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<!DOCTYPE html><html><head><title>Sepsis Management in Resource-limited Settings - Google Books</title><link rel="stylesheet" href="/books/css/_a33f2a89320471e58c940b9287b9d4eb/kl_viewport_kennedy_full_bundle.css" type="text/css" /><link rel="stylesheet"href="https://fonts.googleapis.com/css2?family=Product+Sans:wght@400"><script src="/books/javascript/v2_a33f2a89320471e58c940b9287b9d4eb__en.js"></script><script>_OC_Hooks = ["_OC_Page", "_OC_SearchReload", "_OC_TocReload", "_OC_EmptyFunc", "_OC_SearchPage", "_OC_QuotePage" ];for (var _OC_i = 0; _OC_i < _OC_Hooks.length; _OC_i++) {eval("var " + _OC_Hooks[_OC_i] + ";");}function _OC_InitHooks () {for (var i = 0; i < _OC_Hooks.length; i++) {var func = arguments[i];eval( _OC_Hooks[i] + " = func;");}}</script><link rel="canonical" href="https://books.google.com/books/about/Sepsis_Management_in_Resource_limited_Se.html?id=MkWHDwAAQBAJ"/><meta property="og:url" content="https://books.google.com/books/about/Sepsis_Management_in_Resource_limited_Se.html?id=MkWHDwAAQBAJ"/><meta name="title" content="Sepsis Management in Resource-limited Settings"/><meta name="description" content="This book is open access under a CC BY 4.0 license. It constitutes a unique source of knowledge and guidance for all healthcare workers who care for patients with sepsis and septic shock in resource-limited settings.More than eighty percent of the worldwide deaths related to sepsis occur in resource-limited settings in low and middle-income countries. Current international sepsis guidelines cannot be implemented without adaptations towards these settings, mainly because of the difference in local resources and a different spectrum of infectious diseases causing sepsis. This prompted members of the Global Intensive Care working group of the European Society of Intensive Care Medicine (ESICM) and the Mahidol-Oxford Tropical Medicine Research Unit (MORU, Bangkok, Thailand) - among which the Editors – to develop with an international group of experts a comprehensive set of recommendations for the management of sepsis in resource-limited settings. Recommendations are based on both current scientific evidence and clinical experience of clinicians working in resource-limited settings. The book includes an overview chapter outlining the current challenges and future directions of sepsis management as well as general recommendations on the structure and organization of intensive care services in resource-limited settings. Specific recommendations on the recognition and management of patients with sepsis and septic shock in these settings are grouped into seven chapters. The book provides evidence-based practical guidance for doctors in low and middle income countries treating patients with sepsis, and highlights areas for further research and discussion. 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Over time it became apparent that the true ... \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings where the majority of sepsis mortality resides . Reasons were multiple , ranging from a\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PR9\u0026vq=resource-limited+ICUs"},{"page_id":"PR11","page_number":"xi","snippet_text":"... \u003cb\u003eResource\u003c/b\u003e- \u003cb\u003eLimited\u003c/b\u003e Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Marcus J. Schultz, Martin W. Dünser, and Arjen M. Dondorp 3 Infrastructure and Organization of Adult \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e-\u003cb\u003eLimited\u003c/b\u003e\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PR11\u0026vq=resource-limited+ICUs"},{"page_id":"PR15","page_number":"xv","snippet_text":"... Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Pedro Povoa ... \u003cb\u003eICUs\u003c/b\u003e Contributors xv.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PR15\u0026vq=resource-limited+ICUs"},{"page_id":"PA3","page_number":"3","snippet_text":"... ( \u003cb\u003eICU\u003c/b\u003e ) admission in LMIC . These patients will cur- rently often be treated in general wards , but basic intensive care facilities are becom- ing increasingly available . The scope of the current review is \u003cb\u003elimited\u003c/b\u003e to the \u003cb\u003eICU\u003c/b\u003e setting . \u003cb\u003eICUs\u003c/b\u003e\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA3\u0026vq=resource-limited+ICUs"},{"page_id":"PA6","page_number":"6","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings [34]. We tend to look at LMICs as if they are “uniform,” but this is a too simplistic if not naive approach. Within and between LMICs, there is an important heterogeneity ... Poor Availability of Critical Care.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA6\u0026vq=resource-limited+ICUs"},{"page_id":"PA7","page_number":"7","snippet_text":"... limited mechanical equipment , number of ventilator , renal limited mechanical replacement availability of ventilators , therapy ) advanced widespread treatment unavailability of modalities such as ... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003ePoor\u003c/b\u003e ... 7.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA7\u0026vq=resource-limited+ICUs"},{"page_id":"PA8","page_number":"8","snippet_text":"... \u003cb\u003elimited\u003c/b\u003e budget of many families leaving them with high debts or even causing private bankruptcy . 