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

{"title":"The clinical profile of abdominopelvic injury and the determinants of length of stay and mortality in the intensive care unit of a tertiary hospital.","authors":"Y A Kusi-Mensah, T Masuku, R Swai, N Rehman Siddiqui, S Chetty","doi":"10.7196/SAJCC.2025.v41i3.3252","DOIUrl":"10.7196/SAJCC.2025.v41i3.3252","url":null,"abstract":"<p><strong>Background: </strong>Associated with preventable mortality, 50% of abdominopelvic patients require an intensive care unit (ICU). Limited ICU beds in South Africa are significantly impacted by prolonged stays, with 20% of prolonged stays being a result of abdominopelvic injuries.</p><p><strong>Objectives: </strong>To describe the clinical profile and the determinants of length of stay and mortality in patients with abdominopelvic injury admitted to a tertiary hospital ICU.</p><p><strong>Methods: </strong>A retrospective analysis of abdominopelvic injury patients admitted to the surgical ICU at Tygerberg Hospital from January 2021 to December 2023. Using REDCap, demographic and clinical profile data were captured from the Electronic Content Management system. Negative binomial and logistic regression models were used to examine the determinants of length of stay and ICU mortality. respectively.</p><p><strong>Results: </strong>Of the 82 eligible participants, 79.3% were male, mean age of 36.5 years (95% confidence interval (CI) 33.8 - 39.1), with isolated abdominal injury accounting for 14.6% of cases. The median length of ICU and hospital stay was 5 days (interquartile range (IQR) 3 - 13), and 19 days (IQR 9 - 40.5), respectively, with age, acute physiology and chronic health evaluation (APACHE II) score, shock index and relook surgery being the key determinants of length of ICU stay. Further to these factors, ICU mortality was associated independently with serum lactate levels (odds ratio 1.37 (95% CI 1.04 - 1.80) with the crude mortality rate (CMR) being 29.3%.</p><p><strong>Conclusion: </strong>The majority of abdominopelvic injuries admitted to the ICU are non-isolated, with age, APACHE II score, shock index and relook surgery key determinants of ICU length of stay. Further, ICU mortality is associated with serum lactate levels. Adequate resuscitation and optimising initial surgery may help reduce patients' stay in the ICU, and mortality.</p><p><strong>Contribution of the study: </strong>In South Africa, where the burden of trauma is quite high, this study provides context-specific insights, general overview of abdominal trauma patients needing ICU care, valuable cognisance of the key determinants of ICU morbidity and the predictive role of serum lactate with regard to ICU mortality following abdominal trauma.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 3","pages":"e3252"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438254","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":"Noise levels in intensive care units at Charlotte Maxeke Johannesburg Academic Hospital.","authors":"D Brancato, M Mer, Z Jooma","doi":"10.7196/SAJCC.2025.v41i3.3169","DOIUrl":"10.7196/SAJCC.2025.v41i3.3169","url":null,"abstract":"<p><strong>Background: </strong>Noise exposure can negatively affect patients and staff. Patients may experience sleep disturbance, delirium and sympathetic stimulation. Communication may be hampered, and staff may experience alarm fatigue. The World Health Organization (WHO) recommends time-averaged sound levels of 35 dB. Prolonged exposure to noise levels ≥85 dB may damage hearing. Studies on noise levels in adult intensive care units (ICUs) in South Africa are lacking.</p><p><strong>Objectives: </strong>To compare noise levels with WHO recommendations, across ICUs and between recording zones.</p><p><strong>Methods: </strong>A prospective cross-sectional research design was used. A class 2 sound-level meter measured noise levels in six adult ICUs at the central station and a patient cubicle for three 24-hour periods per ICU.</p><p><strong>Results: </strong>Time-weighted sound levels (L_eq) ranged between 48 and 65 dB. There was no statistically significant difference when comparing noise levels conditioned to ICU size, layout and between recording zones. Daytime noise levels at the central station were higher than night-time values (p<0.001) but diurnal variation was not appreciated in patient cubicles. All ICUs exceeded WHO recommendations >80% of the time. Noise levels >85 dB were very infrequent.</p><p><strong>Conclusion: </strong>Noise levels consistently exceeded WHO recommendations, ranging between 48 and 65 dB. ICU size and layout do not appear to influence noise levels. Elevated daytime noise levels at central stations may result from increased daytime staff and duties. Noise-protective equipment is unnecessary as noise levels do not exceed 85 dB for >8 hours, but noise-reduction strategies should be broadly implemented to improve critical care.</p><p><strong>Contribution of the study: </strong>This is the first study in South Africa to measure sound levels in adult intensive care units and provides baseline data which can be used to implement interventions aimed at reducing noise levels to improve care of critically ill adult patients.