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