An evaluation of the intensive care unit resources and utilization in Trinidad

Updated estimated incidence and prevalence of serious fungal infections in Trinidad and Tobago

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There is an extensive burden of serious fungal infections in Trinidad and Tobago

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Serious fungal infections among PLHIV include PCP, histoplasmosis, and cryptococcosis

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Increased availability of diagnostics and drugs is needed to reduce mortality

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A national surveillance system for fungal infections should be implemented

Objective

: To estimate the incidence and prevalence of serious fungal infections in Trinidad and Tobago (T&T), with a population of 1 394 973 million.

Methods

: The medical literature was searched to obtain published data on the incidence and prevalence of fungal infections in the Caribbean. If data were unavailable, estimations were performed using the frequencies of fungal infection in populations at risk. Asthma and pulmonary tuberculosis rates were used to derive the prevalence of allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensitization (SAFS), and chronic pulmonary aspergillosis (CPA).

Results

: The estimated annual burden of fungal infections was 46 156 persons (3.3% of the population), including 21 455 women with recurrent vulvovaginal candidiasis, 118 persons with invasive aspergillosis, 3637 adults with ABPA, 4800 with SAFS, and 178 with CPA. Annually, we estimated 70 cases of candidemia and 14 647 cases of tinea capitis in children. Of the 11 000 persons living with HIV/AIDS, it was estimated that there were 40 cases of cryptococcal meningitis, 88 cases of disseminated histoplasmosis, and 124 cases of Pneumocystis pneumonia.

Conclusion

: There seems to be an extensive burden of fungal infections in T&T. Hence, targeted interventions are required to improve clinical and laboratory diagnosis and a national surveillance system should be implemented.

A Nationwide Census of ICU Capacity and Admissions in Mongolia

In Mongolia, a Central Asian lower-middle income country, intensive care medicine is an under-resourced and–developed medical specialty. The burden of critical illness and capacity of intensive care unit (ICU) services in the country is unknown. In this nationwide census, we collected data on adult and pediatric/neonatal ICU capacities and the number of ICU admissions in 2014. All hospitals registered to run an ICU service in Mongolia were surveyed. Data on the availability of an adult and/or pediatric/neonatal ICU service, the number of available ICU beds, the number of available functional mechanical ventilators, the number of patients admitted to the ICU, and the number of patients admitted to the study hospital were collected. In total, 70 ICUs with 349 ICU beds were counted in Mongolia (11.7 ICU beds/100,000 inhabitants; 1.7 ICU beds/100 hospital beds). Of these, 241 (69%) were adult and 108 (31%) pediatric/neonatal ICU beds. Functional mechanical ventilators were available for approximately half of the ICU beds (5.1 mechanical ventilators/100,000 inhabitants). While all provincial hospitals ran a pediatric/neonatal ICU, only dedicated pediatric hospitals in Ulaanbaatar did so. The number of adult and pediatric/neonatal ICU admissions varied between provinces. The number of adult ICU beds and adult ICU admissions per 100,000 inhabitants correlated (r = 0.5; p = 0.02), while the number of pediatric/neonatal ICU beds and pediatric/neonatal ICU admissions per 100,000 inhabitants did not (r = 0.25; p = 0.26). In conclusion, with 11.7 ICU beds per 100,000 inhabitants the ICU capacity in Mongolia is higher than in other low- and lower-middle-income countries. Substantial heterogeneities in the standardized ICU capacity and ICU admissions exist between Mongolian provinces. Functional mechanical ventilators are available for only half of the ICU beds. Pediatric/neonatal ICU beds make up one third of the national ICU capacity and appear to meet or even exceed the demand of pediatric/neonatal critical care.

Prognostic performance of the Simplified Acute Physiology Score II in major Croatian hospitals: a prospective multicenter study

Aim

To perform an external validation of the original Simplified Acute Physiology Score II (SAPS II) system and to assess its performance in a selected group of patients in major Croatian hospitals.

Methods

A prospective, multicenter study was conducted in five university hospitals and one general hospital during a six-month period between November 1, 2007 and May 1, 2008. Standardized hospital mortality ratio (SMR) was calculated from the mean predicted mortality of all the 2756 patients and the actual mortality for the same group of patients. The validation of SAPS II was made using the area under receiver operating characteristic curve (AUC), 2 × 2 classification tables, and Hosmer-Lemeshow tests.

Results

The predicted mortality was as low as 14.6% due to a small proportion of medical patients and the SMR being 0.89 (95% confidence interval [CI], 0.78-0.98). The SAPS II system demonstrated a good discriminatory power as measured by the AUC (0.85; standard error [SE] = 0.012; 95% CI = 0.840-0.866; P < 0.001). This system significantly overestimated the actual mortality (Hosmer-Lemeshow goodness-of-fit H statistic: χ² = 584.4; P < 0.001 and C statistics: χ²₈ = 313.0; P < 0.001) in the group of patients included in the study.

Conclusion

The SAPS II had a good discrimination, but it significantly overestimated the observed mortality in comparison with the predicted mortality in this group of patients in Croatia. Therefore, caution is required when an evaluation is performed at the individual level.

