Differences in critical care practice between an industrialized and a developing country

Dünser, Martin W.; Bataar, Otgon; Tsenddorj, Ganbat; Lundeg, Ganbold; Torgersen, Christian; Romand, Jacques-André; Hasibeder, Walter

doi:10.1007/s00508-008-1064-8

Cited by 22 publications

(21 citation statements)

References 21 publications

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“…Although no conclusion on cause and effect can be drawn from our results, the lack of the necessary resources to implement SSC guidelines in Mongolia is in all likelihood contributing to the high case fatality rates from sepsis and septic shock. 9 Our study has several limitations. Although the survey response rate was high, not all physicians to whom the questionnaire was sent responded.…”

Section: Discussionmentioning

confidence: 91%

“…Although scant data are available on the management of patients with severe sepsis or septic shock in Mongolia, one study reported extremely high case fatality rates for sepsis and septic shock (20.8 and 80%, respectively). 9 Comparably high fatality rates for sepsis and septic shock have been observed in other middle-and low-income countries. In a cohort study from Tunisia that included 100 septic shock patients, the overall fatality rate was 82%.…”

Section: Discussionmentioning

confidence: 94%

“…8 In a 2008 study, the rate of sepsis among patients admitted to ICUs was found to be twice as high in Mongolia as in Austria. 9 In 2001, 2004 and 2008, international experts released guidelines for the management of patients with severe sepsis and septic shock. [10][11][12] Known as the Surviving Sepsis Campaign (SSC) guidelines, they are among the first international consensus guidelines for septic patients needing intensive care and include recommendations on initial resuscitation, infection management, haemodynamic support, adjunctive therapy and other supportive measures.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nationwide survey on resource availability for implementing current sepsis guidelines in Mongolia

Bataar

Lundeg

Tsenddorj

et al. 2010

Bull. World Health Organ.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nationwide survey on resource availability for implementing current sepsis guidelines in Mongolia

Bataar

Lundeg

Tsenddorj

et al. 2010

Bull. World Health Organ.

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“…Similar evidence exists regarding the implementation of best practices for the care of sepsis patients [3]. Unfortunately, studies of ICU practices in developing countries suggest that compliance with best practices is worse than that reported in developed countries [4,5], with recent calls for greater interest to be taken in quality improvement as a global health priority [6]. …”

mentioning

confidence: 99%

A cluster randomized trial of a multifaceted quality improvement intervention in Brazilian intensive care units: study protocol

Cavalcanti¹

2015

Implementation Sci

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BackgroundThe uptake of evidence-based therapies in the intensive care environment is suboptimal, particularly in limited-resource countries. Checklists, daily goal assessments, and clinician prompts may improve compliance with best practice processes of care and, in turn, improve clinical outcomes. However, the available evidence on the effectiveness of checklists is unreliable and inconclusive, and the mechanisms are poorly understood. We aim to evaluate whether the use of a multifaceted quality improvement intervention, including the use of a checklist and the definition of daily care goals during multidisciplinary daily rounds and clinician prompts, can improve the in-hospital mortality of patients admitted to intensive care units (ICUs). Our secondary objectives are to assess the effects of the study intervention on specific processes of care, clinical outcomes, and the safety culture and to determine which factors (the processes of care and/or safety culture) mediate the effect of the study intervention on mortality.Methods/designThis is a cluster randomized trial involving 118 ICUs in Brazil conducted in two phases. In the observational preparatory phase, we collect baseline data on processes of care and clinical outcomes from 60 consecutive patients with lengths of ICU stay longer than 48 h and apply the Safety Attitudes Questionnaire (SAQ) to 75% or more of the health care staff in each ICU. In the randomized phase, we assign ICUs to the experimental or control arm and repeat data collection. Experimental arm ICUs receive the multifaceted quality improvement intervention, including a checklist and definition of daily care goals during daily multidisciplinary rounds, clinician prompting, and feedback on rates of adherence to selected care processes. Control arm ICUs maintain usual care. The primary outcome is in-hospital mortality, truncated at 60 days. Secondary outcomes include the rates of adherence to appropriate care processes, rates of other clinical outcomes, and scores on the SAQ domains. Analysis follows the intention-to-treat principle, and the primary outcome is analyzed using mixed effects logistic regression.DiscussionThis is a large scale, pragmatic cluster-randomized trial evaluating whether a multifaceted quality improvement intervention, including checklists applied during the multidisciplinary daily rounds and clinician prompting, can improve the adoption of proven therapies and decrease the mortality of critically ill patients. If this study finds that the intervention reduces mortality, it may be widely adopted in intensive care units, even those in limited-resource settings.Trial registrationClinicalTrials.gov NCT01785966Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0190-0) contains supplementary material, which is available to authorized users.

