TITLE:
Utilizing Anesthesiologists, Emergency and Critical Care Physicians with Telemedicine Monitoring to Develop Intubation and Ventilation Services in an Intensive Care Unit in the Austere Medical Environment: A Case Series. Expansion of the EP/CC GAS Project
AUTHORS:
Richard Skupski, Arthur Toth, Michael T. McCurdy, Shane Kappler, James Lantry, Gerson Pyran, Donald Zimmer, Joseph Dynako, Anne Grisoli, David Zimmer, John Wilson, Bhavesh M. Patel, Hannelisa Callisen, Alyssa Chapital, Lovely Nathalie Colas, Marc Edson Augustin, Nathalie Edema, Enzo Del Brocco, Richard Frechette, Mark Thompson, James Corcoran, Michael Mazowiecki, Mark Walsh
KEYWORDS:
Intensive Care Unit (ICU), Critical Care, Mechanical Ventilation, Endotracheal Ventilation, Anesthesiologist, Low and Moderate-Income Country, Austere Environment, Telemedicine
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.8 No.6,
June
29,
2018
ABSTRACT: Background: Significant
resource constraints and critical care training gaps are responsible for the
limited development of intensive care units (ICUs) in resource limited
settings. We describe the implementation of an ICU in Haiti and report the
successes and difficulties encountered throughout the process. We present a
consecutive case series investigating an anesthesiologist, emergency, and
critical care physician implemented endotracheal intubation and mechanical
ventilation protocol in an austere environment with the assistance of telemedicine. Methods: A consecutive case series of fifteen patients admitted to an
ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the months of
February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented.
Patients were followed to either death or discharge. Results: Fifteen
patients (eight women and seven men) were included in the study with an average
age of 37.7 years. The mean duration of ventilation was three days. Of the
fifteen patients intubated, five patients (33.3%) survived and were discharged
from the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthmaticus and
one for hyperosmolar coma associated with intracerebral hemorrhage. Of the
patients dying on the ventilator, four patients died from pneumonia, two from renal failure, and one from tetanus. The
remaining three died from strokes and
cardiac arrests. Conclusions: Mortality of mechanically ventilated
patients in a resource-limited country is significant. Focused training
in core critical care skills aimed at increasing the endotracheal intubation
and ventilatory management capacity of local medical staff should be a priority
in order to continue to develop ICUs in these austere environments.
Collaborative educational and training efforts directed by anesthesiologists,
emergency, and critical care physicians, and aided by telemedicine can
facilitate realizing this goal.