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  

作　　者：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 

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

出　　处：《Open Journal of Anesthesiology》2018年第6期183-197,共15页麻醉学期刊（英文）

摘　　要：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.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.

关 键 词：Intensive CARE Unit (ICU) Critical CARE Mechanical Ventilation ENDOTRACHEAL Ventilation ANESTHESIOLOGIST Low and Moderate-Income Country Austere Environment Telemedicine 

分 类 号：R73[医药卫生—肿瘤]