1.2.4 Incomplete ... \u003cb\u003eICUs\u003c/b\u003e are frequently \u003cb\u003elimited\u003c/b\u003e in the availability of equipment , laboratory support , and skilled physician and\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA8\u0026vq=resource-limited+ICUs"},{"page_id":"PA9","page_number":"9","snippet_text":"... \u003cb\u003eRESOURCE\u003c/b\u003e - RICH SETTINGS , where most patients do have BACTERIAL SEPSIS . FLUID THERAPY IN NON - BACTERIAL SEPSIS ... \u003cb\u003eICUs\u003c/b\u003e , up to a staggering 1 % of total gross domes- tic product in the United States [ 51 ] , demand their\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA9\u0026vq=resource-limited+ICUs"},{"page_id":"PA10","page_number":"10","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in LMICs (Table 1.2). For several reasons these cost-effectiveness ratios might be conservative in the context of LMICs. First, the cost of \u003cb\u003eICUs\u003c/b\u003e in these countries is much lower than in HICs. The two largest standardized\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA10\u0026vq=resource-limited+ICUs"},{"page_id":"PA11","page_number":"11","snippet_text":"... \u003cb\u003eICU\u003c/b\u003e ( USA ) Conventional Intervention EGDT in ED or \u003cb\u003eICU\u003c/b\u003e Standard care Cost / QALY ( in 2015 US $ ) $ 3506- 8953 Talmor Prospective cohort study of Integrated Standard care et al . 2008 patients ... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003ePoor\u003c/b\u003e ... 11.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA11\u0026vq=resource-limited+ICUs"},{"page_id":"PA12","page_number":"12","snippet_text":"... Critical Care Among Regions The mean age of adult patients admitted to \u003cb\u003eICUs\u003c/b\u003e in HICs is consistently higher than those reported in LMICs . For example , in European \u003cb\u003eICUs\u003c/b\u003e , the mean age of adult admissions is typically 55-66 years , much\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA12\u0026vq=resource-limited+ICUs"},{"page_id":"PA13","page_number":"13","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in LMICs . The same is true for scoring systems in children , and scoring systems that are context relevant should also be explored because the Predicted Risk of Mortality may underpredict ... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003ePoor\u003c/b\u003e ... 13.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA13\u0026vq=resource-limited+ICUs"},{"page_id":"PA14","page_number":"14","snippet_text":"... critical care and global public health [82], but quality improvement in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e remains largely unexplored [44, 83]. The latter requires some ability to bench- mark ICUs with severity of illness scores, also a nascent area\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA14\u0026vq=resource-limited+ICUs"},{"page_id":"PA15","page_number":"15","snippet_text":"... could be in particular 1 Current Challenges in the Management of Sepsis in \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003ePoor\u003c/b\u003e ... 15 1.4.2 Challenges with Research in Resource-Restricted Settings 1.5 Suggestions for the Future 1.5.1 Better Definition of Sepsis.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA15\u0026vq=resource-limited+ICUs"},{"page_id":"PA17","page_number":"17","snippet_text":"... limited areas of the world , which could lead to additional studies of this kind [ 44 ] . Beyond these broad areas of research , specific subtypes deserve special attention in ... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003ePoor\u003c/b\u003e ... 17 1.5.4 Opportunities.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA17\u0026vq=resource-limited+ICUs"},{"page_id":"PA18","page_number":"18","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e constraints can yield gains for all. Critical care could be ripe for this at times called “frugal ... \u003cb\u003elimited\u003c/b\u003e settings is a largely unexplored frontier with a clear mandate and exciting opportunities for impact\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA18\u0026vq=resource-limited+ICUs"},{"page_id":"PA19","page_number":"19","snippet_text":"... Limited Interventions for Sepsis Management in Uganda Study Group . Severe sepsis in two Ugandan hospitals : a prospective observational study of management and outcomes in a predominantly HIV - 1 ... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003ePoor\u003c/b\u003e ... 19.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA19\u0026vq=resource-limited+ICUs"},{"page_id":"PA20","page_number":"20","snippet_text":"... , Sadat M , Asian Critical Care Clinical Trials Group . Structure , organization , and delivery of critical care in Asian \u003cb\u003eICUs\u003c/b\u003e . Crit Care Med . 2016 ; 44 : e940-8 . 44. Dondorp AM , Iyer SS , Schultz MJ . 20 M. J. Schultz et al .","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA20\u0026vq=resource-limited+ICUs"},{"page_id":"PA23","page_number":"23","snippet_text":"... critical care practice . World J Crit Care Med . 2015 ; 4 : 55–61 . 86. Baker T , Schell CO , Lugazia E , Blixt J , Mulungu M , Castegren M , Eriksen J , Konrad D. Vital signs directed therapy ... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003ePoor\u003c/b\u003e ... 23.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA23\u0026vq=resource-limited+ICUs"},{"page_id":"PA26","page_number":"26","snippet_text":"... \u003cb\u003eResource\u003c/b\u003e-\u003cb\u003eLimited\u003c/b\u003e Settings” guide- lines group, Marcus J. Schultz, Martin W. Dünser, and Arjen M. Dondorp ... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings. In total, three subgroup chairs per set of recommendations were contacted. Marcus\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA26\u0026vq=resource-limited+ICUs"},{"page_id":"PA28","page_number":"28","snippet_text":"... resource-limited settings, i.e., availability and feasibility in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e, affordability for low-resource ICUs, and last but not the least its safety in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e (Table 2.3). A strong recommendation was worded\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA28\u0026vq=resource-limited+ICUs"},{"page_id":"PA30","page_number":"30","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings . Intensive Care Med . 