Delivering neurocritical care in resource-challenged environments

Shrestha, Gentle S; Goffi, Alberto; Aryal, Diptesh

doi:10.1097/mcc.0000000000000285

Cited by 19 publications

(16 citation statements)

References 22 publications

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“…Obviously, the timely and protocolized goal directed therapy or standardized care in the patients with severe sepsis and septic shock can significantly improve 8,18 patient outcome. The problems attributable to significant lack of knowledge and deficiency of trained health care professionals can be overcome by training the health care professionals dealing with the patients with sepsis about the evidence based and resource-appropriate management 17,19 strategies. The local professional societies and government authorities should make policies to regularly train the health care professionals about recognition and effective early m a n a ge m e nt o f s e ps i s .…”

Section: Methodology Resultsmentioning

confidence: 99%

Understanding of Severe Sepsis and Septic Shock Among Emergency Department and Intensive Care Unit Medical Officers in a Developing Country Nepal: A Survey Study

Shrestha

Parajuli

Acharya

et al. 2017

Birat J. Health Sci.

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KEY WORDS IntroductionSevere sepsis and septic shock is a major cause of morbidity and mortality. The burden is higher and the outcome is dismal in the low and middle income countries. ObjectiveThis study aims to evaluate the knowledge about severe sepsis and septic shock among the medical officers of emergency department and intensive care unit in Nepal. It is a cross-sectional survey study. MethodologyThe medical officers working in emergency department and intensive care unit were asked to fill up the survey questionnaire, which contained the questions related to the demographics of the participant, about the knowledge of sepsis and the hindrances behind the effective management of septic patients. The percentage of correct answers for each question and average correct response for all the questions were analyzed. ResultsSeventy medical officers from twenty-four hospitals across the country were enrolled in the study. Among them, 39 were working in the emergency department and 31 were working in the intensive care unit. For the individual questions, the percentage of correct answers varied from 8.57% to 82.86% (average 48.16%). As per the response of the participants, lack of knowledge about sepsis and management guidelines, lack of experience for management of sepsis and lack of investigation facilities were considered to be the major barriers for effective management of septic patients. ConclusionsKnowledge and understanding about severe sepsis and septic shock among the medical officers of emergency department and intensive care unit in Nepal is sub-optimal. To improve the outcome of septic patients, efforts should be made to increase the understanding among these first-line health care workers by implementing regular and mandatory training programs. Knowledge, medical officer, septic shock, severe sepsis Affiliation:1.

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Section: Methodology Resultsmentioning

confidence: 99%

Understanding of Severe Sepsis and Septic Shock Among Emergency Department and Intensive Care Unit Medical Officers in a Developing Country Nepal: A Survey Study

Shrestha

Parajuli

Acharya

et al. 2017

Birat J. Health Sci.

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“…7,8 In Nepal, there are many studies and publications in Neurosurgery, and many articles from the neurosurgical ICU from other countries but there is only one article from Nepal regarding Neurosurgical ICU. 6,[9][10][11][12] The delay in development of Neurosurgical services and neurocritical care in Nepal can be due to various reasons that include financial constraints, lack of government regulations, poor medical control over the private institutions and lack of proper training of the hospital management and staff. [3][4][5][6] In our study, the male and female distribution was similar and most of them were admitted for postoperative management, including emergency and elective surgeries, which is similar to other studies by Roka et al and also similar to other ICU in low resource countries.…”

Section: Discussionmentioning

confidence: 99%

Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

Acharya

Bhattarai

et al. 2018

J Nepal Health Res Council

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Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being preoperative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.

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“…In past, infection was most common but presently non communicable diseases like trauma, aneurysm, traumatic brain injury, spinal cord injury are most common. [6] These changes in disease pattern requires high degree of expertise of neurocritical care services. It requires electroencephalogram, intracranial pressure monitoring devices in the neurointensive care in addition to general critical care.…”

Section: N Egneuro Volume 01 2019mentioning

confidence: 99%