The document summarizes the history and development of critical care practices in Vietnam, starting from the establishment of the first telemetry unit in 1961 to the current practices. It describes how international cooperation since 1991 has helped improve critical care capacities through training, donations of medical equipment and textbooks, and clinical collaborations. Key achievements include decreased mortality rates for various conditions and participation in international clinical trials. Challenges include limited resources and high infection rates.

1. CRITICAL CARE PRACTICLE IN
COUNTRIES WITH LIMITED RESOURCES
EXPERIENCE FROM VIET NAM
NGUYEN GIA BINH MD, PhD
HEAD OF ICU BACH MAI HOSPITAL HANOI
VIET NAM .email : drbinhicu@gmail.com

2. HISTORY OF ICU
1961
 A Telemetry Unit was established for very sick patients.
6 beds with ambu-bags and oxygen.
2 physicians and 4 nurses.
=>Decreased mortality :
Close monitoring
Early intervention

3. ACTIVITIES OF THE ICU DURING THE WAR
1970 Started performing some techniques and
procedures:
 Airway control and simple respiratory supports
 Fixing fractured bone
 Essential hemostatic techniques
 Intubation, Tracheostomy
 Central line, Cardioversion,
 Peritoneal dialysis

4. ACTIVITIES OF THE ICU AFTER THE WAR
1978 The first Intensive Care Unit was founded based
on the Telemetry Unit:
 18 beds; 5 doctors; 15 nurses
 Taking care critical ill & emergent pts
 Number of pts increased dramatically (more than
1000 pts/year) mostly included:
 Drugoverdose, insecticide intoxications
 Snake bites, bee stings
 Medical emergencies

5. ACTIVITIES OF THE ICU IN 1980S
 Vietnam: GDP < $100
 Common diseases: infectious diseases, cholera,
typhoid, dehydrated diarrhea, Dengue fever
with shock, malaria, pneumonia.
 Pediatric patients: malnutrition (70%) with
pneumonia complication, diphtheria, whooping
cough, tetanus, polio, encephalitis
 High mortality

6. ACTIVITIES OF THE ICU IN 1980’S
 Respiratory resuscitation: airway control, respiratory
support manually with ambu-bags due to lacking of
ventilators
 Acute renal failure: Peritoneal dialysis with common
intravenous fluid ( 1300 ml Nacl 0,9%, 200 ml Glucose
20%, 500ml NaHCO3 1.4%)
 Early treatment for patients with malaria and early
fluid replacement for patients with dengue fever

8. ACTIVITIES OF THE ICU IN 1980 - 1990
1980 -1990:
 Drug overdose, insecticide intoxications
 Snake bites, bee stings
 Medical emergencies
 The Poisoning Control Center was founded,
including 3 units:
 Clinical unit
 Laboratory unit
 Informatics and statistic unit

9. FROM 1991 : INTERNATIONAL COOPERATION
 Cooperation between the Government and UNICEF,
WHO,NGOs…in vaccination programs → reduced
mobility and mortality in children
 ICU: received aids and supports from the international
community: medical books, journals, volunteers
 Medical personnel training and patient cares.
 Guidance for operation of medical equipments

10. FROM 1991 : INTERNATIONAL COOPERATION
 Medical equipment aids: catheter, oxygen mask,
central line pressure scale...
 Received used medical equipments: monitors,
electric shock machines, external pacemakers
with instructions and maintenance guidance.
 Medical training: starting with basic principles:
first aid, triage, CPR, respiratory resuscitation

11. FROM 1991 : INTERNATIONAL COOPERATION
 Accepted volunteered physicians, nurses from
other countries (France, USA, Japan) working in
the hospital as short term staffs ( 1 – 2 weeks)
 Worked and trained medical staffs in daily basic
 Provided medical text books, medical journals
and manuals for medical equipments,
ventilators.

13. FROM 1991 : INTERNATIONAL COOPERATION
 Sent young doctors, nurses abroad (France, US, Japan,
Australia) for short term training 3-12 months
 Update: hemodynamic monitor, acute respiratory failure
management, acute renal failure therapy, severe
infection control.
 Published the first books in Emergency, Critical Care,
Poisoning Control

14. ESTABLISHED AND APPLIED PATIENT CAREPROTOCOLS
 Set up patient care protocols for nurses
 Trained ICU nursing staffs to follow the protocols
 Abroad trained physicians wrote essential, practical,
and easy to apply protocols for emergency and critical
care
 Focused on common problems in daily practice.
 Respiratory cares: providing oxygen supplement
correctly. NIV: high efficient CPAP in pediatric
patients.