2017 ; 44 ( 7 ) : 1133–7 . 3. Mer M , Schultz MJ , Adhikari NK , European Society of Intensive Care Medicine Global Intensive Care Working G , the Mahidol - Oxford Research Unit\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA30\u0026vq=resource-limited+ICUs"},{"page_id":"PA31","page_number":"31","snippet_text":"... \u003cb\u003eintensive care units\u003c/b\u003e ( \u003cb\u003eICUs\u003c/b\u003e ) are based on evidence primarily from resource - rich settings [ 1 ] . These guidelines may be less applicable to \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings [ 2 ] . \u003cb\u003eICUs\u003c/b\u003e A. Papali Division of Pulmonary and Critical Care\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA31\u0026vq=resource-limited+ICUs"},{"page_id":"PA32","page_number":"32","snippet_text":"... \u003cb\u003eICU\u003c/b\u003e entails. In this chapter, we aim to answer seven questions basic prerequisites for quality intensive care in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings: (1) Which healthcare professionals should provide care in \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e- \u003cb\u003elimited\u003c/b\u003e settings? (2)\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA32\u0026vq=resource-limited+ICUs"},{"page_id":"PA33","page_number":"33","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e use a closed - format model where physicians specifically trained or experienced in intensive care medicine direct patient care ( 2B ) . We further suggest that \u003cb\u003eICUs\u003c/b\u003e be staffed ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 33.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA33\u0026vq=resource-limited+ICUs"},{"page_id":"PA34","page_number":"34","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e have one or more mechanical ventilators available (1C). These mechanical ventilators should also deliver ... \u003cb\u003eresource\u003c/b\u003e-rich settings also show that the nurse–staffing model affects outcomes of critically ill patients [10]. More\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA34\u0026vq=resource-limited+ICUs"},{"page_id":"PA35","page_number":"35","snippet_text":"... ICU teams in resource - limited settings were identified by our search . Data on implementation of telemedicine in \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited ICUs\u003c/b\u003e is minimal despite reports of successful implementation in areas with a scarcity of specialists\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA35\u0026vq=resource-limited+ICUs"},{"page_id":"PA36","page_number":"36","snippet_text":"... limited in many ICUs in resource-limited settings [46]. Limited availability of nursing staff in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e naturally leads to low nurse-to-patient ratios of often 1:4 or higher, particularly during off-hours and weekends\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA36\u0026vq=resource-limited+ICUs"},{"page_id":"PA37","page_number":"37","snippet_text":"... limited knowledge about the pathophysiology and diagnostic and therapeutic management of critically ill patients [ 51 ] . It remains unclear how health- care professionals working in \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings , where no estab\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA37\u0026vq=resource-limited+ICUs"},{"page_id":"PA38","page_number":"38","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings. We suggest that all healthcare professionals working in \u003cb\u003eICUs\u003c/b\u003e be specifically trained in the care of the critically ill patient (2C). Unless national or regional spe- cialty training programs in intensive\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA38\u0026vq=resource-limited+ICUs"},{"page_id":"PA39","page_number":"39","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e provide around - the - clock , life - sustaining therapies often by the use of electricity - driven machines such as mechanical ventilators , syringe pumps , or ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 39 3.4 Electricity.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA39\u0026vq=resource-limited+ICUs"},{"page_id":"PA40","page_number":"40","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings, especially given that many of these settings are located in tropical, sunny environments. Solar panel installation was associated with a significant reduction in mean inpatient pedi- atric mortality in\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA40\u0026vq=resource-limited+ICUs"},{"page_id":"PA41","page_number":"41","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings with oxygen : oxygen cylinders , oxygen concentrators , and centralized , piped oxygen systems [ 73 ] . Oxygen cylinders provide pressurized oxygen at variably high flow rates but - depending on their\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA41\u0026vq=resource-limited+ICUs"},{"page_id":"PA42","page_number":"42","snippet_text":"... \u003cb\u003eICU\u003c/b\u003e with oxygen depends on site-specific requirements and conditions. A non-\u003cb\u003eICU\u003c/b\u003e study from The Gambia found that cylinders were better than concentrators due to local factors at 10 ... \u003cb\u003eICU\u003c/b\u003e in a \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e 42 A. Papali et al.