Authors: Lilian Karanja

Affiliation: Aga Khan Hospital Mombasa and Pandya Memorial Hospital

Keywords: Intravenous fluid stewardship Fluid responsiveness, Critical care nursing Intravenous fluid management, Evidence-based nursing practice, Nursing decision-making

Abstract: Effective intravenous (IV) fluid management is a cornerstone of critical care, yet inappropriate fluid administration can lead to adverse patient outcomes. This study examines the knowledge and skills of tertiary-level nurses in Mombasa County .

Objectives: To evaluate the knowledge, practical skills, gaps and challenges of tertiary-level nurses in Mombasa County regarding intravenous fluid responsiveness.

Methods: This study will adopt a mixed-methods approach to comprehensively assess nurses' understanding and practices related to IV fluid responsiveness. Data will be collected through:

Structured Questionnaires
Clinical Scenario Evaluations
Document Reviews
Focus Group Discussions and Interviews

Results: he findings of this study will highlight strengths and gaps in nurses' knowledge and practices regarding IV fluid stewardship. Identifying these gaps will inform targeted training interventions, ensuring that nurses are equipped with the necessary skills to make informed, evidence-based fluid management decisions.

Discussion: The study will provide recommendations on policies and best practices for enhancing IV fluid stewardship, particularly in resource-limited settings like Mombasa County

Conclusion: This study seeks to bridge existing gaps and promote better clinical decision-making

References: Attached

Authors: Lilian Karanja

Affiliation: Aga Khan Hospital and Pandya Memorial Hospital

Keywords: Hemodynamic monitoring, early warning signs, ICU nursing, patient safety, critical care decision-making

Abstract: In the fast-paced environment of critical care, nurses are the first line of defense in recognizing subtle changes in a patient’s hemodynamic status. Early detection of deterioration can mean the difference between recovery and crisis, yet delays in intervention remain a challenge.

Objectives: This study explores the common early and late signs nurses detect during hemodynamic monitoring, emphasizing the critical thinking and clinical intuition required to provide timely, life-saving care.

Methods: Through observations and document reviews among ICU nurses in Mombasa County, we examined their knowledge, practice patterns, and decision-making processes in monitoring vital parameters

Results: Nurses reported that while technology aids in hemodynamic monitoring, their ability to recognize early warning signs relies on a combination of experience, pattern recognition, and patient-specific assessment

Discussion: Challenges such as high workloads and delayed access to interventions sometimes limit nurses ability to act swiftly.

Conclusion: Nurses play an irreplaceable role in hemodynamic monitoring, often sensing deterioration before machines confirm it

References: https://doi.org/10.1111/jocn.17400

Authors: Lilian Karanja

Affiliation: Aga Khan Hospital Mombasa

Keywords: HELLP syndrome, high-risk pregnancy, obstetric critical care, nursing interventions, maternal-fetal outcomes, multidisciplinary care, early detection, critical care nursing, obstetric emergencies, perinatal management.

Abstract: High-risk pregnancies, particularly those complicated by HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelet) syndrome, require specialized obstetric critical care to improve maternal and fetal outcomes. Nurses play a pivotal role in the early identification, management, and support of patients with HELLP syndrome, given its rapid progression and life-threatening complications.

Objectives: To elucidate the critical care nursing interventions essential for managing HELLP syndrome, emphasizing early detection, comprehensive monitoring, and collaborative care strategies to optimize maternal and fetal outcomes.

Methods: A case study approach was used to analyze the care of a lady diagnosed with HELLP syndrome. It involved a retrospective review of medical records and nursing documentation, . The nursing interventions were analyzed based on their impact on patient stabilization, multidisciplinary care and maternal outcomes.

Results: The findings highlighted that early detection of HELLP syndrome through vigilant assessment (monitoring blood pressure, laboratory values, and symptoms) played a crucial role in timely intervention.

Discussion: HELLP syndrome remains a critical challenge in obstetric care due to its unpredictable nature and high maternal-fetal morbidity. This case study underscores the importance of continuous professional development for nurses in critical care obstetrics.

