Southern African Journal of Critical Care最新文献

{"title":"Low albumin levels are associated with mortality in the critically ill: A retrospective observational study in a multidisciplinary intensive care unit","authors":"A. Atrash, K. de Vasconcellos","doi":"10.7196/SAJCC.2020.v36i2.422","DOIUrl":"https://doi.org/10.7196/SAJCC.2020.v36i2.422","url":null,"abstract":"Background Albumin is a determinant of plasma colloid oncotic pressure and buffering capacity. It is a carrier protein for drugs and is important for normal functioning of the glycocalyx. Hypoalbuminaemia is common in the critically ill and has been associated with adverse outcomes. The association between hypoalbuminaemia and outcome has not been specifically explored in the South African context. Objectives To determine whether albumin levels on admission and changes in albumin levels were associated with intensive care unit (ICU) mortality in a heterogenous critically ill population. Methods This was a retrospective observational study of 247 adult patients who were admitted to a multidisciplinary ICU. Albumin levels were measured on admission and 48 hours later, alongside other biochemical and clinical parameters to determine whether they were predictive of ICU mortality. Results The lowest level of albumin on admission was 8 g/L and the highest was 43 g/L. The incidence of hypoalbuminaemia (using the laboratory reference range) was 93.9% on admission and 99.4% at 48 hours. Receiver operating characteristic curve analysis provided an optimal albumin cut-off of 18.5 g/L. Using this cut-off, hypoalbuminaemia at admission and at 48 hours was associated with increased ICU mortality. Hypoalbuminaemia at admission was an independent predictor of mortality using multivariable analysis (OR 3.74; 95% confidence interval 1.87 - 4.48). Conclusion Hypoalbuminaemia is associated with increased ICU mortality. There is currently no evidence to support the use of albumin replacement therapy. Further research is required to determine its role in critically ill patients. Contributions of the study Hypoalbuminaemia is common in critically ill South African (SA) patients and is associated with increased ICU mortality. This has not been well explored in the SA setting. We found that an optimal albumin cut-off was 18.5 g/L, which was much lower than the limits of the laboratory reference range.","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":"46381277","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":"Empirical antibiotic choice alters microbiological outcomes: Findings from comparative antibiograms in a trauma intensive care unit","authors":"S. Savage-Reid, M. Moeng, T. Thomas","doi":"10.7196/SAJCC.2020.v36i2.434","DOIUrl":"https://doi.org/10.7196/SAJCC.2020.v36i2.434","url":null,"abstract":"Background Inappropriate empirical antibiotics promote antibiotic resistance. Antibiograms guide empirical antibiotic therapy by outlining the percentage susceptibility of each pathogen to individual antibiotics. In 2016, the Trauma Intensive Care Unit at Charlotte Maxeke Johannesburg Academic Hospital escalated empirical antibiotic therapy for nosocomial infections from piperacillin-tazobactam to imipenem plus amikacin. Objectives This study assessed the impact of escalation in empirical antimicrobial treatment on organism prevalence and resistance profile. Methods A retrospective analysis of bacterial and fungal microscopy, culture and susceptibility reports from the laboratory information system of the National Health Laboratory Services, from 1 January 2015 to 31 December 2015 and 1 January 2017 to 31 December 2017, was conducted. Data were de-duplicated according to standard guidelines. Fisher’s exact test was used to determine p-values. Results Organism prevalence shifted between the years, with a 2.7% increase in streptococci (p=0.0199), 1.7% increase in Candida auris (p=0.0031) and 4.6% and 4.4% reduction in Acinetobacter baumannii (p=0.0508) and Pseudomonas aeruginosa (p=0.0196), respectively. Similarly, there was a change in the resistance profile, with a 28.9% reduction in multi-drug resistant (MDR) A. baumannii (p=0.0001), 60.4% reduction in MDR P. aeruginosa (p=0.0001) and a 6.5% increase in carbapenem-resistant Enterobacterales (p=0.007). The predominant specimen type differed between the years, with significantly more pus, tissue and fluid samples and fewer respiratory samples sent for investigation in 2017 than 2015. Conclusion Escalation in the use of empirical antibiotics showed a change in organism prevalence and an improvement in the susceptibility profile of MDR non-fermenters. Contributions of the study Current literature on the effects of antibiogram-guided empirical antibiotics is scarce within the South African context. This study shows how antibiograms are an effective antimicrobial stewardship strategy to reduce antimicrobial resistance rates by guiding appropriate choice of empirical antibiotics.","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":"47033819","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":"Haemophagocytic lymphohistiocytosis: Five years’ experience at tertiary hospitals in Free State Province, South Africa","authors":"M. Nienkemper, J. Malherbe, C. Barrett","doi":"10.7196/SAJCC.2020.v36i2.420","DOIUrl":"https://doi.org/10.7196/SAJCC.2020.v36i2.420","url":null,"abstract":"Background Haemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome if not recognised and managed early. It involves an uncontrolled pathological activation of the immune system, and it is either genetic or acquired. It presents with clinical and laboratory features of severe inflammation. Early initiation of effective therapy may reduce mortality from 95% to 35%. Objectives To raise awareness of HLH among healthcare professionals, particularly intensivists. Methods We report