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 3","pages":"e3169"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438304","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 retrospective review of advanced life support interfacility transfers of the public sector emergency medical service in the Western Cape Province, South Africa.","authors":"L C van Rensburg, N Majiet, C Vincent-Lambert, W Stassen","doi":"10.7196/SAJCC.2025.v41i3.3282","DOIUrl":"10.7196/SAJCC.2025.v41i3.3282","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The need for critical care transfers (CCTs) has increased in recent years owing to the growing prevalence of high-acuity patients who require access to specialised care and/or resources that are not readily available at the facility where they find themselves. During their transfer from one facility to another, critically ill and injured patients commonly require ongoing care, monitoring and interventions that can only be provided by transfer teams with advanced training and appropriate equipment. In South Africa (SA), these transfers are undertaken mainly by advanced life support (ALS) providers with variable amounts of training. Understanding the demographics and needs of CCT patients in specific contexts is essential to inform training and policy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To broadly describe the population of adult patients undergoing CCTs facilitated by the public sector emergency medical service (EMS) in the Western Cape Province, South Africa. Patient demographics (age and gender), time intervals (response time, scene time, transfer time), primary diagnosis (respiratory, cardiovascular, gastrointestinal tract, and others), attachments, and clinical or pharmacological interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective descriptive analysis was conducted on electronic patient care records (ePCRs) logged in the EMS's Computer-Aided Dispatch (CAD) database from January 2018 to December 2021. As no universal criteria currently exist for distinguishing a CCT from another transfer, our focus was on cases that required ALS care during the transfer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the study period, 25 635 adult patients underwent ALS transfers, with a nearly equal gender distribution. The median patient age was 40 (range 18 - 101) years. Sixty percent of patients were triaged as orange upon arrival (for urgent management) and the remainder red (for emergency or immediate management). Average response, preparation, and transport times spent (minutes:seconds) were 7:10, 16:58, and 12:56, respectively. Respiratory disease (17.9%), cardiovascular disease (12.2%), and central nervous system disorders (12.0%) were the most prevalent clinical conditions. Non-invasive blood pressure monitors (98%) and pulse oximeters (96%) were commonly used devices. Medications were administered to 22% of patients, primarily via intravenous injection (7.5%) and continuous infusion (6.7%). Morphine (4.3%), midazolam (6.4%), and adrenaline (2.0%) were frequently utilised medications. These findings highlight the demographic profile, clinical conditions, and critical care aspects involved in ALS patient transfers, emphasising the complexity and urgency of prehospital medical transport.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study analyses adult patients undergoing ALS transfers by a public sector EMS in the Western Cape, SA (2018 - 2021), providing insights into the transferred patient population. It highlights the ","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 3","pages":"e3282"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438274","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":"Clinical decision-making process of healthcare workers when feeding critically ill adults in public sector ICUs in South Africa.","authors":"K Coutts, K Eckmann","doi":"10.7196/SAJCC.2025.v41i3.2741","DOIUrl":"10.7196/SAJCC.2025.v41i3.2741","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Feeding critically ill patients is a complex process because swallowing is heterogeneous, and dysphagia in critically ill patients can have multiple causes. Decisions regarding dysphagia in the critically ill need to be made as a team with all possible outcomes and factors taken into account to ensure the best possible outcomes for patients. However, research has shown that in South Africa (SA), the multidisciplinary team (MDT) approach is not generally used when making decisions around feeding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To explore the clinical decision-making (CDM) factors in feeding practices in adults of the MDT in public healthcare intensive care units (ICUs) in Johannesburg, SA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A qualitative design with non-probability purposive sampling was used. There were 15 MDT participants across two tertiary hospitals. Data were derived from observations, focus groups, and individual interviews and analysed using a reflective thematic approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three themes were reported on, namely decision-making factors in the ICU by the MDT, non-patient-related factors and the meaning and misconception of the word 'tolerance'. There are no protocols followed in the ICU and decisions are made on an individual basis. Non-patient related factors impact the decisions and when the MDT collaborates, it positively influences the CDM process. Different MDT members use the word 'tolerance' differently in dysphagia, which needs to be considered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Clinical factors were the primary consideration for all MDT members when selecting a feeding method for critically ill patients. Environmental factors were also considered when adaptations were necessary owing to contextual constraints. The findings indicate that a multidisciplinary approach to feeding is not consistently practised in SA public sector ICUs, and there is no standardised feeding protocol