Conclusion: Nurses are essential in the frontline management of HELLP syndrome, contributing to early diagnosis, timely intervention, and collaborative decision-making. Strengthening nursing education on high-risk obstetric emergencies and enhancing multidisciplinary communication can improve maternal-fetal outcomes.

References: "HELLP Syndrome - StatPearls." NCBI Bookshelf. 2023.

Authors: Idris Nzao Chikophe

Affiliation: Aga Khan University Hospital, Nairobi

Keywords: Stewart's approach, strong ion difference,

Abstract: The Stewart approach to acid-base balance has gained prominence in critical care for its mechanistic understanding of acid-base disturbances. Unlike the traditional Henderson-Hasselbalch method, which focuses on bicarbonate and pCO2, Stewart’s model emphasizes the strong ion difference (SID), total weak acid concentration (Atot), and pCO2 as independent variables influencing hydrogen ion concentration.

Objectives: Literature review on Stewart’s approach, empirically demonstrate the relationship between SID and pH using open-source ABG datasets, and apply case vignettes to illustrate its clinical relevance in critical care.

Methods: A systematic review of key studies on Stewart’s acid-base model examined its application in critically ill patients. Public ABG datasets were analyzed to quantify the correlation between SID and pH using statistical modeling. Case vignettes from real-world critical care scenarios illustrated how SID-guided interpretation influences diagnosis, and fluid resuscitation.

Results: The literature review highlights Stewart’s approach as a valuable tool for diagnosing complex acid-base disorders, including dilutional and strong ion acidosis/alkalosis. Data analysis enabled the development of a proof-of-concept model for SID-pH interactions. Case vignettes illustrate its potential utility in guiding fluid resuscitation, and electrolyte correction in critical care.

Discussion: The Stewart approach redefines acid-base balance by emphasizing independent variables: strong ion difference (SID), total weak acids (Atot), and pCO2. Unlike traditional methods, it explains complex disorders like dilutional acidosis and strong ion imbalances. Though its clinical adoption remains debated, its mechanistic foundation provides deeper insight into acid-base physiology, guiding fluid therapy in critically ill patients.

Conclusion: By integrating literature review, data analysis, and case-based learning, this presentation highlights the clinical applicability of Stewart’s approach.

References: Stewart PA. How to understand acid-base. A qualitative acid-base primer for biology and mdicine. New York: Elsevier ; 1981.

Authors: Martin Musumbi

Affiliation: Aga Khan University Hospital

Keywords: Pharmacologic and non-pharmacologic strategies

Abstract: How we can leverage different therapies to reduce the doses of vasopressors or stop them altogether

Objectives: The objective of the discussion will be to highlight available but seldom used vasopressor sparing agents and interventions

Methods: Literature review

Results: Listing of various modalities

Discussion: • Hemodynamic targets
• Non-traditional vasopressors
• Oral vasopressor
• Non-vasopressor pharmacological agents
• Colloids
• Non-pharmacological interventions

Conclusion: The listener/audience should be able to explain the purpose of vasopressor sparing therapies, different modalities, techniques and agents. The audience will also have a brief understanding of the pathophysiology of each of these therapies.

References: Guinot et al. Vasopressor-Sparing Strategies in Patients with Shock: A Scoping-Review and an Evidence-Based Strategy Proposition. J Clin Med. 2021.

Authors: FRANK GITONGA

Affiliation: KENYATTA UNIVERSITY TEACHING RESEARCH AND REFERRAL HOSPITAL

Keywords: PCO2 Gap

Abstract: Hemodynamic optimization is an important aspect of shock management. PCO2 gap is the difference between the partial pressure of oxygen from a central venous sample and from an arterial sample. A difference of 6 or greater could be a surrogate of reduced perfusion or low cardiac output state.

Objectives: To discuss physiologic rationale and current evidence on the PaCO2 gap.

Methods: Literature review and appraisal of current literature

Results: Delta PCO2 is a useful measure of hemodynamic status of shocked patients. A high Delta CO2 (in the context of elevated lactate and low central venous oxygen saturation) could indicate that a patient could benefit from augmentation of cardiac output for example from use of inotropes and/or fluids.

