The Southern African journal of critical care : the official journal of the Critical Care Society最新文献

{"title":"Fluid tolerance in septic shock: Femoral vein pulsatility versus VExUS score in a cross-sectional study.","authors":"M A Sahbal, A A Hemeda, S Fawzy, S Gaber","doi":"10.7196/SAJCC.2026.v42i1.2816","DOIUrl":"10.7196/SAJCC.2026.v42i1.2816","url":null,"abstract":"<p><strong>Background: </strong>Excessive fluid resuscitation in patients with septic shock is associated with acute organ injury and increased mortality. Accurate assessment of fluid tolerance is therefore essential. Right cardiac chamber fluid tolerance can be evaluated by estimating the right atrial pressure using central venous catheters, inferior vena cava (IVC) measurements, Venous Excess Ultrasound (VExUS) scores and femoral vein pulsatility (FVP).</p><p><strong>Objectives: </strong>To assess the correlation between FVP and VExUS score in evaluating fluid intolerance and venous congestion in patients with septic shock; the correlation of FVP and VExUS score with central venous pressure (CVP); and to evaluate the effect of positive pressure ventilation on the relationship between FVP and VExUS score.</p><p><strong>Methods: </strong>In this observational cross-sectional study, 80 participants were assessed for fluid tolerance using VExUS scores and FVP. CVP, maximum and minimum IVC diameters and IVC dynamicity were regarded as the gold standard and used as reference.</p><p><strong>Results: </strong>FVP showed moderate agreement with VExUS score (Kappa=0.55; p<0.001). Both FVP and VExUS score demonstrated the ability to predict CVP values ≥17 cmH₂O with overall accuracies of 70% and 77.5%, respectively (p<0.001). A CVP ≥17.5 cmH₂O predicted severely congested femoral veins with a sensitivity of 70% and specificity of 90%, whereas a CVP ≥18.5 cmH₂O predicted VExUS grade 3 with a sensitivity of 66.7% and specificity of 83.3%. Maximum IVC diameter accurately predicted abnormal femoral vein Doppler findings, with an overall accuracy of 82.5%.</p><p><strong>Conclusion: </strong>A pulsatile femoral vein pattern indicates fluid intolerance in patients with septic shock, providing an additional marker for assessing fluid status. Doppler assessment of the femoral vein offers advantages of easier anatomical accessibility and a shorter learning curve compared with other methods.</p><p><strong>Contribution of the study: </strong>This study evaluated a simple rapid tool (femoral vein pulsability) in assessing volume state and fluid tolerance in septic patients in comparison with VExsus.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"42 1","pages":"e2816"},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interdisciplinary fibreoptic endoscopic evaluation of swallowing assessments in ICU patients: A file review.","authors":"K Coutts, N Barber, N Israel","doi":"10.7196/SAJCC.2026.v42i1.3328","DOIUrl":"10.7196/SAJCC.2026.v42i1.3328","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dysphagia is a complex condition common in critical care settings, often resulting from multifactorial causes such as trauma, neuromuscular weakness, impaired cognition, intubation and the presence of a tracheostomy. Dysphagia can have serious consequences, including aspiration pneumonia and prolonged hospital stays, which need to be avoided in resource-constrained environments such as South Africa (SA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the characteristics of dysphagia in critically ill patients using an interdisciplinary assessment approach that utilises both bedside evaluations and fibreoptic endoscopic evaluation of swallowing (FEES).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective file review was conducted of 68 adult patients who underwent interdisciplinary dysphagia assessments in a private SA hospital between July 2022 and January 2024. Data collected included clinical notes, anatomical and physiological markers, Penetration-Aspiration Scale (PAS) scores and post-assessment diagnoses. Descriptive statistics were employed to analyse variables such as age, gender, comorbidities and dysphagia symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age of participants was 59.5 years (standard deviation (SD) 17.05 years), with the majority presenting with trauma-related injuries or cerebrovascular accidents. Dysphagia was prevalent, with 49% of patients exhibiting significant swallowing difficulties. The mean PAS score was 3.44 (SD 2.82), indicating that material often entered the airway without being ejected. Notably, 17% of patients presented with silent aspiration, highlighting the need for comprehensive interdisciplinary assessment techniques. Common symptoms included pooling, dysphonia and delayed swallow triggers, which may be identified at the bedside and confirmed using FEES. Patients were referred to speech-language therapy (SLT) after a median of 13 days in the intensive care unit (ICU).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Dysphagia is a significant concern in critical care, necessitating early and co-ordinated assessment strategies to minimise complications and improve patient outcomes. This study advocates enhanced protocols and interdisciplinary collaboration to manage dysphagia effectively. Early referral to SLT is critical for timely intervention, which is essential in an under-resourced setting. Future research across various settings is needed to further validate the interdisciplinary model of dysphagia assessment and management and to generate additional local data on dysphagia in the ICU.