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

BMC Research Notes

Tim Baker⁶  David Konrad⁵  Moses Mulungu¹  Jonas Blixt⁵  Edwin Lugazia⁴  Markus Castegren²  Carl Otto Schell³ 

[1] Department of Anaesthesia and Intensive Care, Muhimbili National Hospital, Dar es Salaam, Tanzania;Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden;Department of Internal Medicine, Medicinkliniken, Nyköping Hospital, Sörmland County Council, Nyköping, 61185, Sweden;Department of Anaesthesia and Intensive Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden;Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

关键词: Tanzania;    Developing countries;    Low income countries;    Quality of care;    Early warning scores;    Goal directed therapy;    Intensive Care Unit;    Task shifting;    Vital signs;    Critical care;   

Others  :  1230941
DOI  :  10.1186/s13104-015-1275-9

 received in 2014-07-17, accepted in 2015-07-13,  发布年份 2015

【 摘 要 】

Background

Critical care saves lives of the young with reversible disease. Little is known about critical care services in low-income countries. In a setting with a shortage of doctors the actions of the nurse bedside are likely to have a major impact on the outcome of critically ill patients with rapidly changing physiology. Identification of severely deranged vital signs and subsequent treatment modifications are the basis of modern routines in critical care, for example goal directed therapy and rapid response teams. This study assesses how often severely deranged vital signs trigger an acute treatment modification on an Intensive Care Unit (ICU) in Tanzania.

Methods

A medical records based, observational study. Vital signs (conscious level, respiratory rate, oxygen saturation, heart rate and systolic blood pressure) were collected as repeated point prevalences three times per day in a 1-month period for all adult patients on the ICU. Severely deranged vital signs were identified and treatment modifications within 1 h were noted.

Results

Of 615 vital signs studied, 126 (18%) were severely deranged. An acute treatment modification was in total indicated in 53 situations and was carried out three times (6%) (2/32 for hypotension, 0/8 for tachypnoea, 1/6 for tachycardia, 0/4 for unconsciousness and 0/3 for hypoxia).

Conclusions

This study suggests that severely deranged vital signs are common and infrequently lead to acute treatment modifications on an ICU in a low-income country. There may be potential to improve outcome if nurses are guided to administer acute treatment modifications by using a vital sign directed approach. A prospective study of a vital sign directed therapy protocol is underway.

【 授权许可】

   
2015 Schell et al.

【 图 表 】

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