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA42\u0026vq=resource-limited+ICUs"},{"page_id":"PA43","page_number":"43","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings choose the type of oxygen supply ( concentrators , cylinders , centralized system ) based on site - specific conditions and ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 43 3.6 Hygiene.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA43\u0026vq=resource-limited+ICUs"},{"page_id":"PA44","page_number":"44","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e and a renal dialysis unit found that hand rubbing with alcohol-based liquids or gels resulted in a higher reduction of bacterial counts on the hands of \u003cb\u003eICU\u003c/b\u003e staff compared to handwashing with soap and water (77–99% vs. 30%, p\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA44\u0026vq=resource-limited+ICUs"},{"page_id":"PA46","page_number":"46","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e or resource-rich settings on the architectural design of \u003cb\u003eICUs\u003c/b\u003e to prevent transmission of microbial pathogens were identified by our search and a previous review of the literature [118]. A pro- spective study from the\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA46\u0026vq=resource-limited+ICUs"},{"page_id":"PA47","page_number":"47","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e . In the absence of adequate hand hygiene dispensers , small pocket bottles containing alcohol - based hand rub solutions can be carried , used , and refilled by each \u003cb\u003eICU\u003c/b\u003e ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 47.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA47\u0026vq=resource-limited+ICUs"},{"page_id":"PA48","page_number":"48","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e countries, autoclavable gowns and cloths may be used instead for the majority of common \u003cb\u003eICU\u003c/b\u003e illnesses. For Ebola virus disease, the WHO emphasizes use of disposable personal protective equipment [132]. We recommend that\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA48\u0026vq=resource-limited+ICUs"},{"page_id":"PA50","page_number":"50","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e setting was feasible and adequate to make clinical decisions in the majority (89%) of cases [58] ... \u003cb\u003eICUs\u003c/b\u003e in Vietnam suggest that general intensive care measures, including mechan- ical ventilation, can improve\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA50\u0026vq=resource-limited+ICUs"},{"page_id":"PA51","page_number":"51","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e varies substantially between \u003cb\u003eresource\u003c/b\u003e- \u003cb\u003elimited\u003c/b\u003e regions [ 196–204 ] . Several studies suggest that hospitals in middle - income countries and metropolitan areas of low - income countries have more technical equipment available than\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA51\u0026vq=resource-limited+ICUs"},{"page_id":"PA52","page_number":"52","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings after short, structured education of \u003cb\u003eICU\u003c/b\u003e staff [159, 208]. A study from India even ... \u003cb\u003eICUs\u003c/b\u003e have basic vital signs monitors (including electrocardiogram, respiratory rate, oscillometric blood pressure\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA52\u0026vq=resource-limited+ICUs"},{"page_id":"PA53","page_number":"53","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in resource - rich settings and resulted in improved accuracy and legibility of documents , a meta - analysis failed to show that implementation of electronic medical records ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 53.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA53\u0026vq=resource-limited+ICUs"},{"page_id":"PA54","page_number":"54","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-rich countries, no evidence currently supports that they translate into improved patient outcomes. A reduction in the standardized mortality ratio in Dutch \u003cb\u003eICUs\u003c/b\u003e ... \u003cb\u003elimited\u003c/b\u003e settings [237– 239]. While several national and\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA54\u0026vq=resource-limited+ICUs"},{"page_id":"PA55","page_number":"55","snippet_text":"... Intensive Care Working Group of the European Society of Intensive Care Medicine . Current challenges in the management of sepsis in \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003epoor\u003c/b\u003e settings and suggestions for the future . Intensive Care Med . 2017 ; 43 : 612\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA55\u0026vq=resource-limited+ICUs"},{"page_id":"PA56","page_number":"56","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e worldwide : critical care in India . Crit Care . 2002 ; 6 ( 6 ) : 479–80 . 29. Sherman CB , Carter EJ ... \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e areas . Glob Heart . 2014 ; 9 ( 4 ) : 425–7 . 39. The World Bank . https://data.worldbank.org\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA56\u0026vq=resource-limited+ICUs"},{"page_id":"PA57","page_number":"57","snippet_text":"... critical care services in Tanzania : a survey of ten hospitals . BMC Health Serv Res . 2013 ; 13 : 140 . 44. Jochberger S , Ismailova F , Lederer W , Mayr VD , Luckner G , Wenzel V ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 57.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA57\u0026vq=resource-limited+ICUs"},{"page_id":"PA59","page_number":"59","snippet_text":"... \u003cb\u003eintensive care units\u003c/b\u003e in three cities of China . Public Health . 