Discussion: Patients admitted in ICU, have a central line and arterial line placed, making the PCO2 gap easy to measure. An elevated PaCO2 gap could potentially indicate a role for cardiac output augmentation using inotropes. However, patients managed with a protocol incorporating the PaCO2 gap have not shown superior outcomes.

Conclusion: Elevated PaCO2 gap is a marker of low cardiac output state or reduced perfusion. Patients with elevated PaCO2 gap have a higher mortality.

References: Gavelli F, Teboul JL, Monnet X. How can CO2-derived indices guide resuscitation in critically ill patients? J Thorac Dis. 2019

Authors: Kaiser Fitzwanga- Muhati

Affiliation: Paediatric and Congenital Cardiac Surgery, Windhoek Central Hospital

Keywords: Analysis; Arterial blood gas ; Boston rules; Interpretation

Abstract: Arterial blood gas interpretation is a very crucial skill for clinicians managing critically ill patients, as it provides insights into a patient’s respiratory and metabolic status, and is crucial for diagnosing and management of acid-base disorders.

Objectives: To review the topic on interpretation of arterial blood gas analysis using the Boston rules, the merits and limitations.

Methods: Literature review search using PubMed and Google Scholar

Results: The interpretation of arterial blood gas results however can be complex and it requires a deep understanding of the underlying physiological mechanisms that lead to acid-base disturbances.
The Boston rules is a widely used clinical approach used for arterial blood gas interpretation

Discussion: provide a systematic framework for interpreting arterial blood gas values by analyzing the interplay between pH, partial pressure of carbon dioxide (pCO2), and partial pressure of oxygen (pO2). These rules can help clinicians quickly differentiate between metabolic and respiratory acid base disorders, and identify the underlying causes to guide the appropriate management of these disorders.

Conclusion: The Boston rules provide a systematic and widely used framework for arterial blood gas interpretation in identification of acid-base disturbances, however, clinicians need to be mindful of the limitations of its use.

References: 1. R Samuel. Indian Journal of Critical Care Medicine 2023

Authors: DAVID ODADA

Affiliation: Aga Khan University Hospital Nairobi

Keywords: Outbreak, Multi-drug resistant organisms, surveillance

Abstract: Intensive Care Units are high-risk environments for healthcare-associated infections, especially carbapenem-resistant organisms. Early detection and intervention are crucial to controlling multidrug-resistant pathogens. While traditional surveillance aids outbreak identification, advanced molecular techniques enhance detection sensitivity. This study retrospectively examines ICU surveillance data to assess infection trends, potential outbreaks, and missed intervention opportunities, highlighting areas for improved infection control.

Objectives: Identify clusters of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli infections in the ICU to detect potential outbreaks
Evaluate gaps in infection control surveillance to enhance outbreak detection and prevention strategies.

Methods: This retrospective analysis (2023–2024) investigated clusters of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli infections in the ICU. It examined organism distribution, patient placement, specimen types, and antibiotic resistance patterns. Outbreak determination relied on epidemiological trends and microbiological data, offering insights into potential transmission events and infection control gaps.

Results: The analysis revealed clusters of Klebsiella pneumoniae and E. coli infections across multiple ICU rooms during overlapping periods, suggesting possible transmission events. These findings indicate the need for further investigation using advanced detection methods, such as phenotypic resistance analysis and molecular typing, to confirm relatedness and transmission dynamics.

Discussion: The analysis identified clusters of Klebsiella pneumoniae and Escherichia coli infections in ICU patients, suggesting potential outbreaks linked to patient placement and antibiotic resistance patterns. Infection control gaps, including delayed cluster detection and possible cross-contamination, highlight the need for enhanced surveillance, molecular typing, and stricter infection prevention strategies to mitigate transmission risks and improve outbreak detection in the ICU.

Conclusion: The clustering of infections highlights outbreaks that may go undetected. In the absence of molecular testing, a comprehensive approach involves routine surveillance, rapid diagnostics, and stringent infection prevention measures remains essential for mitigating transmission risks and strengthening infection control efforts.