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contribution of the study: &lt;/strong&gt;This retrospective file review demonstrates the prevalence, clinical features, and consequences of dysphagia among critically ill adults assessed with an interdisciplinary FEES approach in a South African (SA) ICU. The study contributes to important local evidence by (i) quantifying the burden of dysphagia and silent aspiration in an ICU population, ","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"42 1","pages":"e3328"},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enteral feeding barriers in the intensive care unit of a tertiary hospital in Ghana.","authors":"E K Anku, L T Hill, M A Agyarko, O E Ekor, G Akafity, S A Amoo, S O Lamptey, N Kumi","doi":"10.7196/SAJCC.2026.v42i1.3661","DOIUrl":"10.7196/SAJCC.2026.v42i1.3661","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Enteral nutrition (EN) is an important aspect of patient management in the intensive care unit (ICU). However, various barriers have been reported that limit the provision of EN, with implications for patient care and outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the perceived barriers to the provision of EN among ICU healthcare professionals in our resource-limited setting, as a preliminary step toward developing tailored quality improvement interventions in our unit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional survey of 21 ICU healthcare professionals (17 nurses and 4 doctors) was conducted. The Revised Barriers to Feeding Critically Ill Patients questionnaire was used to evaluate barriers to the provision of EN in our ICU. A Likert scale was used to assess perceived barriers, with each factor rated from 0 to 6; 0 indicating 'not at all' and 6 indicating 'an extreme amount'. Descriptive statistics were used to describe the data as medians, interquartile ranges, counts and proportions. The Wilcoxon-Mann-Whitney test was used to evaluate differences in medians between doctors and nurses, given the skewed distribution of data. Likert-based responses were used to generate a stacked bar chart. Statistical significance was set at p&lt;0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The main barriers to the provision of EN were related to dietitian support, ICU resources and EN delivery. Dietitian-related barriers included insufficient coverage on weekends, evenings and holidays (median 5), delayed nutritional assessments (median 3) and limited time dedicated to education and training on optimal feeding (median 3). ICU resource constraints included the absence or shortage of feeding pumps and the unavailability of enteral formulas (median 3 for both). Barriers to EN delivery included delayed initiation of motility agents in patients with feeding intolerance (median 3).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;These findings underscored the importance of developing context-specific quality improvement initiatives to address local barriers to the provision of EN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contribution of the study: &lt;/strong&gt;This study describes the perceived barriers to the provision of enteral nutrition in an intensive care unit (ICU) in Ghana, adding to the limited data available from African ICUs on this topic. The study provides insights into the systemic, operational, and workforce-related challenges that affect enteral feeding in resource-constrained critical care settings, including limited dietitian coverage, shortage of feeding pumps, and enteral formulas. These challenges highlight the needs and opportunities for strengthening nutrition support through context-specific quality improvement initiatives. As such, this work contributes valuable locally generated evidence to support enhanced care for critically ill patients as well as inform professional development strategies for ICU healthcare professionals in similar low-resour","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"42 1","pages":"e3661"},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provision of physiotherapy services for children in intensive care units in Uganda: A descriptive study.","authors":"I Sendagala, B M Morrow","doi":"10.7196/SAJCC.2026.v42i1.2889","DOIUrl":"10.7196/SAJCC.2026.v42i1.2889","url":null,"abstract":"<p><strong>Background: </strong>No prior studies have described physiotherapy practices for critically ill and injured children admitted to intensive care units (ICUs) in Uganda, a low-income African country with high childhood morbidity and mortality.</p><p><strong>Objectives: </strong>To describe the patient profile and physiotherapy practices of children admitted to Ugandan ICUs.</p><p><strong>Methods: </strong>Routinely collected data were extracted for all infants and children admitted to three participating Ugandan ICUs on two study days per week over six months. Demographic and clinical admission data were collected, as well as data on physiotherapy service provision, including referral practices, frequency of treatment and modalities used.