Intensive care admissions and outcome at the University of Calabar Teaching Hospital, Nigeria

An intensive care unit (ICU) is for critically ill patients who are likely to benefit from the expertise care provided. The outcome is dependent on the available human and material resources. The University of Calabar Teaching Hospital is a 410-bed hospital. It has a 3-bed general ICU consisting of 2 adult and 1 pediatric beds. A retrospective analysis of all ICU admissions as well as the mortality rate during a 12-month period that spans April 2009 and March 2010 was done. The data were collected from the ICU admissions and nurses' report books. The data extracted were the patients ages, stratified to pediatric (0-18 years) and adult (>18 years); the source of admission, primary diagnosis, the duration of admission, and the patients who were ventilated were also noted. The outcome in terms of mortality was examined in relation to parameters stated above. Eighty-five patients were admitted during the 1-year period, with a bed occupancy rate of 23%. There were 11 (12.9%) pediatric patients and 74 (87.1%) adult patients. Sources of admissions were 64 (75.3%) patients from the operating room, 8 (9.4%) from the inpatient wards, and 13 (15.3%) from the accident and emergency department. Among the adult patients, there were 23 (31%) patients with trauma. There were 45 (61%) surgical patients and 6 (8%) medical patients. Sixteen (19%) patients were mechanically ventilated. The overall mortality was 28 (32.9%). Sixty-four percent of the mortality occurred during the first 24 hours of admission. A mortality rate of 83.3% was recorded among medical patients and 62.5% in those referred from the wards. In mechanically ventilated patients, the mortality rate was 62.5%. Ventilator malfunction, power failure, and oxygen exhaustion led to the unfavorable outcome in patients who were ventilated. In pediatric patients, the mortality rate was 45.5%. Early identification and referral of critically ill patients from the wards, availability of ventilator with battery backup, and maintenance of functioning equipment would reduce the high mortality rate recorded in the study.

Características clínicas e gravidade de pacientes internados em UTIs públicas e privadas

Este estudo objetivou comparar as características clínicas, evolução e gravidade de pacientes adultos internados em Unidades de Terapia Intensiva públicas e privadas. Trata-se de uma análise retrospectiva, longitudinal e quantitativa de 600 pacientes admitidos em quatro Unidades de Terapia Intensiva em São Paulo, Brasil. Diferenças foram encontradas entre os pacientes admitidos nos hospitais privados e públicos em relação às seguintes variáveis: idade, procedência, tempo de internação e mortalidade na unidade crítica, insuficiências cardiológica, hematológica, neurológica e renal, além de algumas comorbidades. Tais resultados revelam a importância de se analisar detalhadamente as características clínicas e a assistência prestada aos pacientes admitidos em instituições públicas, frente a maior mortalidade encontrada. O Enfermeiro de Terapia Intensiva pode contribuir para alterar esse panorama, visto que detém um papel de liderança no planejamento assistencial e na provisão de recursos necessários para assistência intensiva.

Critical care and the global burden of critical illness in adults

Critical care has evolved from treatment of poliomyelitis victims with respiratory failure in an intensive care unit to treatment of severely ill patients irrespective of location or specific technology. Population-based studies in the developed world suggest that the burden of critical illness is higher than generally appreciated and will increase as the population ages. Critical care capacity has long been needed in the developing world, and efforts to improve the care of the critically ill in these settings are starting to occur. Expansion of critical care to handle the consequences of an ageing population, natural disasters, conflict, inadequate primary care, and higher-risk medical therapies will be challenged by high costs at a time of economic constraint. To meet this challenge, investigators in this discipline will need to measure the global burden of critical illness and available critical-care resources, and develop both preventive and therapeutic interventions that are generalisable across countries.

Pregnant and postpartum admissions to the intensive care unit: a systematic review

PURPOSE

To determine the incidence and characteristics of pregnant and postpartum women requiring admission to an intensive care unit (ICU).

METHODS

Medline, PubMed, EMBASE and CINAHL databases (1990-2008) were systematically searched for reports of women admitted to the ICU either pregnant or up to 6 weeks postpartum. Two reviewers independently determined study eligibility and abstracted data.

RESULTS

A total of 40 eligible studies reporting outcomes for 7,887 women were analysed. All studies were retrospective with the majority reporting data from a single centre. The incidence of ICU admission ranged from 0.7 to 13.5 per 1,000 deliveries. Pregnant or postpartum women accounted for 0.4-16.0% of ICU admissions in study centres. Hypertensive disorders of pregnancy were the most prevalent indication for ICU admission [median 0.9 cases per 1,000 deliveries (range 0.2-6.7)]. There was no difference in the profile of ICU admission in developing compared to developed countries, except for the significantly higher maternal mortality rate in developing countries (median 3.3 vs. 14.0%, p = 0.002). Studies reporting patient outcomes subsequent to ICU admission are lacking.

CONCLUSIONS

ICU admission of pregnant and postpartum women occurs infrequently, with obstetric conditions responsible for the majority of ICU admissions. The ICU admission profile of women was similar in developed and developing countries; however, the maternal mortality rate remains higher for ICUs in developing countries, supporting the need for ongoing service delivery improvements. More studies are required to determine the impact of ICU admission for pregnant and postpartum women.