Conformity to the Surviving Sepsis Campaign International Guidelines among Physicians in a general Inensive care unit in Nairobi

Background: There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage. Objectives: To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit. Design: Cross sectional observational study. Setting: The general intensive care unit, Aga Khan University Hospital, Nairobi. Subjects: Admitting physicians from all specialties in the general intensive care unit. Results: The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had moderate conformity rates for blood cultures prior to administering antibiotics (57%) and administration of antibiotics within first hour of recognition of septic shock (54%). There was high conformity rate to the glucose control policy (81%), use of protective lung strategy in acute lung injury/Acute respiratory distress syndrome, venous thromboembolism prophylaxis (100%) and stress ulcer prophylaxis (100%) in the management bundle. Conformity was moderate for use of sedation, analgesia and muscle relaxant policy (69%), continuous renal replacement therapies (54%) and low for steroid policy (35%), administration ofdrotrecogin alfa (0%) and selective digestive decontamination (15%). Conclusion: There is varying conformity to the international sepsis guidelines among physicians caring for patients in our general ICU. Since increased conformity would improve survival and reduce morbidity, there is need for sustained education and guideline based performance improvement.East African Medical Journal Vol. 87 No. 8 August 201

Course and outcome of obstetric patients admitted to a University Hospital Intensive Care Unit

Background: Obstetric Critical Care is an important service in the reduction of maternal morbidity and mortality, but few developing country data are available.Objectives: To review all maternity patients admitted to the ICU over a seven year period to determine the causes and outcomes of these admissions and the frequency and causes of maternal morbidity and mortality.Design: Retrospective patient file and ICU chart review.Subjects: ICU Charts and medical files of obstetric patients admitted to the ICU at The Aga Khan University Hospital between (November 2003 – November 2010) were reviewed.Setting: The ICU at The Aga Khan University Hospital, Nairobi, Kenya.Results: Fourty two obstetric patients were admitted to the intensive care unit for the period of November 2003 to November 2010. This constituted 0.24% of deliveries and 1.25% of ICU admissions. Seventeen patients (52%) were in the age group 30 to 40 years, 13 patients (45%) were on their second pregnancy, and 15 patients (51%) were at term. Twenty five patients (76%) did not have prior co-morbidities. Indications for ICU admission were haemorrhage 15 (44%), sepsis nine (26%), help syndrome four (12%), thromboembolism two (6%), cardiomyopathy two (6%) and anaemia two (6%). The duration of stay ranged from two to 35 days with a mean of seven and median of two days. The outcome was19 patients (58%) were discharged home, 11 patients (33%) deaths and three patients (9%) were transferred to the National referral hospital- their survival outcome unknown. Case fatality rates were three of four patients (75%) for HELLP syndrome, four of fifteen patients (26.7%) for haemorrhage and three of ten patients (30%) after sepsis.Conclusion: Critical Care Obstetrics is vital to the reduction of maternal morbidity. The main indications for ICU admission may be unpredictable but are largely preventable by improved and timely antenatal and intrapartum care. For the few but very sick patients requiring ICU care, a team based approach, as is achieved using the ‘closed’ care model may be feasible. Support to peripheral obstetric facilities via public private partnership initiatives is necessary. Healthcare planners and financiers should factor in critical care obstetric needs. Provision of a planned level of obstetric intensive care with the associated triage and referral infrastructure is a priority for the Region. As part of the drive towards Millennium Development Goal 5, health care financing models should support this essential component of life saving care, through all available channels including public private partnership