tetano
Editor, Senior Moderator
Crit Care Med. 2011 Nov 10. [Epub ahead of print]
The epidemiology of Hajj-related critical illness: Lessons for deployment of temporary critical care services.
Mandourah Y, Ocheltree A, Al Radi A, Fowler R.
Source
From the Department of Intensive Care Services (YM), Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia; the Saudi Critical Care Society Trial Group (AO, AA) (Hajj Critical Care Medicine); and the Departments of Critical Care Medicine and Medicine (RF), Sunnybrook Hospital, University of Toronto, Canada.
Abstract
RATIONAL:: The annual Hajj experience has direct relevance for other jurisdictions planning rapid deployment strategies for intensive care for large groups during expected or emergent events.
OBJECTIVE:
Approximately 2-3 million Muslims from over 160 countries travel to Saudi Arabia each year for Hajj. These pilgrims are typically older adults with a spectrum of comorbid conditions and of various ethnicities. This, coupled with a 2-wk period of physical migration in close contact with others, can lead to acute and critical illness from a variety of infectious and noninfectious causes and a requirement for full-scale but temporary intensive care to a large population. We describe patient characteristics, patterns of disease, and critical illness, including episodes of Influenza A 2009 (H1N1), therapies delivered, and clinical outcomes.
METHODS:
Prospective cohort study of 110 critically ill patients in four hospitals during the 2009 ("1431": November 18 to December 4) Hajj in Saudi Arabia.
MEASUREMENTS AND MAIN RESULTS:
Median (interquartile range) age was 60.5 (51.3-70) yrs, 69 (62.7%) were male, and Acute Physiology and Chronic Health Evaluation IV score was 60.5 (47-78.3). Forty-one patients (37.3%) were critically ill due to cardiovascular diseases (23.6% with myocardial infarction); 51 (46.4%) had severe infections (21.8% with H1N1); electrolyte disturbance (21.8%); or pulmonary illness (15.5%). Sixty patients (54.6%) required ventilation. Median predicted mortality by Acute Physiology and Chronic Health Evaluation IV was 14% while actual short-term mortality was 6.4% (p = .009). Longer-term mortality may be higher.
CONCLUSION:
Both event-specific conditions and patient-specific comorbid conditions are common causes of critical illness during large gatherings. With the ability to provide temporary but full-service intensive care, morbidity and mortality due to critical illness can be low, even among an older patient population and difficult care conditions.
PMID:
22080635
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/22080635
The epidemiology of Hajj-related critical illness: Lessons for deployment of temporary critical care services.
Mandourah Y, Ocheltree A, Al Radi A, Fowler R.
Source
From the Department of Intensive Care Services (YM), Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia; the Saudi Critical Care Society Trial Group (AO, AA) (Hajj Critical Care Medicine); and the Departments of Critical Care Medicine and Medicine (RF), Sunnybrook Hospital, University of Toronto, Canada.
Abstract
RATIONAL:: The annual Hajj experience has direct relevance for other jurisdictions planning rapid deployment strategies for intensive care for large groups during expected or emergent events.
OBJECTIVE:
Approximately 2-3 million Muslims from over 160 countries travel to Saudi Arabia each year for Hajj. These pilgrims are typically older adults with a spectrum of comorbid conditions and of various ethnicities. This, coupled with a 2-wk period of physical migration in close contact with others, can lead to acute and critical illness from a variety of infectious and noninfectious causes and a requirement for full-scale but temporary intensive care to a large population. We describe patient characteristics, patterns of disease, and critical illness, including episodes of Influenza A 2009 (H1N1), therapies delivered, and clinical outcomes.
METHODS:
Prospective cohort study of 110 critically ill patients in four hospitals during the 2009 ("1431": November 18 to December 4) Hajj in Saudi Arabia.
MEASUREMENTS AND MAIN RESULTS:
Median (interquartile range) age was 60.5 (51.3-70) yrs, 69 (62.7%) were male, and Acute Physiology and Chronic Health Evaluation IV score was 60.5 (47-78.3). Forty-one patients (37.3%) were critically ill due to cardiovascular diseases (23.6% with myocardial infarction); 51 (46.4%) had severe infections (21.8% with H1N1); electrolyte disturbance (21.8%); or pulmonary illness (15.5%). Sixty patients (54.6%) required ventilation. Median predicted mortality by Acute Physiology and Chronic Health Evaluation IV was 14% while actual short-term mortality was 6.4% (p = .009). Longer-term mortality may be higher.
CONCLUSION:
Both event-specific conditions and patient-specific comorbid conditions are common causes of critical illness during large gatherings. With the ability to provide temporary but full-service intensive care, morbidity and mortality due to critical illness can be low, even among an older patient population and difficult care conditions.
PMID:
22080635
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/22080635