Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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There was a lack of available data regarding intensive care unit (ICU) characteristics, human resources, workload, and ICU outcomes in Thai ICUs. Therefore, the objectives of the present study were to describe these parameters and to demonstrate the association of these predictors to ICU outcome indicators including crude mortality, ventilator days and ICU length of stay (ICU-LOS). ⋯ Thai ICUs showed differences in administration systems. The outcome indicators of crude mortality, ventilator days and ICU-LOS were impacted by the ICU characteristics, human resources and ICU workload (Thai Clinical Trial Registry: TCTR-201200005).
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Acute right ventricular dysfunction (RVD) is one of the hemodynamic alterations in patients with septic shock, pulmonary embolism and ARDS. This condition had previously been diagnosed by pulmonary artery catheters (PAC). This report is on the use of transthoracic echocardiography (TTE) to diagnose RVD in critically ill patients. ⋯ TTE is an accurate tool for the diagnosis RVD in critically ill patients with acceptable sensitivities and specificities.
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There have been no data available on physicians and nurses who are vital human resources in Thailand. The objective of this study is to describe these characteristics as well as their working patterns in Thai ICUs. ⋯ Intensivists continue to be only scarcely available in Thai ICUs. Nurse workloads in non-academic ICUs were higher than those in academic ICUs. Specialty training for certified critical care nurses is in place for only one-third of the total number of ICU nurses. APNs are available in 25% of participating ICUs (Thai Clinical Trial Registry: TCTR201200005).
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Pragmatic surveys for shock management by Thai physicians are unavailable. The objective of this study is to identify the shock management patterns on both; the incidence of septic shock and hemorrhagic shock here in Thailand. ⋯ Most physicians manage shock with the current protocols. Hemodynamic goals are preferred over tissue perfusion targets. Early antimicrobial therapy and de-escalation are routinely practiced without the use of infective biomarkers. Crystalloids are preferred over colloids for the initial resuscitation. CVPs and fluid challenges are still preferred over the new fluid responsiveness methods for preload assessment. Hydrocortisone is the most common steroid prescribed for septic shock but the threshold of initiation, frequency of use and methods of discontinuation vary.
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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.