Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providers
Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providers
复制标题
DOI：
10.1186/cc9410
复制
发表时间：
2011-01-01
期刊：
影响因子：
15.1
通讯作者：
Duenser, Martin W.
中科院分区：
文献类型：
--
作者：
Baelani, Inipavudu;Jochberger, Stefan;Duenser, Martin W.
简介：目前尚不清楚在非洲是否有必要的资源来实施败血症生存运动指南和败血症捆绑包。这种自我报告，大陆范围内的调查比较了非洲和高收入国家之间的这些资源的可用性，以及两个非洲地区（撒哈拉以南非洲与南非，毛里求斯和北方非洲国家）。方法：这项研究是作为一个匿名的麻醉剂为基础的，横断面调查麻醉供应商参加一个跨大陆的大会。根据答复者的国家实践，将收回的调查表分为非洲国家和高收入国家。该问卷包含74个项目，并评估了实施最新败血症生存运动指南所需的所有物质资源。组间比较采用卡方检验、Fisher精确检验或Mann Whitney U检验。结果：总有效率为74.3%（318/428）。分析了307份问卷（非洲国家，n = 263;高收入国家，n = 44）。与高收入国家的受访者相比，非洲医院的受访者不太可能有急诊室（85.5%对97.7%，P = 0.03）或重症监护室（73.8%对100%，P < 0.001）。在非洲，实施败血症生存运动指南或败血症捆绑所需的药物、设备和一次性材料的供应频率低于高收入国家。在所有非洲和撒哈拉以南非洲国家中，1.5%（4/263）和1.2%（3/248）的受访者拥有可用于全面实施败血症生存运动指南的资源。非洲国家可执行建议的百分比低于高收入国家（72.6（57.7至87.7）% vs. 100（100 - 100）%，P < 0.001），撒哈拉以南非洲国家低于南非、毛里求斯、和北方非洲国家（72.6（56.2至86.3）% vs. 90.4（71.2 ~ 94.5）%，P = 0.02）。这项自我报告的调查结果强烈表明，最新的败血症生存指南不能在非洲实施，特别是在撒哈拉以南非洲，由于缺乏所需的医院设施、设备、药品和一次性材料，然而，实施大多数强有力的败血症生存运动建议和败血症捆绑包的资源的可用性可能允许根据可用资源修改当前的败血症指南，并在非洲败血症护理中实施大量挽救生命的干预措施。
Introduction: It is unknown whether resources necessary to implement the Surviving Sepsis Campaign guidelines and sepsis bundles are available in Africa. This self-reported, continent-wide survey compared the availability of these resources between African and high-income countries, and between two African regions (Sub-Sahara Africa vs. South Africa, Mauritius and the Northern African countries).Methods: The study was conducted as an anonymous questionnaire-based, cross-sectional survey among anaesthesia providers attending a transcontinental congress. Based on the respondents' country of practice, returned questionnaires were grouped into African and high-income countries. The questionnaire contained 74 items and evaluated all material resources required to implement the most recent Surviving Sepsis Campaign guidelines. Group comparisons were performed with the Chi(2), Fisher's Exact or Mann Whitney U test, as appropriate.Results: The overall response rate was 74.3% (318/428). Three-hundred-seven questionnaires were analysed (African countries, n = 263; high-income countries, n = 44). Respondents from African hospitals were less likely to have an emergency room (85.5 vs. 97.7%, P = 0.03) or intensive care unit (73.8 vs. 100%, P < 0.001) than respondents from high-income countries. Drugs, equipment, and disposable materials required to implement the Surviving Sepsis Campaign guidelines or sepsis bundles were less frequently available in African than high-income countries. Of all African and Sub-Saharan African countries, 1.5% (4/263) and 1.2% (3/248) of respondents had the resources available to implement the Surviving Sepsis Campaign guidelines in entirety. The percentage of implementable recommendations was lower in African than in high-income countries (72.6 (57.7 to 87.7)% vs. 100 (100 to 100)%, P < 0.001) and lower in Sub-Saharan African countries than South Africa, Mauritius, and the Northern African countries (72.6 (56.2 to 86.3)% vs. 90.4 (71.2 to 94.5)%, P = 0.02).Conclusions: The results of this self-reported survey strongly suggest that the most recent Surviving Sepsis guidelines cannot be implemented in Africa, particularly not in Sub-Saharan Africa, due to a shortage of required hospital facilities, equipment, drugs and disposable materials. However, availability of resources to implement the majority of strong Surviving Sepsis Campaign recommendations and the sepsis bundles may allow modification of current sepsis guidelines based on available resources and implementation of a substantial number of life-saving interventions into sepsis care in Africa.