Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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There are varieties of clinical practices for intensive care respiratory support. However there has been no published report characterizing its current practice in Thailand. The present study was undertaken to characterize the practice of respiratory support for intensive care patients in Thai tertiary hospitals. ⋯ The VC-CMV was more commonly used as the initial mode of ventilation in both surgical and medical ICUs. Pressure support was the predominant weaning mode in the medical ICUs, while SIMV was more predominant in the surgical ICUs. Individual patients in medical ICU had a greater number of ventilator days and less probability of being ventilator-free.
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Fluid management is one of the most important treatments for critically ill patients. It has an influence in patients outcomes and is considered one of the most common pitfalls encountered in the management of the critically ill patient. In Thailand, fluid overload (> 10% of fluid accumulation), mismanagement of fluid restrictions and the "bolusing" of colloid solutions are the main pitfalls that may lead to serious complications. ⋯ Evaluation of the fluid responsiveness for goal directed therapy is another problem in Thailand. This has been predominant in critically ill surgical patients both intra-operatively and postoperatively. To obtain optimal benefits of fluid therapy and for the prevention of complications associated with this treatment, physician need to acquire more knowledge, choose the right strategy, choose the proper type and amount of colloid and assure the correct mode of evaluation.
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The problem of a shortage of intensivists in Thailand is increasing annually. As stated in The Thai Society of Critical Care Medicine Database, 2013, the number of qualified intensivists currently is 163, working in 76 provinces in Thailand. This disproportion in the ratio of intensivists has affected patient outcomes. ⋯ Their competencies vary depending on their experience and training. In other countries, there has been evidence that properly trained hospitalists can work effectively in the ICU. This awareness of the importance of intensivists in Thailand is one of the stifling factors; the improvement of the hospitalists, determining the hospitalists' workforce and increasing the number of the intensivists to match future demands are needed.
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Septic shock is a serious condition associated with a high mortality rate. The 'Early goal-directed therapy" has been reported as the effective treatment. Whether or not an intensive care unit (ICU) admission can improve the outcomes of septic shock patients, has not been elucidated. ⋯ Apart from the early goal-directed therapy, early ICU admission substantially improves the outcomes of septic shock patients.
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Ventilator-associated pneumonia (VAP) is a serious illness with substantial morbidity and mortality resulting in increased costs of hospital care. Even though bundles of care to prevent VAP have been established, the incidence has not been shown to have improved. ⋯ The incidence of VAP was high in the SICU. VAP bundles including weaning protocols and airway care should be implemented.