in place. This was evident from the infrequent communication and collaboration among MDT members. Improved interdisciplinary co-ordination is needed. Additionally, inconsistent use of medical terminology among team members may affect patient care. Clear communication of terminology is essential to ensure mutual understanding of clinical decisions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contribution of the study: &lt;/strong&gt;This study contributes to the understanding of feeding practices for critically ill patients in South African public sector intensive care units (ICUs) by highlighting the absence of standardised feeding protocols and the inconsistent application of a multidisciplinary team (MDT) approach. It highlights how clinical decision-making is influenced not only by patient-related factors but also by environmental and contextual constraints. Importantly, the research draws attention to the impact of inconsistent terminology, such as varied interpretations of 'tolerance', on patient care and team collaboration. By ","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 3","pages":"e2741"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438252","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 and outcomes of early hyperglycaemia in critically ill patients.","authors":"P Anauth, K de Vasconcellos","doi":"10.7196/SAJCC.2025.v41i3.1541","DOIUrl":"10.7196/SAJCC.2025.v41i3.1541","url":null,"abstract":"<p><strong>Background: </strong>Hyperglycaemia is common in hospitalised patients. Acute illness or injury may result in glucose intolerance and insulin resistance leading to hyperglycaemia. There is a lack of data on the incidence and impact of early hyperglycaemia in critically ill patients in South Africa (SA).</p><p><strong>Objectives: </strong>To determine the incidence of hyperglycaemia within 48 hours of admission to a multidisciplinary SA ICU and to determine if there was any association between blood glucose level and ICU outcomes.</p><p><strong>Methods: </strong>This was a retrospective observational study of patients admitted to ICU at King Edward VIII Hospital from November 2021 to August 2022. All blood glucose values were recorded within the first 48 hours of admission. The primary outcome was ICU mortality, with secondary outcomes including ICU length of stay (LOS), ventilator days (LOV), renal replacement therapy (RRT) and wound infection.</p><p><strong>Results: </strong>A total of 177 patients were included in the study. Hyperglycaemia with a blood glucose of more than 10 mmol/L within 48 hours of ICU admission occurred more frequently in those who died in ICU (79.5%) v. ICU survivors (60.1%) (p=0.026). Hyperglycaemia was associated with an increase in ICU LOS, LOV and wound infection. No statistically significant relationship was found between hyperglycaemia and RRT. Hypoglycaemia within 48 hours of ICU admission was also associated with an increased ICU mortality.</p><p><strong>Conclusion: </strong>Extremes of blood glucose were associated with increased ICU mortality. We recommend a moderate glycaemic control target of 6 - 10 mmol/L in resource-limited settings.</p><p><strong>Contribution of the study: </strong>The study provides insight into associations with blood glucose level in a multidisciplinary critical care population in South Africa. Hyperglycaemia is common in critically ill patients in South Africa and is associated with severity of illness. Hypergylcaemia is associated with increased ICU mortality, ICU length of stay, length of ventilation and wound sepsis. Hypoglycaemia was also associated with increased ICU mortality. Based on the findings of this study, moderate glycaemic control, with avoidance of hypoglycaemia remains a reasonable strategy for critically ill patients in South Africa.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 3","pages":"e1906"},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438256","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":"Evaluating complications in a South African neurocritical care unit: A 1-year retrospective audit.","authors":"B A Kgaodi, C Arnold-Day, S Linde, P L Semple","doi":"10.7196/SAJCC.2025.v412.1896","DOIUrl":"10.7196/SAJCC.2025.v412.1896","url":null,"abstract":"<p><strong>Background: </strong>The benefits of setting up a dedicated neurocritical care unit (NCCU) for critically ill neurological patients are well documented. These units are specifically designed to care for individuals with conditions affecting the brain and spine. However, complications particular to these units in low- and middle-income countries are not widely reported.</p><p><strong>Objectives: </strong>To describe the complications observed in an NCCU at a tertiary-level academic hospital over the course of 1 year and examine their link with intensive care unit (ICU) length of stay (LOS) and mortality rates.</p><p><strong>Methods: </strong>The study involved retrospective analysis of complications experienced by critically ill neurological patients admitted to the NCCU between 1 January and 31 December 2020, according to the NCCU patient data registry.</p><p><strong>Results: </strong>A total of 850 patients, most of whom were male (61.2% in the high-care unit (HCU) and 68.1% in the ICU), were admitted to the NCCU, with a median age of 43 years and 41 years in the HCU and the ICU, respectively. The overall rate of complications was 38.2% (n=325/850 patients). Statistically significant complications (p<0.05) included metabolic and electrolyte imbalances, infections (including ventilator-associated pneumonia, surgical site infections and central line-associated bloodstream infections), and deep-vein thrombosis. The most common complication was metabolic disturbances (28.2%), particularly sodium homoeostasis abnormalities. The number of complications significantly affected NCCU LOS (p<0.001), but did not have a statistically significant impact on mortality (p=0.067).