Southern African Journal of Critical Care最新文献

{"title":"Human poisoning in South Africa – the knowledge gap","authors":"C. Stephen","doi":"10.7196/SAJCC.2021.V37I1.493","DOIUrl":"https://doi.org/10.7196/SAJCC.2021.V37I1.493","url":null,"abstract":"","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44143365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital heart disease in Africa threatens Sustainable Development Goals","authors":"B. Rossouw","doi":"10.7196/SAJCC.2021.V37I1.486","DOIUrl":"https://doi.org/10.7196/SAJCC.2021.V37I1.486","url":null,"abstract":"Labaeka’s[1] case study in this issue of the SAJCC describes the fatal outcome of a baby presenting late, in extremis, with transposition of the great arteries. This is a typical example of what many African parents face when their newborn baby is diagnosed with complex congenital heart disease (CHD). CHD is the most common birth defect, and is associated with higher mortality than any other congenital abnormality.[2] In Africa, late presentation of CHD is the norm.[3,4] Complications due to multi-organ involvement usually prompt the families to seek medical advice. Once the baby presents with established organ dysfunction, decision-making around early timed treatment and surgery becomes critically complex.[2] Pulse oximetry, an easy and inexpensive screening strategy, can help to diagnose complex CHD at birth and alert healthcare workers to direct babies timeously for further assessment before complications develop.[4,5] Access to affordable comprehensive cardiac healthcare is restricted to a handful of specialised cardiac centres on the African continent. A few lucky children receive treatment from philanthropic fly-in-fly-out medical missions sponsored by high-income countries (HICs). However, this healthcare model is not sustainable unless long-term co-operation and education programmes are established between local and international healthcare teams. The only alternative treatment option for families is to send their baby to specialised paediatric cardiac centres abroad. This is unfortunately unaffordable for the majority of African families.[3] Worldwide, the prevalence of CHD is estimated at 1.8 per 100 live births, according to the 2017 Global Burden of Diseases, Injury and Risk Factor (GBDIRF) study funded by the Bill & Melinda Gates Foundation. Approximately 261 247 people died of CHD during the study year, and 69% of the deaths occurred in children <1 year old.[6] Despite the seemingly high mortality, CHD treatment has been one of modern medicine’s greatest success stories. Management of CHD has grown from the first pioneers creating the Blaloch-Taussig shunt for tetralogy of Fallot in the 1940s, to the present-day subspecialty of paediatric cardiac critical care and dedicated paediatric cardiac intensive care units. There are currently more adult survivors worldwide living with complex congenital heart lesions than children.[7,8] The 2017 GBDIRF study found that about 12 million people are living with CHD worldwide.[5] Survival has become the norm in HICs, and nowadays medical treatment is focused on improving quality of life by reducing morbidity.[2,8] In HICs, 85% of all children with CHD survive to adulthood. Almost 95% of children with simple CHD lesions such as ventricular septal defect, and 90% of moderate complex CHD such as tetralogy of Fallot or neonatal coarctation, survive long term. Currently, ~80% of children with complex CHD such as transposition of the great arteries or truncus arteriosus survive to adulthood in HICs.[8","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43816324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed presentation of transposition of the great arteries with intact ventricular septum in an 8-week-old male infant at University College Hospital in Ibadan, Nigeria","authors":"A. Labaeka","doi":"10.7196/SAJCC.2021.V37I1.460","DOIUrl":"https://doi.org/10.7196/SAJCC.2021.V37I1.460","url":null,"abstract":"Abstract Transposition of the great arteries is a rare type of critical congenital heart disease (CCHD) which commonly presents in the neonatal period and requires early diagnosis and intervention if the infant is to witness his/her first birthday. Here, we report a case of an 8-week-old term male infant who presented with a 2-day history of cough, breathlessness and cyanosis. Echocardiography confirmed dextro-transposition of the great arteries (d-TGA) with patent ductus arteriosus (PDA) and patent foramen ovale (PFO). The infant succumbed to cardiogenic shock due to late presentation and no access to definitive surgical intervention.