Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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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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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.
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Septicemia is a major cause of death for patients in the intensive care unit. Patient care is not only a function of doctors or nurses but also requires teamwork from all healthcare professionals. Starting from the screening of the patient in the emergency room, management of these patients includes; early antimicrobial therapy, controlling the source of the infection, initiating hemodynamic therapy, admitting the patient to the intensive care unit, monitoring and surveillance for complications of mechanical ventilation and multiple organ failure. ⋯ Lack of understanding and knowledge in the management of clinical practices can predispose the patient to errors in the treatment of patients here, in Thailand. This present guideline is acceptable as an international standard and is the current practice of the Faculty of Medicine, Vajira Hospital, Navamindradhiraj University. This is an example of the multidisciplinary management of septicemia patients in a university hospital in Thailand as set by international standards.
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Critical care medicine, one of the newest medical specialties in Thailand, has had most of its evolution in the past 25 years. There have been many advances and critical care services in major regional hospitals and currently, most university medical centers have become state of the art. Critical care fellowship training; a subspecialty certification of the primary board of internal medicine, anesthesiology, and surgery; has been in place for approximately 14 years. ⋯ The movement toward one ASEAN community has prompted government policies to encourage Thailand to become the Medical Hub of Asia as well as a world-class destination for healthcare. Thus, the demand for critical care services will increase disproportionally when compared to the training capacity and its popularity as a specialty to new medical graduates. A critical look at critical care medicine by policymakers and the medical community is a blueprint for preparing and optimizing the critical care workforce regarding future planning and the development of future policies.