1. Background to MKAIC & VSDT

2. Introduction MKAIC: The context for VSDT Research background to VSDT Vital Signs are the basis of critical care

3. MKAIC Long term collaboration since 2008 Karolinska: 200 anaesthesiologists Muhimbili: 4 anaesthesiologists Aims –Improve Anaesthesia & Intensive Care –Increase understanding between countries Courses, exchanges, guidelines, research, equipment

4. MKAIC 2013 Training Refresher Course in Obstetric Anaesthesia for 63 participants (Total now trained on MKAIC courses = 226) Training-of-Trainers course at Muhimbili for 9 trainers Exchanges 6 exchanges to Karolinska from Muhimbili for doctors & nurses Bedside teaching in Muhimbili by 3 doctors & 3 nurses from Stockholm

5. MKAIC 2013 Equipment Donation of 22 pulse oximeters Donation of a bedside Haemoglobin machine and 100 tests Donation of an Ambu intubation dummy Donation of 80 books Donation of 50 USB Memory sticks filled with medical e-books & information Research Publication of “Emergency and Critical Care Services in Tanzania: a survey of 10 hospitals” 3 Resident Doctor Research Projects 2 Manuscripts for research projects: “Paediatric Anaesthesia at Muhimbili” and “Obstetric Anaesthesia at Muhimbili”

6. What facilities and resources do hospitals in Tanzania have for critical care?

7. Method Ten hospitals from four regions of Tanzania Cross-sectional survey Structured interview and facilities assessment using a data collection tool Quality assessed using newly developed standards

9. How can we improve routines for critical care? -Needs to be nurse-led as nurses are always present -Needs to allow continuous changes to treatment as patient changes condition -Goal Directed Therapy

10. Goal- directed therapy Rivers 2001 – reduced mortality by 30% in Detroit Give treatment based on goals Goals were ScVO2, CVP etc

11. Vital Signs HR RR BP Saturation Conscious Level (Temp, Urine Output)

12. Vital Signs Signs of how stable the body is Deranged vital signs show illness severity Many studies have shown deranged vital sigs are associated with death & cardiac arrest ICUs in Karolinska & other high income countries routinely use Vital Sign Goals for daily management of patients This has been shown to reduce mortality

13. Vital Signs Directed Therapy Designed by MKAIC Uses Vital Signs to continuously modify treatments Before-After research design Hope to reduce mortality by 20% Implementation now

14. VSDT Team at Muhimbili Dr Lugazia Dr Mulungu Agness Laizer Erasto Kalinga Nazahed Richard Elizabeth Stephens

15. Vital Signs Directed Therapy NIMR Ethical Clearance MUHAS Ethical Clearance COSTECH Research Clearance MNH Research permission Supported by ED, DSS, HoD (Dr Mulungu & Dr Rita) SOP

16. Summary VSDT is part of long term collaboration, MKAIC VSDT is based on previous research findings Vital Signs Directed Therapy could reduce mortality on ICU