2015 ; 129 ( 7 ) : 979–88 . 88. Miranda - Novales MG , Sobreyra - Oropeza M , Rosenthal VD , Higuera F , Armas - Ruiz ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 59.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA59\u0026vq=resource-limited+ICUs"},{"page_id":"PA60","page_number":"60","snippet_text":"... \u003cb\u003eIntensive Care Unit\u003c/b\u003e. Pak J Med Sci. 2014;30(2):272–5. 101. Daschner F, Frank U, Just HM. Proven and unproven methods in hospital infection control in \u003cb\u003eintensive care units\u003c/b\u003e. Chemioterapia. 1987;6(3):184–9. 102. Croft LD, Harris AD\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA60\u0026vq=resource-limited+ICUs"},{"page_id":"PA61","page_number":"61","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e . Crit Care Med 2016 ; 44 ( 10 ) : e940–8 . 123. Escombe AR , Moore DA , Gilman RH , Navincopa M , Ticona E , Mitchell B , et al . Upper room ultraviolet light and negative air ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 61.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA61\u0026vq=resource-limited+ICUs"},{"page_id":"PA63","page_number":"63","snippet_text":"... Intensive Care Med . 2016 ; 42 ( 1 ) : 100–3 . 154. Becker DM , Tafoya CA , Becker SL , Kruger GH , Tafoya MJ , Becker TK . The use of portable ultrasound devices in low- and middle ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 63.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA63\u0026vq=resource-limited+ICUs"},{"page_id":"PA65","page_number":"65","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e ( \u003cb\u003eICU\u003c/b\u003e - resource I study ) . J Med Assoc Thail . 2014 ; 97 ( Suppl 1 ) : S15–21 . 199. Chittawatanarat K , Bunburaphong T , Champunot R. Mechanical ventilators availability sur ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 65.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA65\u0026vq=resource-limited+ICUs"},{"page_id":"PA66","page_number":"66","snippet_text":"... low-income countries: a cost-effectiveness analysis. Bull World Health Organ. 2014;92(12):858–67. 209. Chen A ... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003epoor\u003c/b\u003e settings and suggestions for the future. Intensive Care Med. 2017;43(5):612–24. 217. Thompson\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA66\u0026vq=resource-limited+ICUs"},{"page_id":"PA67","page_number":"67","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e improve outcome ? Curr Opin Crit Care . 2009 ; 15 ( 5 ) : 450–5 . 238. Rhodes A , Moreno RP , Azoulay E , Capuzzo M , Chiche JD , Eddleston J , et al . Prospectively defined ... \u003cb\u003eIntensive Care Units\u003c/b\u003e in \u003cb\u003eResource\u003c/b\u003e - \u003cb\u003eLimited\u003c/b\u003e ... 67.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA67\u0026vq=resource-limited+ICUs"},{"page_id":"PA86","page_number":"86","snippet_text":"... resource-rich settings. Knowledge translation to \u003cb\u003eintensive care units\u003c/b\u003e (\u003cb\u003eICUs\u003c/b\u003e) in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings is limited by restricted availability of skilled staff, equipment, and laboratory support, compounded by infrastructure and\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA86\u0026vq=resource-limited+ICUs"},{"page_id":"PA87","page_number":"87","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited ICUs\u003c/b\u003e Topic Corticosteroids Sedation Use of neuromuscular blocking agents Recommendation We suggest intravenous hydrocortisone ( 200 mg per day , or equivalent dose of another corticosteroid ) in adult patients with\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA87\u0026vq=resource-limited+ICUs"},{"page_id":"PA90","page_number":"90","snippet_text":"... low - \u003cb\u003eresource ICUs\u003c/b\u003e . The role of pressure monitoring via a central venous catheter to direct resuscitation and de - resuscitation is contentious . Conservative fluid administration may be associated with higher levels of blood urea\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA90\u0026vq=resource-limited+ICUs"},{"page_id":"PA94","page_number":"94","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings have advocated the administration of intravenous hydrocortisone (up to 300 mg/ day) or ... \u003cb\u003eICUs\u003c/b\u003e) and considering availability, feasibility, affordability, and safety, our recommenda- tion and grading are\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA94\u0026vq=resource-limited+ICUs"},{"page_id":"PA95","page_number":"95","snippet_text":"... ICUs . The search and references from relevant reviews did not produce any trials that directly addressed the question posed . The 2016 Surviving Sepsis guidelines made a best practice recommendation that ... \u003cb\u003eResource\u003c/b\u003e-\u003cb\u003eLimited ICUs\u003c/b\u003e.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA95\u0026vq=resource-limited+ICUs"},{"page_id":"PA96","page_number":"96","snippet_text":"... group of patients who received continuous intravenous sedation (n = 132, 41.1% of total), the protocol- directed ... \u003cb\u003eICUs\u003c/b\u003e, n = 163). The majority ( 79.1 % ) of patients remembered seriously uncomfortable experiences 96 M. Mer et al.