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43962188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute poisonings presenting to King Edward VIII hospital intensive care unit in Durban, South Africa","authors":"R. Goga, K. de Vasconcellos, D. Singh","doi":"10.7196/SAJCC.2021.v37i1.408","DOIUrl":"https://doi.org/10.7196/SAJCC.2021.v37i1.408","url":null,"abstract":"Background Acute poisoning is a potentially preventable burden on the healthcare systems and a significant cause of morbidity and mortality worldwide. Improved knowledge of the patterns of poisoning, the clinical course and outcomes of these cases may help create better preventive and management approaches. Objectives To describe the demographics, clinical characteristics and outcomes of patients with acute poisonings who were admitted to a multidisciplinary intensive care unit (ICU) at King Edward VIII Hospital, Durban, South Africa. Methods A retrospective observational chart review of patients admitted to the study ICU with acute poisoning over a 24-month period (1 July 2015 - 30 June 2017). Results A total of 85 patients with acute poisoning were admitted to the ICU during the study period. There was a female preponderance (55%) with a median age of 28 years. ICU mortality was 16.5% with a median ICU length of stay of 3 days. Tricyclic antidepressants (TCA) were the most common toxin identified (16.5%). The ingestion of amphetamines was associated with a statistically significant increase in mortality (100.0% v. 13.4%; p=0.04). Ethylene glycol was a commonly ingested toxin (9.4% of admissions) and had a high mortality rate of 37.5% that was not statistically significant (p=0.121). Referral for inotropic support, a Glasgow Coma Scale ≤5 and metabolic acidosis on admission were associated with higher ICU mortality. Conclusion Acute poisoning results in potentially preventable ICU admission and mortality. TCA poisoning was the most common presentation and this warrants review of TCA prescription practice. Ingestion of illicit drugs, ethylene glycol or presentation with a markedly reduced level of consciousness, shock or metabolic acidosis should alert treating physicians to a possible elevated risk of adverse outcomes. Contributions of the study This is the first study to describe acute poisoning patterns in KwaZulu-Natal from a critical care perspective. This will increase knowledge of common toxins and the presentations that lead to critical care referral. Furthermore, prescription practices for common toxins like TCAs need to be reviewed as a prevention strategy.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41879341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa","authors":"N. Biyase, H. Perrie, J. Scribante, M. Muteba, S. Chetty","doi":"10.7196/SAJCC.2021.v37i1.439","DOIUrl":"https://doi.org/10.7196/SAJCC.2021.v37i1.439","url":null,"abstract":"Background Stress ulcer prophylaxis (SUP) is part of the management of critically ill patients in intensive care units (ICUs). However, inappropriate use of these drugs has important clinical implications such as ventilator-associated pneumonia and Clostridium difficile-associated gastrointestinal tract infections. The overuse of proton pump inhibitors (PPIs) as SUP is a rapidly growing problem globally. Objectives To describe the use of SUP in three selected ICUs in Johannesburg, South Africa (SA). Methods A retrospective, descriptive, contextual study design was used. Data were collected from ICU records of adult patients admitted into these units during the study period (1 August 2013 - 31 October 2013). Results A total of 174 patients were included in the study. Of these, 156 were on SUP and only 38.5% (n=60/156) were appropriately treated with SUP according to the American Society of Health-System Pharmacists guidelines. There was an inappropriate use of SUP in over 50% of those who were treated. The most frequently prescribed SUP was histamine-2 receptor antagonist (H2RA) (51.3%; n=80/156), followed by PPIs (30.8%; n=48/156), sucralfate (17.3%; n=27/156), and a combination of PPI and H2RA (0.6%; n=1/156). Conclusion The study demonstrated overuse of SUP. The most commonly used drug for SUP was H2RA and not PPIs. This study demonstrates that the problem of SUP overuse internationally also exists locally. The development of local guidelines may help to improve the practice of SUP in SA. Contributions of the study This study showed overuse of SUP and should encourage doctors to critically evaluate why they prescribe SUP and whether it is really indicated. This should help in the adoption of practices towards appropriate use of SUP.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42576446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal replacement therapy in intensive care units in KwaZulu-Natal Province, South Africa","authors":"D. Skinner, K. de Vasconcellos, R. Wise, T. Kisten, M. Faurie, T. Hardcastle, D. Muckart","doi":"10.7196/SAJCC.2021.v37i1.454","DOIUrl":"https://doi.org/10.7196/SAJCC.2021.v37i1.454","url":null,"abstract":"Background Renal replacement therapy (RRT) is a scarce resource in southern Africa. Critically ill patients are at risk of developing acute kidney injury (AKI), which may require RRT. There are few data on the utilisation of RRT in southern African intensive care units (ICUs). Objectives To determine the indications for initiating RRT in critically ill patients in ICUs in KwaZulu-Natal, South Africa (SA) and to describe the methods and dosing of RRT. Methods A prospective observational study was performed to investigate the indications for initiating, methods and dosing of RRT among patients admitted to four ICUs in KwaZulu-Natal Province, SA. All adult patients were eligible for inclusion. Results A total of 108 patients who received RRT were included in the study. The most common reasons for initiation of RRT were a high/rising creatinine, high/rising urea, acidosis and fluid balance. The majority of the patients (79.6%; n=86) had three