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“…The epidemiology of critical illness in Mongolian intensive care units is comparable to Western countries with a high prevalence of stroke, liver failure and traumatic brain injury [4]. Mortality of a general intensive care population was substantial ranging around 25% [4, 5]. Health care facilities in Mongolia are separated into three different levels of care.…”

Section: Introductionmentioning

confidence: 99%

Management of potentially life-threatening emergencies at 74 primary level hospitals in Mongolia: results of a prospective, observational multicenter study

et al. 2016

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BackgroundWhile the capacities to care for and epidemiology of emergency and critically ill patients have been reported for secondary and tertiary level hospitals in Mongolia, no data exist for Mongolian primary level hospitals.MethodsIn this prospective, observational multicenter study, 74 primary level hospitals of Mongolia were included. We determined the capacities of these hospitals to manage medical emergencies. Furthermore, characteristics of patients presenting with potentially life-threatening emergencies to these hospitals were evaluated during a 6 month period.ResultsAn emergency/resuscitation room was available in 62.2% of hospitals. One third of the study hospitals had an operation theatre (32.4%). No hospital ran an intensive care unit or had trained emergency/critical care physicians or nurses available. Diagnostic resources were inconsistently available (sonography, 59.5%; echocardiography, 0%). Basic emergency procedures (wound care, 97.3%; foreign body removal, 86.5%; oxygen application, 85.2%) were commonly but advanced procedures (advanced cardiac life support, 10.8%; airway management, 13.5%; mechanical ventilation, 0%; renal replacement therapy, 0%) rarely available. During 6 months, 14,545 patients were hospitalized in the 74 study hospitals, of which 8.7% [n = 1267; median age, 34 (IQR 18–53) years; male gender, 54.4%] were included in the study. Trauma (excl. brain trauma) (20.4%), acute abdomen (16.9%) and heart failure (9.6%) were the most common conditions. Five-hundred-thirty patients (41.8%) were transferred to a secondary level hospital. The hospital mortality of patients not transferred was 3.2%.ConclusionsCapacities of Mongolian primary level hospitals to manage life-threatening emergencies are highly limited. Trauma, surgical and medical conditions make up the most common emergencies. In view of the fact that almost half of the patients with a potentially life-threatening emergency were transferred to secondary level hospitals and the mortality of those hospitalized in primary level hospitals was 3.2%, room for improvement is clearly evident. Based on our findings, improvements could be obtained by strengthening inter-hospital transfer systems, training staff in emergency/critical care skills and by making mechanical ventilation and advanced life support techniques available at the emergency rooms of primary level hospitals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-017-0127-4) contains supplementary material, which is available to authorized users.

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Differences in critical care practice between an industrialized and a developing country

Cited by 22 publications

References 21 publications

Nationwide survey on resource availability for implementing current sepsis guidelines in Mongolia

Nationwide survey on resource availability for implementing current sepsis guidelines in Mongolia

A cluster randomized trial of a multifaceted quality improvement intervention in Brazilian intensive care units: study protocol

Management of potentially life-threatening emergencies at 74 primary level hospitals in Mongolia: results of a prospective, observational multicenter study

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