporate new tools and technologies that assist prediction of critical illness in the pregnant patient. The goal must be improved outcomes following early interventions, early initiation of resuscitation, and early transfer to an appropriate level of care, whenever possible.

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“…An intensive care unit is a highly complex unit in a hospital [1][2][3]. Correct use of mechanical ventilation (MV) can affect the progress and prognosis of patients hospitalized in a pediatric intensive care unit (PICU) [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Correct use of mechanical ventilation (MV) can affect the progress and prognosis of patients hospitalized in a pediatric intensive care unit (PICU) [3][4][5]. It is therefore fundamental for the safety of critically ill patients to monitor the quality of the services provided [1,2,4,5].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of a bundle to prevent unplanned extubation in a pediatric intensive care unit: A multidisciplinary approach

Neves¹,

Ribas²,

Miranda³

et al. 2020

Pediatr Dimensions

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Endotracheal intubation is one of the most common invasive procedures in routine pediatric intensive care. Unplanned extubation occurs when an endotracheal tube is inadvertently removed. To observe and report the incidence of unplanned extubation in children before and after the introduction of a series of measures aimed at controlling and reducing this adverse event in a pediatric intensive care unit. In 2016, a total of 312 patients were hospitalized in the pediatric intensive care unit. Of these, 120 received mechanical ventilation and there were 30 unplanned extubations, corresponding to an annual incidence of 4.24%. In 2017, the corresponding figures were 301, 163, 42 and 3.4%. In 2018, after the introduction of measures to control and reduce the number of unplanned extubations, the corresponding figures were 335, 195, 31 and 1.79%. The incidence in 2018 was statistically significantly lower than in 2017 and 2016 (p < 0.01). Systematic control of the incidence of unplanned extubation and the introduction of a bundle of measures led to a significant reduction in this type of extubation in the pediatric intensive care unit.

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Improving outcomes for the critically ill in developing countries: what is next?

Cited by 7 publications

References 15 publications

Availability of resources to treat sepsis in Brazil: a random sample of Brazilian institutions

Availability of resources to treat sepsis in Brazil: a random sample of Brazilian institutions

Maternal critical care in resource-limited settings. Narrative review

Effectiveness of a bundle to prevent unplanned extubation in a pediatric intensive care unit: A multidisciplinary approach

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