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA96\u0026vq=resource-limited+ICUs"},{"page_id":"PA97","page_number":"97","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e with one nurse per one to two patients . These issues point to the need for caution in managing seda- tion needs in low - \u003cb\u003eresource ICUs\u003c/b\u003e , many of which have less nursing staffing . After reviewing the evidence ( no additional trials\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA97\u0026vq=resource-limited+ICUs"},{"page_id":"PA98","page_number":"98","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e than in resource-rich settings. Other indications for neuro- muscular blockade are to reduce peak airway pressures and to improve chest wall compliance [104] and to reduce oxygen consumption by decreasing the\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA98\u0026vq=resource-limited+ICUs"},{"page_id":"PA99","page_number":"99","snippet_text":"... ICUs ) and considering availability , feasibility , affordability , and safety , our first recommenda- tion and grading are consistent with the Surviving Sepsis guidelines . We suggest neuromuscular blockade ... \u003cb\u003eResource\u003c/b\u003e-\u003cb\u003eLimited ICUs\u003c/b\u003e.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA99\u0026vq=resource-limited+ICUs"},{"page_id":"PA101","page_number":"101","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings [ 55 ] . Recently , a prospective multicenter study ( n = 113 ) from a high - resource ... \u003cb\u003eICUs\u003c/b\u003e and can be delivered feasibly and safely . The WHO Essential Medicines List includes both heparin and\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA101\u0026vq=resource-limited+ICUs"},{"page_id":"PA102","page_number":"102","snippet_text":"... ICUs. Stress ulceration of the gastric mucosa in critically ill patients has been studied for many years, with mechanical ventilation for ≥48 h and presence of coagulopathy identified as risk factors [166]. A ... \u003cb\u003eResource\u003c/b\u003e-\u003cb\u003eLimited ICUs\u003c/b\u003e.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA102\u0026vq=resource-limited+ICUs"},{"page_id":"PA103","page_number":"103","snippet_text":"... ICUs ) and considering availability , feasibility , affordability , and safety , our recommendations are consistent with the Surviving Sepsis guidelines . We recommend that stress ulcer prophylaxis be given to ... \u003cb\u003eResource\u003c/b\u003e-\u003cb\u003eLimited ICUs\u003c/b\u003e.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA103\u0026vq=resource-limited+ICUs"},{"page_id":"PA104","page_number":"104","snippet_text":"... \u003cb\u003eICU\u003c/b\u003e [174], a large variety of oral antihyperglycemic agents are available that may simplify and possibly improve blood glucose control in the \u003cb\u003eICU\u003c/b\u003e. The MEDLINE search did not find trials of “intensive insulin therapy” from \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA104\u0026vq=resource-limited+ICUs"},{"page_id":"PA106","page_number":"106","snippet_text":"... ICUs) and considering availability, feasibility, affordability, and safety, our recommendations are consistent with the Surviving Sepsis guidelines and the Indian guidelines [8]. We make no recommendations ... \u003cb\u003eResource\u003c/b\u003e-\u003cb\u003eLimited ICUs\u003c/b\u003e.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA106\u0026vq=resource-limited+ICUs"},{"page_id":"PA107","page_number":"107","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings [ 2 , 68 ] and a sepsis guideline from Pakistan [ 69 ] . Several additional studies and guidelines from resource - rich \u003cb\u003eICUs\u003c/b\u003e were identified and are discussed below . Published guidelines are not consistent\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA107\u0026vq=resource-limited+ICUs"},{"page_id":"PA111","page_number":"111","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited ICUs\u003c/b\u003e . We suggest early enteral feeding as tolerated in patients with sepsis and septic shock ( low quality of evidence ) . Additional consid- erations include starting oral or enteral intake within 24–48 h in\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA111\u0026vq=resource-limited+ICUs"},{"page_id":"PA113","page_number":"113","snippet_text":"... ICUS Sepsis is traditionally treated with large volume fluid resuscitation , which frequently causes accumulation of bodily fluids . However , numerous studies have demon- strated that a positive fluid balance ... \u003cb\u003eResource\u003c/b\u003e-\u003cb\u003eLimited ICUs\u003c/b\u003e.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA113\u0026vq=resource-limited+ICUs"},{"page_id":"PA114","page_number":"114","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e. Our recommendations are not informed by the Surviving Sepsis guidelines. We suggest conservative fluid administration in patients with sepsis who are not in shock (low quality of evidence; indirect evidence from\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA114\u0026vq=resource-limited+ICUs"},{"page_id":"PA121","page_number":"121","snippet_text":"... Intensive Care Med . 2001 ; 27 : 1729-36 . 113. De Jonghe B , Sharshar T , Lefaucheur JP , Authier FJ , Durand ... \u003cb\u003eintensive care unit\u003c/b\u003e : a prospective multicenter study . JAMA . 2002 ; 288 : 2859–67 . 114. Kesler SM , Sprenkle MD\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA121\u0026vq=resource-limited+ICUs"},{"page_id":"PA124","page_number":"124","snippet_text":"... Group. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med. 1994;330:377–81. 167. Krag M, Perner A, Wetterslev J, Wise MP, Borthwick M, Bendel S, McArthur C, Cook D\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA124\u0026vq=resource-limited+ICUs"},{"page_id":"PA127","page_number":"127","snippet_text":"... \u003cb\u003eintensive care unit\u003c/b\u003e . Curr Opin Clin Nutr Metab Care . 2013 ; 16 : 202–8 . 