1 - Bukenya Symposium abstract-1. .ppt

Abstract

1. Abstract Presentation
•Title: Contributions of Neurocritical Care as a
Prognostic Factor in Neurotrauma in low & middle
income countries.
•Event: 2024 Registrars Symposium and Prof.
Kijjambu Public Lecture
•Presenter: Bukenya Ali
•Date: Friday 27
TH
/ Sept/2024

2. Introduction
Overview:
•Traumatic brain injury (TBI) is a significant health issue in low- and middle-
income countries (LMICs).
•Effective Neurocritical care is essential for improving patient outcomes.
•Key Objectives:
•Evaluate patient flow from surgery to ICU and HDU at Nsambya Hospital,
Uganda.
•Analyze the roles of intensivists in managing these patients.
•Assess patient outcomes related to neurocritical care.

3. Patient Admissions Overview
Data from Nsambya Hospital: Total TBI admissions (2021-2023): 933 patients
Reference: This data reflects the increasing burden of TBI in the region.

4. Surgical Interventions:
Reference:
Muili et al. (2023) discuss
the necessity of structured
care for improving TBI
management.
Management of Traumatic
Brain Injury in Africa:
Challenges and
Opportunities.

5. Patient Flow to ICU and HDU
Transfer Data:
•ICU: 198 (57.56)% patients are
transferred directly to the ICU.
•HDU: 89 (25.87) % of operated
patients go directly to the HDU
post-surgery.
•For the 57 (16.57) % of patients,
were probably referred after the
operation or died in between.
Reference:
•Buh et al. (2021) highlight the
significance of immediate post-surgical
care for better outcomes.
•Demographics, Causes, and Outcome of
Traumatic Brain Injury among Trauma
Cases in Cameroon

6. Role of Intensivists in the ICU
Intensivist Responsibilities:
•Continuous monitoring of neurological status.
•Management of intracranial pressure and vital signs.
•Administration of medications and critical interventions as
may be needed.
Reference:
Souaré et al. (2022) emphasize the need for trained personnel in neurotrauma
management.
Article: Epidemiology and Challenges of Neurotraumas Care in the Emergency
Department of a Semi-Urban Hospital in Guinea, West Africa

7. Specific Interventions in the ICU
At Nsambya Hospital:
•Initiate family conferences
•Maintain intubation and immediately take to IMV
•Insert the central line
•Offer the Neurocritical care bundle.
•Osmotherapy
•Prophylactic antibiotic
•Analgesics
•Give ANALGO-sedation

8. Specific Interventions in the ICU
•Routine care for ICU pts
•FAST HUGS BID
•Assess for extubation
•Nursing care of 2 hrly turning
•Continuous monitoring of neurological status.
•Management of intracranial pressure and vital signs.
•Administration of medications and critical interventions
as may be needed.

9. Patient Outcomes
Patient outcomes are based on five parameters;
GCS of the patient
Length of the surgery
Stability of the patient
Intra-op complications
•Age of patient. (Extremity of the age with comorbidities)
Outcome Data:
•Patients receiving immediate neurocritical care demonstrate lower mortality rates
and improved recovery.
•Preliminary findings suggest a significant correlation between timely
interventions and positive outcomes.
Reference: Ramos et al. (2023) indicate that ENLS training enhances patient management in low-
resource settings.
Article: Repercussions of the Emergency Neurological Life Support on Scientific Literature: A
Bibliometric Study

10. Barriers to Effective Care
Challenges Identified:
•Financial constraints and inadequate infrastructure affecting patient access.
•Limited medical personnel and specialized training opportunities affecting access
to care.
Reference: Okon et al. (2020) highlight systemic barriers to accessing neurosurgical care in Africa.
Article: Barriers to Accessing Neurosurgical Care in Low- and Middle-Income Countries from Africa.
Opportunities for Improvement
Strategic Recommendations:
•Enhance training programs for intensivists and medical staff.
•Implement established trauma care networks to improve patient management.
•Foster collaborations between hospitals for resource sharing.
•Expand research into neurocritical care practice in LMICs to identify best
practices.
•Implement & standardize ENCLS training to improve patient management.
Reference: Muili et al. (2023) emphasizes the importance of developing trauma care networks.
Article: Management of Traumatic Brain Injury in Africa: Challenges and Opportunities.

11. Conclusion
Summary:
•Neurocritical care is crucial for improving outcomes in neurotrauma patients.
•Addressing systemic challenges and enhancing training for healthcare providers
can optimize care in LMICs.
Take Home:
•Effective neurocritical care is essential for improving outcomes in patients with
traumatic brain injury (TBI) in low- and middle-income countries (LMICs).
•Specifically, immediate post-surgical transfers to the ICU and HDU significantly
enhance the monitoring and management of patients, leading to lower mortality
rates and better recovery.
•Addressing systemic challenges, such as financial constraints and inadequate
infrastructure, alongside enhancing training for healthcare providers, is crucial for
optimizing neurotrauma care and improving patient outcomes.

12. Cited Articles
1. Demographics, Causes, and Outcome of Traumatic Brain Injury among
Trauma Cases in Cameroon
Authors: Franklin Chu Buh et al. (2021)
Focus: This multi-center study investigates the demographics of traumatic brain
injury (TBI) patients in Cameroon, analyzing causes such as road traffic accidents,
falls, and violence.
Outcomes: The study highlights the mortality rate, long-term disability, and
factors influencing patient outcomes, such as age and severity of injury.
2. Epidemiology and Challenges of Neurotraumas Care in the Emergency
Department of a Semi-Urban Hospital in Guinea, West Africa
Authors: I. S. Souaré et al. (2022)
Focus: This article examines the epidemiology of neurotrauma cases in a semi-
urban hospital, identifying common causes and patient demographics.
Challenges: It outlines systemic challenges in neurotrauma care, including
resource limitations, training deficits, and access to timely interventions.

13. Cited Articles
3. Barriers to Accessing Neurosurgical Care in Low- and Middle-Income
Countries from Africa
Authors: Inibehe I. Okon et al. (2020)
Focus: This editorial discusses the barriers faced by patients in accessing
neurosurgical care, such as financial constraints, inadequate infrastructure, and
limited medical personnel.
Implications: The article emphasizes the need for policy changes and investment
in healthcare systems to improve access to care.
4. Management of Traumatic Brain Injury in Africa: Challenges and
Opportunities
Authors: Abdulbasit Opeyemi Muili et al. (2023)
Focus: This paper reviews the current management practices for TBI in Africa,
identifying common challenges such as late presentation and lack of specialized
care.
Opportunities: It suggests potential strategies for improving management,
including training programs and the establishment of trauma care networks.

14. Cited Articles
5. Repercussions of the Emergency Neurological Life Support on Scientific
Literature: A Bibliometric Study
Authors: Miguel Bertelli Ramos et al. (2023)
Focus: This bibliometric study assesses the impact of Emergency Neurological Life
Support (ENLS) training on the scientific literature, particularly in low-resource
settings.
Findings: The study highlights the importance of ENLS in improving patient
outcomes and encourages further research and training initiatives in neurocritical
care.