or more indications for RRT. A total of 353 intermittent haemodialysis/slow low-efficiency dialysis (IHD/SLED) sessions and 84 continuous renal replacement therapy (CRRT) sessions were recorded. The median (interquartile range (IQR)) CRRT dose was 25.8 (19.1 - 28.8) mL/kg/h. The median (IQR) urea reduction ratio for IHD/SLED was 32.4% (15.0 - 49.8). Conclusion Patients in this study had multiple indications for initiating RRT. The dosing of RRT was not optimal, with a wide range shown in CRRT, and the majority of patients did not achieve a urea reduction ratio (URR) >65%. Contributions of the study Renal replacement therapy is a scarce resource in Africa. Little is known about the current types and dosing of RRT in critical care units in South Africa. We showed that critically ill patients had multiple indications for RRT and the dosing was not optimal.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45541442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An investigation into specialist practice nurses’ knowledge of cardiopulmonary resuscitation guidelines in a tertiary hospital in Gauteng Province, South Africa","authors":"M. Botes, M. Moepeng","doi":"10.7196/SAJCC.2020.v36i2.397","DOIUrl":"https://doi.org/10.7196/SAJCC.2020.v36i2.397","url":null,"abstract":"Background Cardiac arrest is among the major causes of sudden deaths globally. Although out-of-hospital cardiac arrest occurs more commonly, in-hospital cardiac arrest is still a major health problem. Critical care areas provide care to critically ill patients who are at risk of cardiac arrest. It is important that nurses are knowledgeable and competent in cardiopulmonary resuscitation (CPR) in order to optimise the patient’s chances of survival and quality of life after cardiac arrest. Objectives To investigate specialist practice nurses’ knowledge of evidence-based guidelines for CPR Methods A descriptive cross-sectional survey was utilised. We sampled all critical care registered nurses (n=96) currently working in the adult emergency departments and intensive care units at Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa. A self-administered instrument, the ‘evaluation questionnaire on CPR knowledge for health personnel from emergency services’ was used. Data were analysed using descriptive and comparative statistics. Results The mean CPR knowledge score was 46%. A score of 84% was considered adequate for a pass, and no respondents achieved this score. The majority of the respondents (80.85%; n=76) were specialists in the field of intensive care nursing. Conclusion The CPR knowledge of specialist practice nurses was suboptimal for the care required in high-risk settings. Further training is indicated. Contributions of the study We showed that specialist nurses working in critical care environments at a public hospital in Johannesburg scored poorly in a CPR knowledge test.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45355528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-flow oxygen therapy v. standard care in infants with viral bronchiolitis","authors":"S. Murphy, E. Bruckmann, L. Doedens, A. Khan, A. Salloo, S. Omar","doi":"10.7196/SAJCC.2020.v36i2.438","DOIUrl":"https://doi.org/10.7196/SAJCC.2020.v36i2.438","url":null,"abstract":"Background High-flow humidified oxygen (HFHO) therapy has demonstrated benefit in infants with bronchiolitis. Objectives To investigate the efficacy of HFHO in infants with moderate to severe viral bronchiolitis, when used outside the paediatric intensive care unit (PICU), in a hospital with limited PICU resources. Methods A randomised controlled trial, which enrolled 28 infants between 1 month and 2 years of age, with a clinical diagnosis of acute viral bronchiolitis and moderate to severe respiratory distress. Participants were randomised to receive HFHO 2L/kg/min or oxygen by nasal cannula/ face mask. Respiratory rate, heart rate, oxygen saturations, and modified TAL (M-TAL) score were measured at baseline, 60 - 90 minutes after starting therapy and at 6- and 12-hourly intervals. The primary outcome evaluated was the improvement in respiratory distress (M-TAL score). The secondary outcome assessed was the need for intubation and ventilation. Results There was a significant improvement in respiratory distress (M-TAL score), in infants who received HFHO therapy. Additionally, there was also a reduction in heart rate in the HFHO group as well as a trend to lower intubation rates. Conclusion HFHO is a beneficial therapy for infants with moderate-severe viral bronchiolitis. It can be safely used outside the PICU and could potentially reduce the need for intubation and admission to PICU in resource-limited settings. Contributions of the study High-flow humidified oxygen (HFHO) is effective in infants with moderate to severe bronchiolitis, and not only in those with milder forms of the disease. It can be safely used outside the paediatric intensive care unit, where adequate respiratory monitoring is available. This is important in low-resource areas where there may be insufficient critical care resources to manage these patients.