</p><p><strong>Results: </strong>A total of 326 patients (49.4% male) were enrolled in the study, on median (interquartile range (IQR)) ICU Day 4.0 (2.0 - 8.0). Most children (63.5%) were >2 years of age. Physiotherapy had been provided to 190 (58.2%) children during their ICU admission. Physiotherapy referrals were made by the attending doctor in 80.5% of cases. Chest physiotherapy - percussions (89.6%) and vibrations (88.8%) - was the most common technique, followed by passive limb exercises in bed (63.4%). Active out-of-bed mobilisation activities were provided in <20% of cases, mostly among children <6 years of age (p<0.05) and those with minimal or no respiratory support requirements (p<0.001). No invasively mechanically ventilated children were actively mobilised out of bed.</p><p><strong>Conclusion: </strong>Over 40% of children admitted to Ugandan ICUs did not receive any physiotherapy contact during their admission, suggesting missed opportunities. Most physiotherapy techniques were passive; active out-of-bed activities were seldom implemented and were reserved for older, non-ventilated patients.</p><p><strong>Contribution of the study: </strong>This is the first study to describe physiotherapy practices for children admitted to intensive care units in Uganda, providing an important baseline for targeted, context-appropriate practice improvement initiatives. The study demonstrates that physiotherapy services in Ugandan ICUs are predominantly passive, referral-dependent and inconsistently applied. Active rehabilitation, including out-of-bed mobilisation, is seldom implemented, representing missed opportunities for early rehabilitation in a resource-constrained setting with a high paediatric critical illness burden.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"42 1","pages":"e2889"},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-dose insulin euglycaemic therapy (HIET): How high is high enough and what are the risks?","authors":"A Dos Santos, S Feris, Z Farina","doi":"10.7196/SAJCC.2026.v42i1.3800","DOIUrl":"10.7196/SAJCC.2026.v42i1.3800","url":null,"abstract":"<p><strong>Abstract: </strong>Calcium-channel blockers (CCBs) are widely prescribed in South Africa and are frequently implicated in overdose-related morbidity and mortality. We report a case of amlodipine overdose in a teenager. Her management is notable for the exceptionally high dose of insulin used as part of high dose insulin euglycaemic therapy (HIET), far exceeding standard protocol. Despite the aggressive dosing, no clinically significant hypoglycaemia or hypokalaemia occurred. The patient showed progressive improvement and was discharged from the intensive care unit on day 3, making a full recovery. This case demonstrates that insulin doses significantly exceeding conventional protocols may be safe and effective in resource-limited settings when supported by experienced staff and close monitoring. More research is needed to guide optimal HIET dosing and safe discontinuation protocols.</p><p><strong>Contribution of study: </strong>This case demonstrates that concentrated insulin formulations, combined with appropriate monitoring and level of care, can safely deliver higher than usual insulin doses. The use of concentrated insulin significantly reduces its contribution to total fluid administration, providing a practical approach to fluid stewardship. The report highlights a clinical management gap: the absence of standardised protocols for discontinuing insulin and dextrose infusions after high-dose insulin euglycaemic therapy. This case provides data on successful weaning and cessation of HIE and dextrose therapy following unconventionally high insulin dosing. High insulin doses may warrant consideration in severe calcium channel blocker toxicity when conventional haemodynamic support is unavailable or deemed insufficient.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"42 1","pages":"e3800"},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of nosocomial pneumonia and clinical outcomes of patients requiring non-invasive ventilation: A systematic review and meta-analysis.","authors":"S Singhal, S K Mudgal, M Verma, M Gurjar, R Garg, R K Garg, B P Singh, J Singh","doi":"10.7196/SAJCC.2026.v42i1.4031","DOIUrl":"10.7196/SAJCC.2026.v42i1.4031","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Non-invasive ventilation (NIV) is used for an increasing range of clinical conditions at various levels of care, including intensive care units (ICUs), and has been shown to carry a lower risk of nosocomial pneumonia (NP) compared with invasive mechanical ventilation (IMV).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the incidence of NP and clinical outcomes (intubation rates and mortality) in patients receiving NIV as initial support.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of PubMed, Embase and Scopus for relevant research articles published in English was conducted up to 6 February 2025. Eligible studies included adult patients who received NIV for any respiratory condition and reported the incidence of NP. NP was defined as any new-onset pneumonia occurring at any point during the clinical course and ≥48 hours after initiating NIV. Furthermore, a subset of patients in whom NP was attributed solely to NIV support was defined as NIV-associated pneumonia (NIVAP). Two reviewers independently conducted database searches, data extraction and risk-of-bias assessment. A subgroup analysis was performed based on the indication for NIV, country and study design to identify heterogeneity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We incorporated 30 studies, including 36 049 patients receiving NIV. Of these, 29 studies reported the incidence of NP, while only 22 reported the incidence of NIVAP. Overall, the incidence of NP was 