Author(s)

Richard Skupski¹, Arthur Toth¹, Michael T. McCurdy², Shane Kappler², James Lantry², Gerson Pyran², Donald Zimmer¹, Joseph Dynako^3*, Anne Grisoli³, David Zimmer³, John Wilson⁴, Bhavesh M. Patel⁵, Hannelisa Callisen⁵, Alyssa Chapital⁵, Lovely Nathalie Colas⁶, Marc Edson Augustin⁶, Nathalie Edema⁶, Enzo Del Brocco⁶, Richard Frechette⁶, Mark Thompson¹, James Corcoran⁶, Michael Mazowiecki⁷, Mark Walsh^3,8*

¹Memorial Hospital Trauma Center, South Bend, IN, USA.
²University of Maryland School of Medicine, Baltimore, MD, USA.
³Indiana University School of Medicine, South Bend Campus, South Bend, IN, USA.
⁴Mayo Clinic, Rochester, MN, USA.
⁵Mayo Clinic, Phoenix, AZ, USA.
⁶Hôspital Saint Luc, Port-Au-Prince, Haiti.
⁷Excela Health Westmoreland Hospital, Greensburg, PA, USA.
⁸Saint Joseph Regional Medical Center, Mishawaka, IN, USA.

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.

Intensive Care Unit (ICU), Critical Care, Mechanical Ventilation, Endotracheal Ventilation, Anesthesiologist, Low and Moderate-Income Country, Austere Environment, Telemedicine

Skupski, R. , Toth, A. , McCurdy, M. , Kappler, S. , Lantry, J. , Pyran, G. , Zimmer, D. , Dynako, J. , Grisoli, A. , Zimmer, D. , Wilson, J. , Patel, B. , Callisen, H. , Chapital, A. , Colas, L. , Augustin, M. , Edema, N. , Brocco, E. , Frechette, R. , Thompson, M. , Corcoran, J. , Mazowiecki, M. and Walsh, M. (2018) 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. Open Journal of Anesthesiology, 8, 183-197. doi: 10.4236/ojanes.2018.86019.