nine cases of secondary HLH seen at tertiary hospitals in Bloemfontein, South Africa. Results All patients presented with fever, hypertriglyceridaemia, hyperferritinaemia, transaminitis and cytopenia. Haemophagocytosis was noted on bone marrow biopsy in 66.7% (n=6/9) of the patients. More than one-third (44.4%; n=4/9) of the cases were triggered by a lymphoma, 44% (n=4/9) were associated with infection and 11% (n=1/9) were associated HIV. Finally, 11.1% (n=1) of the patients were triggered by an underlying autoimmune disease. More than half (55.6%; n=5/9) of the cases had a fatal outcome. Conclusion A high index of suspicion may promote the accurate diagnosis of HLH in patients presenting with fever, transaminitis and unexplained cytopenia. Contributions of the study HLH is a rare, life-threatening condition that may be missed in the intensive care setting. This report emphasises the importance of clinical suspicion, early diagnosis and appropriate intervention.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"36 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42077088","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":"The incidence and outcomes of patients with acute kidney injury in a multidisciplinary intensive care unit in Durban, South Africa","authors":"M. A. Khuweldi, D. Skinner, K. de Vasconcellos","doi":"10.7196/SAJCC.2020.v36i2.426","DOIUrl":"https://doi.org/10.7196/SAJCC.2020.v36i2.426","url":null,"abstract":"Background Acute kidney injury (AKI) in critically ill and resource-limited settings is under investigated. Objectives To describe the incidence, outcomes and healthcare burden of AKI in a multidisciplinary intensive care unit (ICU) in Durban, South Africa (SA). Methods All adult patients admitted to the ICU at King Edward VIII Hospital from January 2016 to June 2016, who did not have end-stage renal disease and survived for more than 6 hours after admission were evaluated for AKI using the kidney disease improving global outcomes (KDIGO) creatinine criteria. Potential risk factors for AKI and an association between AKI and outcomes including ICU mortality and length of stay were analysed. Results We screened 204 patients for inclusion into the study and 26 patients were excluded. About half of the patients (50.5%; n=90/178) who were included in the study were diagnosed with AKI at the time of admission and 16.3% (n= 29/178 developed AKI in the ICU. Among the patients who had AKI on admission, 50% (n=45/90) were classified as KDIGO stage1, 21.1% (n=19/90) as stage 2 and 28.8% (n=26/90) as stage 3. Less than one-third (24.7%; n=44/178) of the patients who developed AKI in the ICU were classified as KDIGO stage 1, 14% (n=25/178) were stage 2, and 28% (n=50/178) were stage 3. The mortality rate for patients with AKI on admission was 40.0% (n=36/90) compared with 39.8% (n=35/88) for those without AKI on admission (p=0.975). The mortality rate for all patients with AKI was 46.2% (n=55/119) compared with 27.1% (n=16/59) in patients who did not develop AKI (p=0.014). Conclusion AKI is common in critically ill patients presenting to a tertiary ICU in Durban, SA. AKI is associated with increased mortality and length of stay in the ICU. Strategies to prevent the development or worsening of AKI must be emphasised. These include prevention or at least early treatment of sepsis, adequate fluid resuscitation, aggressive haemodynamic optimisation and avoidance of nephrotoxins. This is especially important in settings where there is limited access to renal replacement therapy (RRT). Contributions of the study This is one of the first studies to describe the incidence and outcomes of AKI in a general critical care population in a resource-limited setting. The study highlights that AKI is very common in critically ill patients in a resource-limited setting, and is associated with increased mortality and resource utilisation. It also highlights the importance of sepsis as a risk factor for AKI.","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":"47419010","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":"COVID Recommendations","authors":"B. Morrow","doi":"10.7196/sajcc.2020.v36i1.451","DOIUrl":"https://doi.org/10.7196/sajcc.2020.v36i1.451","url":null,"abstract":"","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/sajcc.2020.v36i1.451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49348098","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":"Abstracts of scientific presentations at the 2019 National Annual Congress of the Critical Care Society of Southern Africa in Cape Town, South Africa","authors":"B. Morrow","doi":"10.7196/SAJCC.2019.V35I1.405","DOIUrl":"https://doi.org/10.7196/SAJCC.2019.V35I1.405","url":null,"abstract":"","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45942995","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":"Family-centred practices of healthcare professionals in three emergency departments in KwaZulu-Natal, South Africa","authors":"W. Emmamally, P. Brysiewicz","doi":"10.7196/SAJCC.2018.V34I2.358","DOIUrl":"https://doi.org/10.7196/SAJCC.2018.V34I2.358","url":null,"abstract":"Background. Emergency healthcare professionals can practise family-centred care (FCC) by engaging in active partnerships with families. In a chaotic environment, which challenges communication and supportive behaviours, responding to and acknowledging families’ individuality enhance positive family outcomes.  Objective. To describe the adherence of emergency healthcare professionals to family-centred practices in some emergency departments in KwaZulu-Natal, South Africa.  Methods. A quantitative survey was conducted among healthcare professionals in three emergency departments. A previously published checklist was used to collect data on adherence to relational and participatory family-centred practices.  