6% (95% confidence interval (CI) 4 - 8; I2=89.4%), and the pooled incidence of NIVAP was 3% (95% CI 2 - 4; I²=32.9%). The rate of intubation was 28% (95% CI 22 - 35; I²=89.3%), and overall mortality was 18% (95% CI 15 - 23; I²=99.0%) among patients receiving NIV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;NP, including NIVAP, remains a significant complication in patients receiving NIV. Our findings underscore the need for standardised diagnostic criteria for NP in patients receiving NIV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contribution of the study: &lt;/strong&gt;This systematic review and meta-analysis provide robust pooled estimates of nosocomial pneumonia (NP) (6%; 95% CI: 4-8) and NIV-associated pneumonia (NIVAP) (3%; 95% CI: 2-4) among patients receiving non-invasive ventilation (NIV), addressing an important gap in the literature. It shows that the risk of pneumonia persists despite avoidance of intubation, challenging the prevailing assumption that NIV substantially mitigates infection risk. It also reveals significant variability in NP incidence across study designs, geographic regions, and patient subgroups-particularly a higher risk in patients with acute respiratory distress syndrome (ARDS)-highlighting the importance of context-specific risk assessment. Importantly, it underscores the lack of standardised definitions and diagnostic criteria for NP and NIVAP, which likely contributes to under-recognition and heterogeneity in reported outcomes. Collectively, these findings emphasise the need for improved surveillance, uni","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"42 1","pages":"e4031"},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children admitted to paediatric intensive care at Red Cross War Memorial Children's Hospital with non-accidental injuries (2012 - 2020): A retrospective descriptive study.","authors":"L Bowes, B Rossouw, B M Morrow","doi":"10.7196/SAJCC.2026.v42i1.3260","DOIUrl":"10.7196/SAJCC.2026.v42i1.3260","url":null,"abstract":"<p><strong>Background: </strong>Violence against children remains common in South Africa (SA). Children sustaining severe non-accidental injuries (NAIs) may require admission to paediatric intensive care units (PICUs), however, their outcomes have not been well described in SA.</p><p><strong>Objectives: </strong>To describe the characteristics and outcomes of patients admitted to the PICU with suspected NAIs at Red Cross War Memorial Children's Hospital (RCWMCH).</p><p><strong>Methods: </strong>A retrospective descriptive study of routinely collected data from all children admitted to the PICU at RCWMCH with suspected NAIs from 1 January 2012 to 31 December 2020.</p><p><strong>Results: </strong>Of 11 345 children admitted to the PICU, 42 (0.4%) patients with suspected NAI (median (IQR) age 20.3 (7.9 - 62.6) months; 61.9% male) were included in data analysis. Most patients sustained physical injury (n=35; 83.3%) from assaults (n=19; 45.2%), and head injuries were the most common injury site, while 37 (88.1%) received invasive mechanical ventilation for a median (interquartile range) of 2.0 (1.0 - 3.8) days. PICU mortality was 28.6% (n=12), with a risk-adjusted mortality (observed/mean predicted mortality) of 3.6. Of the 30 PICU survivors, 7 (23.3%) were discharged with long-term disability, while the functional outcome of 16 (53.3%) survivors remains unknown.</p><p><strong>Conclusion: </strong>Children who have sustained NAI represent a small proportion of PICU admissions, with high mortality and considerable morbidity.</p><p><strong>Contribution of the study: </strong>Children with severe non-accidental injury (NAI) represent fewer than 0.5% of paediatric intensive care unit (PICU) admissions at Red Cross War Memorial Children's Hospital over a nine-year period. PICU mortality was 28.6%, more than double the general PICU mortality rate, with a risk adjusted mortality nearly four times the predicted rate. Head injury was the most common and most fatal injury pattern; most incidents occurred in the home, and the perpetrator was most often a family member. Nearly a quarter of survivors were discharged with long-term disability. These findings highlight the need for early clinical recognition of NAI, strict compliance with mandatory reporting obligations, and structured interdisciplinary follow-up of survivors.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"42 1","pages":"e3260"},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on the \"Use of intravenous immunoglobulin for the treatment of severe COVID-19\".","authors":"H Aaungsupawong, V Wiwanitkit","doi":"10.7196/SAJCC.2025.v41i3.3107","DOIUrl":"10.7196/SAJCC.2025.v41i3.3107","url":null,"abstract":"","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 3","pages":"e3107"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The process of rapid sequence intubation in the prehospital setting: A scoping review.","authors":"T J Mathobela, N Mshunqane, T L Khoza","doi":"10.7196/SAJCC.2025.v41i3.3228","DOIUrl":"10.7196/SAJCC.2025.v41i3.3228","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ensuring that the patient's airway is secured is one of the essential priorities for emergency care providers in the prehospital setting. Rapid sequence intubation (RSI) intervention allows the administration of induction and paralytic medications that optimise the conditions for insertion of the endotracheal tube. RSI is essential in the management of critically