Bild 1

1
Background to MKAIC VSDT
2
Introduction

• MKAIC The context for VSDT
• Research background to VSDT
• Vital Signs are the basis of critical care

3
MKAIC

• Long term collaboration since 2008
• Karolinska 200 anaesthesiologists
• Muhimbili 4 anaesthesiologists
• Aims
• Improve Anaesthesia Intensive Care
• Increase understanding between countries
• Courses, exchanges, guidelines, research,
  equipment

4
MKAIC 2013

• Training
• Refresher Course in Obstetric Anaesthesia for 63
  participants
• (Total now trained on MKAIC courses 226)
• Training-of-Trainers course at Muhimbili for 9
  trainers
• Exchanges
• 6 exchanges to Karolinska from Muhimbili for
  doctors nurses
• Bedside teaching in Muhimbili by 3 doctors 3
  nurses from Stockholm

5
MKAIC 2013

• Equipment
• Donation of 22 pulse oximeters
• Donation of a bedside Haemoglobin machine and 100
  tests
• Donation of an Ambu intubation dummy
• Donation of 80 books
• Donation of 50 USB Memory sticks filled with
  medical e-books information
• Research
• Publication of Emergency and Critical Care
  Services in Tanzania a survey of 10 hospitals
• 3 Resident Doctor Research Projects
• 2 Manuscripts for research projects Paediatric
  Anaesthesia at Muhimbili and Obstetric
  Anaesthesia at Muhimbili

6
What facilities and resources do hospitals in
Tanzania have for critical care?
7
Method

• Ten hospitals from four regions of Tanzania
• Cross-sectional survey
• Structured interview and facilities assessment
  using a data collection tool
• Quality assessed using newly developed standards

8
(No Transcript)
9
How can we improve routines for critical care?

• Needs to be nurse-led as nurses are always
  present
• Needs to allow continuous changes to treatment as
  patient changes condition
• Goal Directed Therapy

10
Goal- directed therapy

• Rivers 2001 reduced mortality by 30 in Detroit
• Give treatment based on goals
• Goals were ScVO2, CVP etc

11
Vital Signs

• HR
• RR
• BP
• Saturation
• Conscious Level
• (Temp, Urine Output)

12
Vital Signs

• Signs of how stable the body is
• Deranged vital signs show illness severity
• Many studies have shown deranged vital sigs are
  associated with death cardiac arrest
• ICUs in Karolinska other high income countries
  routinely use Vital Sign Goals for daily
  management of patients
• This has been shown to reduce mortality

13
Vital Signs Directed Therapy

• Designed by MKAIC
• Uses Vital Signs to continuously modify
  treatments
• Before-After research design
• Hope to reduce mortality by 20
• Implementation now

14
VSDT Team at Muhimbili

• Dr Lugazia
• Dr Mulungu
• Agness Laizer
• Erasto Kalinga
• Nazahed Richard
• Elizabeth Stephens

15
Vital Signs Directed Therapy

• NIMR Ethical Clearance
• MUHAS Ethical Clearance
• COSTECH Research Clearance
• MNH Research permission
• Supported by ED, DSS, HoD (Dr Mulungu Dr Rita)
• SOP

16
Summary

• VSDT is part of long term collaboration, MKAIC

• VSDT is based on previous research findings

Vital Signs Directed Therapy could reduce
mortality on ICU