National intensive care unit bed capacity and ICU patient characteristics in a low income country

Purpose. In high-income countries, improved survival has been documented among intensive care unit (ICU) patients infected with human immune deficiency virus (HIV). There are no data from low-income country ICUs. We sought to identify clinical characteristics and survival outcomes among HIV patients in a low-income country ICU.Materials and Methods. A retrospective cohort study of HIV infected patients admitted to a university teaching hospital ICU in Uganda. Medical records were reviewed. Primary outcome was survival to hospital discharge. Statistical significance was predetermined in reference toP<0.05.Results. There were 101 HIV patients. Average length of ICU stay was 4 days and ICU mortality was 57%. Mortality in non-HIV patients was 28%. Commonest admission diagnoses were Acute Respiratory Distress Syndrome (ARDS) (58.4%), multiorgan failure (20.8%), and sepsis (20.8%). The mean Acute Physiologic and Chronic Health Evaluation (APACHE II) score was 24. At multivariate analysis, APACHE II (OR 1.24 (95% CI: 1.1–1.4,P=0.01)), mechanical ventilation (OR 1.14 (95% CI: 0.09–0.76,P=0.01)), and ARDS (OR 4.5 (95% CI: 1.07–16.7,P=0.04)) had a statistically significant association with mortality.Conclusion. ICU mortality of HIV patients is higher than in higher income settings and the non-HIV population. ARDS, APACHE II, and need for mechanical ventilation are significantly associated with mortality.

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Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country

PLoS ONE ◽

10.1371/journal.pone.0144801 ◽

2015 ◽

Vol 10 (12) ◽

pp. e0144801 ◽

Cited By ~ 23

Author(s):

Tim Baker ◽

Carl Otto Schell ◽

Edwin Lugazia ◽

Jonas Blixt ◽

Moses Mulungu ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Low Income ◽

Vital Signs ◽

Income Country ◽

Low Income Country

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Severely deranged vital signs as triggers for acute treatment modifications on an intensive care unit in a low-income country

BMC Research Notes ◽

10.1186/s13104-015-1275-9 ◽

2015 ◽

Vol 8 (1) ◽

Cited By ~ 9

Author(s):

Carl Otto Schell ◽

Markus Castegren ◽

Edwin Lugazia ◽

Jonas Blixt ◽

Moses Mulungu ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Low Income ◽

Acute Treatment ◽

Vital Signs ◽

Income Country ◽

Low Income Country

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Parameters of bed occupancy of intensive care units in Hungary

Orvosi Hetilap ◽

10.1556/oh.2011.29137 ◽

2011 ◽

Vol 152 (24) ◽

pp. 946-950 ◽

Cited By ~ 1

Author(s):

Miklós Gresz

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Health Insurance ◽

Intensive Care Units ◽

Emergency Care ◽

Present Author ◽

Bed Occupancy ◽

National Network ◽

Bed Capacity

According to the Semmelweis Plan for Saving Health Care, ”the capacity of the national network of intensive care units in Hungary is one but not the only bottleneck of emergency care at present”. Author shows on the basis of data reported to the health insurance that not on a single calendar day more than 75% of beds in intensive care units were occupied. There were about 15 to 20 thousand sick days which could be considered unnecessary because patients occupying these beds were discharged to their homes directly from the intensive care unit. The data indicate that on the whole bed capacity is not low, only in some institutions insufficient. Thus, in order to improve emergency care in Hungary, the rearrangement of existing beds, rather than an increase of bed capacity is needed. Orv. Hetil., 2011, 152, 946–950.

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Completeness of the operating room to intensive care unit handover: a matter of time?

BMC Anesthesiology ◽

10.1186/s12871-021-01247-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fabian Dusse ◽

Johanna Pütz ◽

Andreas Böhmer ◽

Mark Schieren ◽

Robin Joppich ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Information Transfer ◽

Time Pressure ◽

Intraoperative Complications ◽

Patient Characteristics ◽

Information Loss ◽

Ensure Patient Safety ◽

Underlying Diseases

Abstract Background Handovers of post-anesthesia patients to the intensive care unit (ICU) are often unstructured and performed under time pressure. Hence, they bear a high risk of poor communication, loss of information and potential patient harm. The aim of this study was to investigate the completeness of information transfer and the quantity of information loss during post anesthesia handovers of critical care patients. Methods Using a self-developed checklist, including 55 peri-operative items, patient handovers from the operation room or post anesthesia care unit to the ICU staff were observed and documented in real time. Observations were analyzed for the amount of correct and completely transferred patient data in relation to the written documentation within the anesthesia record and the patient’s chart. Results During a ten-week study period, 97 handovers were included. The mean duration of a handover was 146 seconds, interruptions occurred in 34% of all cases. While some items were transferred frequently (basic patient characteristics [72%], surgical procedure [83%], intraoperative complications [93.8%]) others were commonly missed (underlying diseases [23%], long-term medication [6%]). The completeness of information transfer is associated with the handover’s duration [B coefficient (95% CI): 0.118 (0.084-0.152), p<0.001] and increases significantly in handovers exceeding a duration of 2 minutes (24% ± 11.7 vs. 40% ± 18.04, p<0.001). Conclusions Handover completeness is affected by time pressure, interruptions, and inappropriate surroundings, which increase the risk of information loss. To improve completeness and ensure patient safety, an adequate time span for handover, and the implementation of communication tools are required.

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Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00226-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tessa L. Steel ◽

Shewit P. Giovanni ◽

Sarah C. Katsandres ◽

Shawn M. Cohen ◽

Kevin B. Stephenson ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

Patient Characteristics ◽

Response To Treatment ◽

Alternative Measure ◽

Icu Patients ◽

Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

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Intensive care unit (ICU) diaries and the experiences of patients’ families: a grounded theory approach in a lower middle-income country (LMIC)

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-020-00229-2 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Swagata Tripathy ◽

Swati Priyadarshini Acharya ◽

Alok Kumar Sahoo ◽

Jayanta Kumar Mitra ◽

Kishen Goel ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Grounded Theory ◽

Middle Income Country ◽

Income Country ◽

Theory Approach ◽

Middle Income ◽

Lower Middle Income Country ◽

Grounded Theory Approach

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Changes in the Number of Intensive Care Unit Beds in U.S. Hospitals During the Early Months of the COVID-19 Pandemic, as reported to the National Healthcare Safety Network’s COVID-19 Module

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.266 ◽

2021 ◽

pp. 1-12

Author(s):

Lindsey M. Weiner-Lastinger ◽

Margaret A. Dudeck ◽

Katherine Allen-Bridson ◽

Raymund Dantes ◽

Cindy Gross ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Type ◽

National Healthcare ◽

National Healthcare Safety Network ◽

Bed Capacity ◽

Using Data

Abstract Using data from the National Healthcare Safety Network (NHSN), we assessed changes to intensive care unit (ICU) bed capacity during the early months of the COVID-19 pandemic. Changes in capacity varied by hospital type and size. ICU beds increased by 36%, highlighting the pressure placed on hospitals during the pandemic.

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