ill patients to address the risks of aspiration of gastric contents and morbidity and premature mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To systematically explore, map, describe, and provide the extent and nature of published research of the most up-to-date evidence-based elements and guidance of RSI in the prehospital setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This scoping review followed a framework proposed by Arksey and O'Malley and refined by the Joanna Briggs Institute. The following databases were utilised to guide the literature searching process across multiple resources: Scopus, Web of Science and PubMed engines. The articles included were full-text publications written in English, published between 2000 and 2023. A search strategy incorporating different combinations of keywords was developed with the assistance of a librarian. A population, context and concepts (PCC) framework was used to guide the inclusion criteria of identified articles. The selected titles and full-text articles were screened on Rayyan software (Rayyan, USA) and presented on the PRISMA flow diagram. Data were extracted and displayed on an Excel spreadsheet (Microsoft Corp, USA). Concepts were identified, categorised, and grouped into themes through thematic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 2 585 titles and abstracts were screened after duplicates had been removed. Only 138 full-text articles were screened, and 40 articles met eligibility criteria. Categories that were formed from concepts identified were grouped into seven themes, which included: RSI preparations, RSI procedure, training, system requirements, clinical governance, standardisation of RSI, and potential adverse events (AEs) associated with prehospital RSI (PRSI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The seven themes generated from this review indicate that safe, effective, and successful PRSI is achievable, with success and complication rates comparable to, or better than, those in in-hospital settings. The findings underscore that PRSI is a complex intervention that must be performed by appropriately trained personnel. Furthermore, the review highlights the importance of using a well-practised checklist approach and implementing a robust clinical governance framework to minimise AEs, support continuous quality improvement, enhance patient safety, and ultimately improve clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contribution of the study: &lt;/strong&gt;This scoping review contributes to the existing body of knowledge by synthesising the current best evidence on rapid sequence intubation in the prehospita","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 3","pages":"e3228"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of doctors' perspectives on critical laboratory result communication in Cape Town, South Africa.","authors":"A Davids, A E Zemlin, E C Kruger","doi":"10.7196/SAJCC.2025.v41i3.3259","DOIUrl":"10.7196/SAJCC.2025.v41i3.3259","url":null,"abstract":"<p><strong>Background: </strong>Critical laboratory results indicate that a patient is in imminent danger without timely intervention, and prompt communication can improve patient safety. Our laboratory has been trialling different methods of communication to improve our service, including the patient referral application Vula.</p><p><strong>Objectives: </strong>To evaluate clinicians' perceptions of critical laboratory results reported by the Tygerberg Hospital Chemical Pathology Laboratory in South Africa (SA) at various levels of care to identify current challenges, areas for improvement, and preferred communication methods.</p><p><strong>Methods: </strong>A cross-sectional survey was utilised to explore medical professionals' perceptions at different levels of health facilities within Cape Town, SA. The electronic survey targeted clinicians employed at the study sites and excluded auxiliary healthcare staff and was distributed from 10 September 2024 to 31 December 2024. The survey collected data on participants' demographics, experiences, preferences, and expectations regarding critical result communication methods.</p><p><strong>Results: </strong>A total of 76 responses were obtained; 2 were incomplete and excluded. Over half of the respondents had at least 4 years of clinical experience across various disciplines. The majority (n=71, 95.9%) found the communication of critical results to impact patient care. Direct phone calls were favoured by 45.9% (n=34), whereas 44.6% (n=33) preferred mobile methods such as short message service (SMS) or WhatsApp.</p><p><strong>Conclusion: </strong>This study provides insights into clinicians' perceptions of critical laboratory result reporting in healthcare facilities in Cape Town. The findings will help enhance communication practices and develop a standard operating procedure for the Tygerberg Hospital Chemical Pathology Laboratory.</p><p><strong>Contribution of the study: </strong>This study provides insights into clinicians' perspectives of critical laboratory result reporting from different levels of care within Cape Town, South Africa. It highlights both the value of existing communication practices and the areas that require improvement. The findings will support the development of standardised communication strategies aimed at enhancing patient care.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 3","pages":"e3259"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}