220. McClave SA , Martindale RG , Vanek ... low - volume enteral supplement containing key nutrients in the critically ill . Clin Nutr . 2011 ; 30 : 599–603\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA127\u0026vq=resource-limited+ICUs"},{"page_id":"PA132","page_number":"132","snippet_text":"... resource-rich settings [1, 2]. Often, it is not practical to directly translate this evidence to \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings. Indeed, \u003cb\u003eintensive care units\u003c/b\u003e (\u003cb\u003eICUs\u003c/b\u003e) in these settings are frequently restricted in availability of equipment\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA132\u0026vq=resource-limited+ICUs"},{"page_id":"PA135","page_number":"135","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-rich \u003cb\u003eICUs\u003c/b\u003e established the role of semi-recumbent posi- tion in the prevention of aspiration and ventilator-associated pneumonia in critically ill patients [24–26]. The actual degree of elevation of head of bed needs to be indi\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA135\u0026vq=resource-limited+ICUs"},{"page_id":"PA136","page_number":"136","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-rich \u003cb\u003eICUs\u003c/b\u003e and suggests discretionary use of NIV in cases of sepsis-associated acute respiratory failure and concomitant immunosuppressed state [33], hypercapnia due to obstructive lung disease [34, 35], or hydrostatic pulmonary\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA136\u0026vq=resource-limited+ICUs"},{"page_id":"PA137","page_number":"137","snippet_text":"... low level of pressure support, continuous positive airway pressure, or the use of a T-piece, increases the likelihood of successful dis- continuation of ventilation. Three well-performed trials in \u003cb\u003eresource\u003c/b\u003e-rich \u003cb\u003eICUs\u003c/b\u003e [37–39] clearly\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA137\u0026vq=resource-limited+ICUs"},{"page_id":"PA138","page_number":"138","snippet_text":"... \u003cb\u003elimited resources\u003c/b\u003e. Notably, evidence is growing for the benefit of low tidal volume ventilation in patients ... \u003cb\u003eICU\u003c/b\u003e survival and a higher number of ventilation-free days, \u003cb\u003eICU\u003c/b\u003e-free days, and hospital-free days. The findings are\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA138\u0026vq=resource-limited+ICUs"},{"page_id":"PA140","page_number":"140","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e (2B). Based on the available evidence, we suggest using higher levels of PEEP only in patients with moderate or severe ARDS (2A). If lack of CXR and ABG availability hampers making an ARDS diagnosis, we suggest\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA140\u0026vq=resource-limited+ICUs"},{"page_id":"PA142","page_number":"142","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e in patients with moderate or severe ARDS (2B) and suggest using recruitment maneuvers in patients in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e with refractory hypoxemia in whom a diagnosis of ARDS cannot be made due to lack of CXR and\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA142\u0026vq=resource-limited+ICUs"},{"page_id":"PA152","page_number":"152","snippet_text":"... resource-limited settings, (3) advises regarding the preferable type of intravenous fluid to be used during fluid resuscita- tion, as well as (4) amounts and timing of intravenous fluids for sepsis shock in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e, are\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA152\u0026vq=resource-limited+ICUs"},{"page_id":"PA159","page_number":"159","snippet_text":"... resource - limited settings , dobutamine is only available in selected regions , and stockouts of the drug are very common . Titration of inotropes in \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited ICUs\u003c/b\u003e is a challenge , as assessed by means of plasma lactate\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA159\u0026vq=resource-limited+ICUs"},{"page_id":"PA166","page_number":"166","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in China, 381 cases of severe sepsis and septic shock in 10 units across 6 provinces were studied prospectively between 2004 and 2005. The majority (53.8%) of cases were caused by Gram-negative bac- teria, but in a significant\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA166\u0026vq=resource-limited+ICUs"},{"page_id":"PA167","page_number":"167","snippet_text":"... \u003cb\u003eICU\u003c/b\u003e [ 22 ] . However , in a different series of Thai \u003cb\u003eICU\u003c/b\u003e patients with severe sepsis and septic shock due to respiratory infection , 22 % community- acquired S. aureus infections were found to be methicillin - resistant [ 14 ] . Across 55\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA167\u0026vq=resource-limited+ICUs"},{"page_id":"PA171","page_number":"171","snippet_text":"... resource settings and three studies from \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings . A retrospective study included patients from both high- and middle - income countries ( total 17,990 patients , with approximately 12 % from South American \u003cb\u003eICUs\u003c/b\u003e )\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA171\u0026vq=resource-limited+ICUs"},{"page_id":"PA180","page_number":"180","snippet_text":"... low and middle income countries. Trop Med Int Health. 2011;16:1167–79. 22. Nickerson EK, Hongsuwan M, Limmathurotsakul ... \u003cb\u003eintensive care units\u003c/b\u003e of 8 developing countries. Ann Intern Med. 2006;145:582–91. 