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46081660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiotherapists’ perceptions of collaborations with inter-professional team members in an ICU setting","authors":"M. N. Ntinga, H. van Aswegen","doi":"10.7196/SAJCC.2020.v36i2.431","DOIUrl":"https://doi.org/10.7196/SAJCC.2020.v36i2.431","url":null,"abstract":"Background In the intensive care unit (ICU) environment, inter-professional team collaborations have direct impact on patient care outcomes. Current evidence shows that providing physiotherapy to ICU patients shortens their length of stay and reduces their incidence of ventilator associated pneumonia and severity of critical illness neuropathy. Physiotherapists’ perceptions of their interactions with nurses and doctors as inter-professional team members in the ICU is important. Objectives To identify barriers and enablers of physiotherapists’ interactions with inter-professional team members in adult ICU settings, identify solutions to the barriers and determine if perceptions of interactions with ICU team members differ between junior and senior physiotherapists. Methods A qualitative study was done using semi-structured group discussions. Participants were recruited using convenience sampling. Participants were junior and senior physiotherapists from four private and four public sector hospitals in urban Johannesburg, South Africa. Interviews were audio recorded. Recordings were transcribed and direct content analysis of data was done to create categories, subcategories and themes. Results Twenty-two junior and 17 senior ICU physiotherapists participated in the study. Barriers raised by physiotherapists regarding communication with inter-professional team members in the ICU were non-ICU trained staff working in ICU, personality types, lack of professional etiquette, and frequent rotation of ICU staff. Enablers of communication with inter-professional team members were presence of team members in ICU during the day, good time management, teamwork approach to care and sharing of knowledge. Differing paradigms of teamwork among health professionals was highlighted as a cause of tension in the ICU inter-professional collaborations. Conclusion Physiotherapists are important members of the inter-professional ICU team. Exploring their interactions with other team members identified solutions that may improve collaboration between inter-professional team members to facilitate improved patient outcomes. Inter-professional education should inform ICU policies to create an environment that fosters teamwork. Finding creative ways to adequately staff the ICU without losing quality or driving up costs of care are matters that should take priority among policy makers. Contributions of the study Physiotherapists are essential and strategically placed in the ICU to reduce length of stay, and prevent patient physical function decline post ICU admission. This work explored physiotherapists’ perceptions of collaboration within inter-professional teams in the ICU and identified barriers that impede communication in inter-professional teams and suggested solutions. This research will contribute in improving collaboration between inter-professional teams in the ICU setting.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45836046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring moral distress among critical care nurses at a private hospital in Kwa-Zulu Natal, South Africa","authors":"W. Emmamally, O. Chiyangwa","doi":"10.7196/SAJCC.2020.v36i2.435","DOIUrl":"https://doi.org/10.7196/SAJCC.2020.v36i2.435","url":null,"abstract":"Background Moral distress resulting from frequent and intense exposures to morally challenging encounters with critically ill patients, their families and other healthcare professionals negatively impacts on the personal and professional wellbeing of critical care nurses. Objectives To determine the frequency, intensity and overall severity of moral distress among critical care nurses working in the critical care environment of a private hospital in the eThekwini district of KwaZulu-Natal Province, South Africa. Methods A descriptive survey was conducted using a 21-item moral distress scale revised questionnaire. We assessed the influence of sociodemographic variables of the respondents on the moral distress composite scores. Results The moral distress composite scores of the 74 critical care nurses who completed the questionnaires ranged from 0 - 303 out of a possible 336. The mean (standard deviation (SD)) composite moral distress score was 112.12 (73.21). Analysis of the relationship between sociodemographic variables and the moral distress composite scores revealed that female respondents experienced higher distress scores than males (p=0.013). There was an inverse relationship between composite scores and an increase in age (p=0.009) and years of service (p=0.022). Conclusion The mean composite score of the critical care nurses was suggestive of moderate levels of moral distress. Counselling services and empowerment skills training are advocated to support critical care nurses to manage moral distress. Contributions of the study Findings of the study can be used to identify sources of the distress, potential interventions, as well as the risks and benefits of taking action to assist critical care nurses to overcome moral distress.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44202721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}