Results. A total of 77 completed questionnaires were received from the 79 participants surveyed, giving a response rate of 97.5%. Analysis showed that healthcare professionals endeavour to practise FCC, but that their implementation of practice indicators of family-centred care is inconsistent. Results suggested that healthcare professionals used relational practices to a larger extent than participatory practices.  Conclusion. In the emergency department, collaboration and partnering with families should be emphasised to ensure that principles of FCC are practised as a standard.  Keywords. Family, health care professionals, emergency department, relational practices, participatory practices.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJCC.2018.V34I2.358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45198088","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":"Muscle strength and endurance to predict successful extubation in mechanically ventilated patients: A pilot study evaluating the utility of upper-limb muscle strength and ergometry","authors":"C. D. Beer, A. J. V. Rooijen, J. Pretorius, P. Becker, P. Rheeder, F. Paruk","doi":"10.7196/SAJCC.2018.V34I2.360","DOIUrl":"https://doi.org/10.7196/SAJCC.2018.V34I2.360","url":null,"abstract":"Background. Successful extubation of mechanically ventilated patients is essential for the physiotherapist to succeed in respiratory rehabilitation of the patient. Delay in the weaning process increases the complication rate of mechanical ventilation. A variety of parameters are used as predictors of extubation readiness, but the association between muscle strength (deltoid, neck flexor muscle group and trapezius), endurance and extubation readiness has not been determined.  Objectives. The aim of the study was to determine if muscle strength and endurance can be used as possible predictors of successful extubation in mechanically ventilated patients. The objectives were to determine if muscle strength measured with the Oxford grading scale can be used as a possible predictor, and if muscle endurance measured with the MOTOmed letto2 cycle ergometer can be used as a possible predictor.  Methods. During the pilot study, 37 subjects were recruited. Deltoid, neck flexors and trapezius muscle strength was tested using the Oxford grading scale and respiratory muscle strength using maximum inspiratory and expiratory pressures. Endurance was determined by riding the MOTOmed letto2 cycle ergometer for 5 minutes with the upper limbs.  Results. Muscle strength of the deltoid and the neck flexor muscle group tested with the Oxford grading scale was associated with successful extubation respectively, ( p =0.022; p =0.019). Muscle endurance tested with the MOTOmed letto2 cycle ergometer also demonstrated an association with successful extubation ( p =0.014).  Conclusion. Future studies with larger sample sizes are recommended.  Keywords. Mechanical ventilation, intensive care unit, extubation failure, respiratory muscle strength, peripheral muscle strength, muscle endurance","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJCC.2018.V34I2.360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46605615","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":"Family-centred care in intensive care units","authors":"P. Jordan","doi":"10.7196/SAJCC.2018.V34I2.369","DOIUrl":"https://doi.org/10.7196/SAJCC.2018.V34I2.369","url":null,"abstract":"","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJCC.2018.V34I2.369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71268448","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":"Parental satisfaction with the quality of care in a South African paediatric intensive care unit","authors":"C. Mol, A. Argent, B. Morrow","doi":"10.7196/SAJCC.2018.V34I2.366","DOIUrl":"https://doi.org/10.7196/SAJCC.2018.V34I2.366","url":null,"abstract":"Background. The quality of family-centred care in the paediatric intensive care unit (PICU) has been poorly studied in South Africa (SA).  Objective. To explore parents’ satisfaction with care in a PICU in SA.  Methods. A prospective descriptive survey study was conducted among a convenience sample of 100 parents of children admitted to the PICU for ≥48 hours. Participants completed the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30) questionnaire, which includes 30 closed questions rating satisfaction in different domains and four open-ended questions to qualitatively describe PICU experiences.  Results. Of the 100 admissions included in the study, 35% were unplanned and 88% were mechanically ventilated. Parents were very satisfied with the quality of PICU care, with mean scores in all domains reaching ≥5.5 on a 6-point Likert scale. Parents were most satisfied with the professional attitude of PICU staff, whereas the lowest scores were seen in the ‘Information’ and ‘Parental participation’ domains. The internal consistency (Cronbach’s α) associated with the different domains ranged between 0.25 (Parental participation) and 0.59 (Care and cure). The need for communication and support during the admission period, and the importance of environmental factors, proximity to the child, the attitude of medical staff and social support during the PICU stay emerged as common themes from the responses to the open-ended questions.  Conclusion. Although parents were generally well satisfied with the quality of care, improving family involvement and providing adequate information in the PICU can contribute to quality family-centred care.  Keywords. Family- centered care; patient- centered care; paediatric intensive care unit; quality of care","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJCC.2018.V34I2.366","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41510216","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}