ABSTRACT
Objective: To evaluate the preoperative status of children admitted for renal transplantation, and their supportive care, complications and outcomes during the immediate postoperative period in the intensive care unit (ICU). Design: Prospective observational study Setting: ICU, Teaching Hospital, Peradeniya (THP) Patients: Children who underwent renal transplantation at THP from July 2004 to October 2008 Measurements: Data regarding preoperative status and postoperative ICU complications was recorded in an Excel work sheet. Results: Of 28 recipients of kidney transplantation at this centre during the specified period, 19 were male with a mean age of 9.6 (range 2-16) years. The commonest cause of end stage renal disease (ESRD) was obstructive uropathy (28.6%). All received live donor transplantation. The mean (±SD) pre-transplant haemoglobin (Hb) and blood urea were 9.28± 2.42g/dl and 2l.97±10.17mmol/L respectively. Of the patients78.5% did not meet the minimum satisfactory Hb levels. Pre-operatively, 68.4% of the patients were hypertensive in spite of 18 (64.3%) of them being on regular antihypertensive treatment. One patient (3.6%) had haemodialysis (HD), 8 (28.6%) had peritoneal dialysis (PD) and 2 (7.1%) had had both prior to transplant. Seventeen (60.7%) were pre-emptive transplants. The mean (± SD) creatinine and creatinine clearance were 460.91±261.55 micromol/L and 22.89±25.98 ml/min/1.73m2 respectively. Mean (±SD) duration of mechanical ventilation during the immediate postoperative period was 4.88±2.80 days while the mean (±SD) ICU stay was 6.44 ± 3.35 days. Postoperative ICU complications occurred in 75% of transplant recipients. Hypertension (46%), metabolic complications such as acidosis, hyperglycaemia, hypocalcaemia, hyponatraemia (32%), heart failure (29%), convulsions (25%) and sepsis (25%) were the more common. Post-transplant creatinine and creatinine clearance were 60.69±31.19 micromol/L and 114±48 ml/min/1.73m2 respectively. No deaths or lost grafts were reported during the study period. Conclusion: Kidney transplantation in the current context warrants a significant duration of ICU therapy postoperatively in children.
ABSTRACT
OBJECTIVE: To survey the facilities, functioning characteristics, bed strength, manpower, operational practices and the distribution of the Intensive Care Units (ICU) of Government Hospitals in Sri Lanka. DESIGN: A cross-sectional observational study. METHOD: Interview of the sister or the nurse in charge of each unit by telephone using a structured questionnaire. SETTING: Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya. STUDY POPULATION: All intensive care units of the government hospitals in Sri Lanka. MEASUREMENTS: Bed strength, facilities, functioning characteristics, manpower and equipment. RESULTS: Fifty two intensive care units were identified in the island. Two units could not be contacted over the telephone and one refused to participate. Of the 49 ICUs studied 28 (57.1%) were located in teaching hospitals, six (12.2%) in provincial hospitals, 13 (26.5%) in base hospitals and two (4.1%) in special hospitals. Twenty five (51%) of the 49 ICUs were multidisciplinary, three (6.1%) general medical, four (8.2%) general surgical and the remainder were of medical, surgical and paediatric subspecialities. The minimum acceptable standard of a ventilator: bed ratio of 1:1 was seen in 28 (57%) and a nurse : bed ratio of 1:1 was seen in 37 (75.5%) ICUs. A 24-hour resident medical officer was available in 46 (93.9%) of the 49 ICUs. ICUs are mostly located in larger cities. The lowest ICU coverage (one ICU for about 1.2 million people) was seen in the Uva Province. CONCLUSIONS: ICUs in Sri Lanka are mainly located in teaching hospitals. The standards and management strategies vary widely.