Presentation and activities of the surgical and medical intensive care unit (SICU)

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Presentation and activities of the surgical and
medical intensive care unit (SICU)
Dabor Resiere MD

General Intensive Care Unit, Fort-de-France
University Hospital, Martinique, France French
West Indies
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Adult Medical-Surgical Intensive Care Unit

• Creation in January 1973 (Dr L. Elisabeth)
• 18-bed unit which provides intensive care for
  organ failure, patients requiring mechanical
  ventilation, hemodynamic monitoring and treatment
  of shock etc
• Staff 75
• Medical staff 1 head of department, 4
  consultants, 3 senior medical officer, 2
  Assistants, 6 residents
• Paramedical staff 1 sister, 44 registered
  nurses, 26 ward assistant, 4 hospital agents

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Adult Medical-Surgical Intensive Care Unit
MSICU accepts patients throughout the Caribbean,
Latin America and Europe
Around 700 patients are treated annually
MSICU is a tertiary centre for trauma, burns,
neurosurgery, infectious diseases, post
resuscitation cardiothoracic surgery, cardiac
arrests, patients requiring mechanical
ventilation, extracorporeal membrane oxygenation
(ECMO) , hemodynamic monitoring and treatment
for shock
MSICU provides treatment for patients with
pneumonia, therapeutic plasma exchange(TPE),
continuous venovenous haemodiafiltration and
intermittent haemodialysis, chronic obstructive
pulmonary disease (COPD), and management of acute
poisoning, stroke, seizures.
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Adult Surgical and MedicaI ntensive Care Unit
A 18-bed critical and surgical unit, 24/7, 365
days a year

• The Intensive Care unit also manages
  postoperative patients
• Neurosurgery (craniotomy for tumor removal,
  treatment for haemorrhage and
• laminectomy) and some cardio-thoracic or complex
  abdominal and
• orthopaedic surgery

The ICU also provides care for children with
multi organ failure or post-traumatic shock.
An Hyperbaric Oxygenation (HBO) chamber is
located nearby.
The entire medical team works on a daily basis
with  Guadeloupe, St Martin, French Guyana,
Dominica, St Lucia, St Barthelemy and other
Caribbean Islands whenever requested to do so.
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Activities in care
18-bed unit 700 patients /year Median age   48 Median IGS II 35 DMS  7,44days Mortality 19,4
4-bed intermediate-care Unit 1028 patients / year 3-bed post-operative surgical intensivve care225 patients /year Trauma room (AE)

• Unique intensive care unit in Martinique
• - Recourse for patients with neurosurgical
  conditions
• Recrutement on the other Caribbean islands
• - Fallback for the European tourism in the
  Caribbean area

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Objectives

• Universitary teaching for students and residents
• Coverage in the management, theorical teaching
  within services
• 6 -7 residents every 6/month 5 specialists, 2
  emergencies physicians
• Help to write thesis
• Help to present and communiquate in congress and
  to perform publications

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Ongoing cooperation (other activities)

• Early management of burn patients (gt40)
• Resuscitation procedure of the brain death donor
  for transplantation (renal transplantation
  activities in the French Caribbean islands)
• Development of the circulatory support mobile
  unit (CSMU) (ECLS/ECMO in collaboration with the
  cardiothoracic surgery department)
• Hyperbaric medicine (emergency, undersea)
• Plasma exchanges, plasmapheresis (neuromyelitis
  optica (Devic))
• Acute circonstances
• Chronic 4 patients weekly

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Role in critical events (1)

• Violent Haitian earthquake

January 12, 2010 16h30 earthquake 7,2 Richter,
230 000 deaths International mobilisation Medical
care or assistance to survivors 154 patients
were admitted to CHU de Fort de France 50
children 15 underwent amputations 19 patients in
intensive care unit 1 Death ( 8-year-old child
for severe head injury)
Reorganization of the unit (bed availability)
Renforcement de léquipe paramédicale et
médicale Role of the French rescue teams
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Role in critical events (2)
Epidemy of dengue

• From May to sept. 2010 approximately 50 000
  people were infected by the virus, in which 500
  were admitted to the hospital, 27 in ICU
• Severe form of dengue
• - ARDS, renal failure, DIC, severe
  thrombocytopenia ,
• -liver failure, acute hepatitis
• - Drugs complications Acetaminophen
• - Mortality 38

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refractory ARDS
ECLS/ECMO over a 5year period in the region
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Recent activity with mobile unit 2-3 patients /
month

• ECLS/ ECMO initiation 5-year ago
• in collaboration with the cardiothoracic surgeons
• From Dec 2009 to Nov 2013
• Total number of ECMO134
• 80 patients implanted with veno-veno ECMO(VV) for
  refractory ARDS
• 44 patients implanted with veno-arterial ECMO
  (VA) for refractory cardiogenic shock
• EOLIA (ECMO to rescue lung injury in severe ARDS
  trial), a multicentric international randomized
  study. UHM participated.

Survival (70/134)47
Resiere D , CSS Curacao 2013
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Project common perspective
Ischemic stroke induced by Bothrops lanceolatus
envenomation A need for a new treatment
approaches
Bothrops lanceolatus (named Fer-de-Lance) a
Martiniquan specificity Bothrops Caribeus Saint
Lucian specificity Member of the crotalidae
family, considered to be the only snake involved
in this French Caribbean island. Increasing
incidence 25 to 30 annually reported bites,
however underestimated
Thomas L, 1994 - Warrell DA, 2004
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Inter-regional medical cooperation
Structuring the ICU department admission ICU
10-15 overseas patients
Our experience 2003-2013
Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Total 130 145 137 215 189 198 269 249 269 278 203
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• PROBLEMS???

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Problems to be solved!!!!
What can we do?

1. Patients Referral
2. Bed availability in our Unit new building, new
   facility in 2016
3. Communication
4. Patients with insurance or help for patients
   without insurance
5. Debts, administrative issues !!!
6. Visa, immigration
7. State agreements (ARS/St Lucian ministry of
   health)
8. Medical evacuation, medical transportation for
   patients
9. New horizon

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Regional cooperation ongoing need

• Regional collaboration (CARICOM, OECS, PAHO,
  CARPHA)
• Regional cooperation in training of physicians
  scientific researches
• Complement existing exchanges
• Using distance based technologies for ICU
  training and education
• Using telecommunications advances to improve
  regional education
• Improvement relationship and collaboration with
  our colleagues in Miami
• Development of telemedicine exploitation plan for
  the Open Networking and Consultation

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Cooperation and implementation activities

• More development of our website
  www.universityhospitalmartinique.fr
• Fight against common diseases dengue
  leptospirosis-snake-bite
• Efficient relationship between our Intensive Care
  Unit and others
• Medical training in our ICU (15 days up to 6
  months)
• Teaching in the American University of the
  Caribbean school of medicine

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Cooperation and implementation activities

• Help in material and human resources to maintain
  a functional ICU at Victoria
• Medical training for students from UWI (Exchange
  program, internship)
• Work closely with existing associations and
  organisms (CARPHA, PAHO, CARICOM)
• Cooperation to promote advances in ICU, common
  protocol.
• Regional cooperation and the role of France

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Medical cooperation today Bridge to

• Recovery
• Communication
• Mutual respect
• True exchanges
• Network
• Decision