title: Severely deranged vital signs as triggers for acute treatment modifications on an intensive care unit in a low-income country.
abstract: BACKGROUND
  Critical care saves lives of the young with reversible disease. Little is known about critical care services in low-income countries. In a setting with a shortage of doctors the actions of the nurse bedside are likely to have a major impact on the outcome of critically ill patients with rapidly changing physiology. Identification of severely deranged vital signs and subsequent treatment modifications are the basis of modern routines in critical care, for example goal directed therapy and rapid response teams. This study assesses how often severely deranged vital signs trigger an acute treatment modification on an Intensive Care Unit (ICU) in Tanzania.
  
  
  METHODS
  A medical records based, observational study. Vital signs (conscious level, respiratory rate, oxygen saturation, heart rate and systolic blood pressure) were collected as repeated point prevalences three times per day in a 1-month period for all adult patients on the ICU. Severely deranged vital signs were identified and treatment modifications within 1 h were noted.
  
  
  RESULTS
  Of 615 vital signs studied, 126 (18%) were severely deranged. An acute treatment modification was in total indicated in 53 situations and was carried out three times (6%) (2/32 for hypotension, 0/8 for tachypnoea, 1/6 for tachycardia, 0/4 for unconsciousness and 0/3 for hypoxia).
  
  
  CONCLUSIONS
  This study suggests that severely deranged vital signs are common and infrequently lead to acute treatment modifications on an ICU in a low-income country. There may be potential to improve outcome if nurses are guided to administer acute treatment modifications by using a vital sign directed approach. A prospective study of a vital sign directed therapy protocol is underway.
authors.affiliation: Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden. carlottos@hotmail.com.|Department of Internal Medicine, Medicinkliniken, Nyköping Hospital, Sörmland County Council, 61185, Nyköping, Sweden. carlottos@hotmail.com.
authors.forename: Carl Otto
authors.initials: CO
authors.lastname: Schell
authors.affiliation: Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
authors.forename: Markus
authors.initials: M
authors.lastname: Castegren
authors.affiliation: Department of Anaesthesia and Intensive Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Edwin
authors.initials: E
authors.lastname: Lugazia
authors.affiliation: Department of Anaesthesia, Intensive Care and Surgical Services, Karolinska University Hospital, Stockholm, Sweden.|Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Blixt
authors.affiliation: Department of Anaesthesia and Intensive Care, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Moses
authors.initials: M
authors.lastname: Mulungu
authors.affiliation: Department of Anaesthesia, Intensive Care and Surgical Services, Karolinska University Hospital, Stockholm, Sweden.|Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Konrad
authors.affiliation: Department of Anaesthesia, Intensive Care and Surgical Services, Karolinska University Hospital, Stockholm, Sweden.|Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.|Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tim
authors.initials: T
authors.lastname: Baker
mesh_terms: D000328:Adult; D001794:Blood Pressure; D016638:Critical Illness; D003906:Developing Countries; D019468:Disease Management; D005260:Female; D006339:Heart Rate; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D000860:Hypoxia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000523:psychology*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D056152:Respiratory Rate; D013610:Tachycardia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D059246:Tachypnea / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D013636:Tanzania; D014474:Unconsciousness / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy