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Background to MKAIC & VSDT
Introduction
• MKAIC: The context for VSDT
• Research background to VSDT
• Vital Signs are the basis of critical care
MKAICLong term collaboration since 2008
Karolinska: 200 anaesthesiologistsMuhimbili: 4 anaesthesiologists
Aims– Improve Anaesthesia & Intensive Care– Increase understanding between countries
Courses, exchanges, guidelines, research, equipment
MKAIC 2013Training
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
MKAIC 2013Equipment
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”
What facilities and resources do hospitals in Tanzania have for critical care?
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
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
Goal- directed therapy
• Rivers 2001 – reduced mortality by 30% in Detroit
• Give treatment based on goals• Goals were ScVO2, CVP etc
Vital Signs
• HR• RR• BP• Saturation• Conscious Level• (Temp, Urine Output)
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
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
VSDT Team at Muhimbili
• Dr Lugazia• Dr Mulungu• Agness Laizer• Erasto Kalinga• Nazahed Richard• Elizabeth Stephens
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
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