References: Fraser, J. L., et al. (2021). "Healthcare-associated outbreaks of bacterial infections in Africa, 2009–2018: a review."

Author: Lilian Lukoko

Title: Neurophysiological monitoring in the ICU

Email: emailnotset@kongamano.co.ke

Summary: Neurophysiological monitoring in the ICU

Summary

Once the brain is injured, there are a series of dynamic changes that culminates into secondary brain injury. Neurophysiological monitoring aims to detect and monitor thereby preventing secondary insults. Because changes detected during clinical examination present as late signs, clinical examination at the bedside was deemed insufficient in preventing secondary insult.
Neurophysiological monitoring aims to detect neurological deterioration early, personalize patient management, guide treatments and prognoses, prevent and treat therapy side effects, and develop management protocols to improve outcomes and quality of life in brain injury survivors.
Modalities for monitoring cerebral physiology in the ICU include intracranial pressure (ICP) devices, electroencephalography (EEG), evoked potentials, jugular bulb catheters, transcranial doppler ultrasonography, laser doppler flowmetry, thermal diffusion flowmetry, micro-dialysis catheters, and brain-tissue oxygen probes. These modalities measure regional injured parts or the whole brain altogether.
This presentation will consolidate the knowledge relevant to the management of neurosurgical patients in the ICU, with the goal of enhancing their care and improving outcomes.
Evidence based information will be gathered through literature review of journal articles, neurocritical care guidelines as well as neurocritical care books.
This presentation will detail the importance, goals, modalities, targets, and future of neurophysiological monitoring in the ICU.

Author: Ahmed Twahir

Title: The Science of Intravenous Fluids

Email: atwahir296@gmail.com

Summary: The Science of IV Fluids: A Critical Care Perspective

Summary:
IV fluid therapy is a fundamental component of critical care, essential for resuscitation, hemodynamic support, and homeostasis. This presentation reviews fluid physiology, including body water compartments, osmotic and oncotic pressure, and electrolyte balance. IV fluids are categorized into crystalloids, colloids, and blood products, with their indications and physiological effects explored. Key principles of fluid balance, fluid responsiveness, and volume assessment are discussed, alongside clinical indications for resuscitation, maintenance, and replacement therapy. The risks of fluid overload—such as endothelial dysfunction, interstitial edema, and organ failure—are highlighted. Strategies for optimizing fluid therapy, including dynamic assessment tools, are examined. The session concludes with a review of recent clinical trials on balanced crystalloids versus normal saline, albumin use in sepsis, and hypertonic solutions. By integrating physiology with evidence-based practice, this presentation provides a framework for improving IV fluid management and patient outcomes in critical care.

Author: Mark Gacii

Title: Vasopressor Use in Paediatric Patients

Email: gaciimark@gmail.com

Summary: Objective:
Overview of pharmcology of vasopressors in the paediatric population, indications and cautions for their use, dosing and dose titration in different shock or other disease states.
Data Source:
Online search using terms “vasopressor”, “noradrenaline”, “norepinephrine”, “vasopressin”,“arginine-vasopressin”, “ phenylephrine”,“ pediatric shock”, looking for references on vasopressor use in children, including review articles, case reports and series, randomized controlled trials, cohort studies. Also included were references to standard textbooks in paediatric cardiac anaesthesia and paediatric critical care.
Outcome measures:
Were in terms of indication for use, dosing, effects on haemodynamics, effects on homeostatic indicators, effects on alleviating pathophysiology, adverse effects and mortality.

Key words: “vasopressors”, “shock”, “paediatrics”.

Author: Jon Sturman

Title: Practical approaches to weaning

Email: jon.sturman@doctors.org.uk

Summary: Patients requiring prolonged weaning from mechanical ventilation are significant from a clinical and resource perspective. This presentation reviews the data on prolonged weaning from ventilation on ICU. It will then present the evidence base for ventilatory strategies before reviewing the key underlying pathophysiologic principles causing delayed weaning with a proposal for a logical ventilatory approach for the intensivist