24. Chen CJ, Huang YC. New\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA180\u0026vq=resource-limited+ICUs"},{"page_id":"PA181","page_number":"181","snippet_text":"... \u003cb\u003eICU\u003c/b\u003e admission in patients with severe sepsis and septic shock reduces hospital mortality . Crit Care . 2015 ; 19 ... \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e setting . World J Emerg Surg . 2012 ; 7 : 4–4 . 48. Guo Q , Li HY , Li YM , Nong LB , Xu YD\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA181\u0026vq=resource-limited+ICUs"},{"page_id":"PA184","page_number":"184","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e . BMC Infect Dis . 2014 ; 14 : 1–11 . 97. Klompas M , Speck K , Howell MD , Greene LR , Berenholtz SM . Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation systematic review\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA184\u0026vq=resource-limited+ICUs"},{"page_id":"PA186","page_number":"186","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited intensive care units\u003c/b\u003e (ICUs) identified key questions concerning the SSC\u0026#39;s management recommendations on these diseases. Pertinent evidence from resource-limited settings was evaluated using the Grading of\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA186\u0026vq=resource-limited+ICUs"},{"page_id":"PA197","page_number":"197","snippet_text":"... \u003cb\u003eintensive care units\u003c/b\u003e ( \u003cb\u003eICUs\u003c/b\u003e ) in \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings are sorely needed . There is no standardized definition of an \u003cb\u003eICU\u003c/b\u003e , but for the purposes of these rec- ommendations , we are focusing on referral hospitals with the capability\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA197\u0026vq=resource-limited+ICUs"},{"page_id":"PA198","page_number":"198","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e, specifically pertaining to using central venous oxygen saturation, lactate, or central venous pressure to guide resuscitation (UG); incorporate quality assurance protocols for timely antibiotic administration\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA198\u0026vq=resource-limited+ICUs"},{"page_id":"PA199","page_number":"199","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e - \u003cb\u003elimited\u003c/b\u003e settings is undoubtedly large , though difficult to define . The International Consensus Conference on Pediatric Sepsis [ 3 ] defines sepsis as the systemic inflammatory response syndrome ( SIRS ) plus\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA199\u0026vq=resource-limited+ICUs"},{"page_id":"PA200","page_number":"200","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings shows great promise [13]. The role of the WHO criteria in defining shock, as outlined ... \u003cb\u003eICUs\u003c/b\u003e to develop a score for early identification of chil- dren with nosocomial infections shows great promise [38]\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA200\u0026vq=resource-limited+ICUs"},{"page_id":"PA204","page_number":"204","snippet_text":"... ICUs in resource-limited settings (1B). For those without evidence of severely impaired circulation in a \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICU\u003c/b\u003e, we recommend administration of maintenance fluids only (1B). For those with evidence of severely impaired\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA204\u0026vq=resource-limited+ICUs"},{"page_id":"PA206","page_number":"206","snippet_text":"... Resource capabilities for fluid resuscitation and monitoring should be expanded to allow for further study and implementation of resuscitation research in critically ill children admitted to \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e. 10.7. Is. Transfusion.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA206\u0026vq=resource-limited+ICUs"},{"page_id":"PA207","page_number":"207","snippet_text":"... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e- \u003cb\u003elimited\u003c/b\u003e settings . Further evidence is needed to make a recommendation for children with severe anemia and malaria ( hemoglobin levels \u0026lt; 4–6 g / dL ) without respiratory distress or shock . 10.8 Noninvasive Ventilation\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA207\u0026vq=resource-limited+ICUs"},{"page_id":"PA208","page_number":"208","snippet_text":"... \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings. Two randomized controlled trials were identified in children looking at the use of ... \u003cb\u003eICUs\u003c/b\u003e in \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited\u003c/b\u003e settings and can be used as an alternative, where available. High-flow nasal cannulas are\u0026nbsp;...","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA208\u0026vq=resource-limited+ICUs"},{"page_id":"PA209","page_number":"209","snippet_text":"... resource-limited setting that demonstrated a mortality benefit to low tidal volume strategy [117]. This review is downgraded for quality and indirectness. The availability of mechanical ventilation is limited in many \u003cb\u003eresource\u003c/b\u003e-\u003cb\u003elimited ICUs\u003c/b\u003e.","page_url":"https://books.google.com.sg/books?id=MkWHDwAAQBAJ\u0026pg=PA209\u0026vq=resource-limited+ICUs"}],"search_query_escaped":"resource-limited ICUs"},{});</script></div></div></div><script>(function() {var href = window.location.href;if (href.indexOf('?') !== -1) {var parameters = href.split('?')[1].split('&');for (var i = 0; i < parameters.length; i++) {var param = parameters[i].split('=');if (param[0] == 'focus') {var elem = document.getElementById(param[1]);if (elem) {elem.focus();}}}}})();</script>