15. NN

16. ESTABLISH PROTOCOLS
 Respiration:
Reducing cost by using ABG in selected cases.
Monitoring SpO2 and clinical symptoms
CPAP : high success rate in pediatric group.
BIPAP: prevented from intubation in 70% of
COPD patients.
 Circulation: CVP, Arterial line , External
pacemaker, monitor urine output, neurology check.
 Kidney : IDH, Peritoneal dialysis if dialysis
machines are not available

17. ACTIVITIES OF THE ICU 1995- 2005
GDP >$1000 USD. IMPROVED WORKING CONDITION
1995- Started Total care
Finished amending nurse’s flowing chart
Started performing new techniques and procedures:
 Swan-Ganz catheter
 Arterial line
 Hemodialysis for ARF with shock
 CRRT
 Mechanical ventilation in ARDS
 ABG

18. ACTIVITIES OF THE ICU 1995-2005
2000 ICU wasreorganized with supports and sponsors
from JICA:
 10 doctors, 45 nurses
 2 subunits: 1 critical care, 1 high dependence
 Total 30 beds
Taking care approximately 1000 pts/year (surgical,
OB and medical):
 Severe pneumonia, ARDS, COPD...
 AMI, cardiogenic shock, severe dysarrhythmias...
 Septic shock, pancreatitis....
 MODS

19. ACTIVITIES OF THE ICU 1995-2005
 Establish protocols based on international
guidelines and the practical condition in
Vietnam
 Apply protocols in: airway control, mechanical
ventilation strategy (ARDS network), glucose
control (<10mmol/L) early fluid resuscitation,
vasopressor, blood purification, infection
control.

20. IMPROVEMENT 2010- NOW
 Better care for critical ill pts: nurse training
program
 Haemofiltration, PEX,CHDF, Haemoadsortion
 CME for all medical staffs:
 ICU journal club
 Sending doctors abroad for further training (US,
France, Japan…)
 Inviting experts from other countries (Japan, USA,
France, Korea....) for lectures

21. DR AMATO VISITED THE ICU BACH MAI HOSPITAL

22. IMPROVEMENT 2010- NOW. CO-OPERATION
 Vietnam:
 Bach Mai Hospital: trying to improve the quality of ICU
in local hospitals (provinces level)
 Hanoi medical school: residency programs, MA, PhD
 Bach Mai Nursing school: nursing programs
International:
 Japan (JICA), USA, France: study tours, books,
research, medical knowledge update...
 USA, France, Korea, ASEANs countries: medical
knowledge update...

23. PROF. KOH FROM ASIAN VENTILATION FORUM ( AVF)

24. PROF. C. FAMER FROM SCCM AND EXPERTS
FROM MAYO CLINIC, COLORADO…

25. MOLECULAR ADSORBENT RECYCLING SYSTEM
(MARS) TREATMENT FOR ACUTE LIVER FAILURE

26. CVVH FOR SEPTIC SHOCK WITH ACUTE RENALFAILURE

27. PLASMA EXCHANGE ( PEX) FOR SEVERE MYASTHENIA
GRAVIS AND TTP, GUILLAIN-BARRE SYNDROME

28. EXTRA COPOREAL MEMBRANE OXYGENATION- ECMO

29. ECMO HAS BEEN ROUTINELY PERFORMED IN THE ICU
 60 patient was treated
with ECMO:
 ECMO was performed
succefully in:
 40 myocarditis, AMI
patients with cardiac
shock
 10 patients with
severe ARDS

30. ACHIEVEMENTS
 Decreased mortalities:
 Severe sepsis and septic shock: 44%, similar to other
countries participating in the MOSAIC trial in 2009
 Severe acute pancreatitis: 45-50% (2002- 2005) → 10-
12%(2012-2013)
 Fulminant hepatic failure: 80% → 50%
 Cardiac shock due to myocarditis: 80% → 30% ( 2014),
 MOF : 70% ( 2005 ) → 50% ( 2013)
 Participated in the multicenter clinical trials.
 Coauthors of 12 scientific articles in international
journals

31. CHALLENGES
 Many medical equipments have been reused
 High nosocomial infection rate:
 VAP: decreased to 10% from 30%
 Catheter related infections: 1% within 7 days
 UIT: 1% within 7 days
 ICU bed: $300-$500/day

32. CHALLENGES
 Overloaded ICU
 Stressful specialty
 Lack of manpower (both physicians and nurses)
 Low compensation rates:
 Physician: $400-$500/month
 Nurse: $200- $300 month

33. EXPERIENCES
 Update medical knowledge, exchange experience with colleagues
from developed countries
 Practice evidence based medicine in diagnosis and treatment
 Team work, networking hospitals
 Establish protocols: practical, easy to apply
 Apply the new, advanced organ-supports methods in
critical care field with reasonable cost

34. THANK YOU FOR YOUR ATTENTION