</p><p><strong>Conclusion: </strong>Complications occurred in 38.2% of critically ill neurological patients in a specialised NCCU in a tertiary-level academic hospital in South Africa, primarily involving electrolyte disturbances and infections. These complications were linked to longer LOS in the ICU, but did not significantly increase the risk of mortality.</p><p><strong>Contribution of the study: </strong>This study provides valuable insight into the burden and nature of complications encountered in a resource-constrained neurocritical care setting. By systematically identifying and quantifying clinical complications over a defined period, the article highlights critical areas for intervention and quality improvement. It contributes to the global body of neurocritical care literature by offering context-specific data from a low- to middle-income country, thereby addressing a significant gap in regional and global neurocritical care outcomes research. The findings support the development of targeted strategies to enhance patient safety, optimise resource use, and improve clinical outcomes in similar healthcare environments.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 2","pages":"e1896"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12622871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552250","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":"Beyond survival: Functionality and health-related quality of life among a cohort of ICU survivors 6 months after hospital discharge - a single-centre study in the Eastern Cape Province of South Africa.","authors":"E van der Merwe, L Stroud, G Sharp, N van Vuuren, M Mosola, T Fodo, F Paruk","doi":"10.7196/SAJCC.2025.v412.1906","DOIUrl":"10.7196/SAJCC.2025.v412.1906","url":null,"abstract":"<p><strong>Background: </strong>New or worsened impairments in physical, cognitive and/or psychological health may persist after critical care discharge and impact negatively on survivors' health-related quality of life (HRQOL), functionality and life roles.</p><p><strong>Objectives: </strong>To describe functionality, changes in life roles and HRQOL among an Eastern Cape single-centre cohort of ICU survivors, 6 months after hospital discharge.</p><p><strong>Methods: </strong>The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape and enrolled critically ill patients who required organ support and had an ICU stay for at least 48 hours. Patients were assessed at 6 weeks and 6 months post hospital discharge. The Lawton's Instrumental Activities of Daily Living (IADL) score and employment/educational status were determined. The Rand Short Form 36 HRQOL questionnaire's physical and mental component scores (PCS and MCS) were used to determine quality of life at baseline and study visits.</p><p><strong>Results: </strong>A total of 107 patients with a median age of 42, half of whom had COVID-19, completed the 6-month follow-up. At the 6-month follow-up, 17.5% of previously non-frail patients were still unable to complete at least two IADLs, and 24.3% one IADL. Overall, 34% had not returned to their life roles of home making, studying or remunerative work due to ill-health. At 6 months, 58.9% and 62.6% had significantly lower mean PCS and MCS scores, respectively. Overall, 62.6 % of survivors had either a significantly lower PCS and/or MCS at 6 months.</p><p><strong>Conclusion: </strong>This relatively young cohort of ICU survivors, with minimal previous comorbidities, demonstrated a high incidence of significantly lower HRQOL scores at the 6-month follow-up, affecting 6 out of every 10 patients. The proportion of patients who were unable to complete all IADLs at follow-up, explains the reported changes in relation to life roles, including remunerative employment. These findings have implications for the introduction or reengineering of rehabilitation resources and ICU follow-up services.</p><p><strong>Contribution of the study: </strong>This study adds to the limited body of evidence on post-ICU outcomes in South Africa by documenting high rates of impaired functionality, reduced HRQOL, and disrupted life roles at 6 months after hospital discharge. These findings support the need for context-appropriate ICU follow-up and rehabilitation strategies.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 2","pages":"e2940"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12622881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552255","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":"Validation of the APACHE‑II scoring system in critically ill patients diagnosed with COVID‑19 and admitted at a regional‑level hospital intensive care unit: A retrospective study.","authors":"Y-C Chang, J Invernizzi, T Mcizana","doi":"10.7196/SAJCC.2025.v412.1522","DOIUrl":"10.7196/SAJCC.2025.v412.1522","url":null,"abstract":"<p><strong>Background: </strong>The use of the Acute Physiology and Chronic Health Evaluation II (APACHE-II) scoring system to predict mortality in the intensive care unit (ICU) has not been validated for use in the coronavirus-19 (COVID-19) pandemic in the South African context.</p><p><strong>Objectives: </strong>To provide data on the outcomes and clinical characteristics of ICU patients in a regional hospital diagnosed with COVID-19. The primary objective was to measure the validity of the APACHE-II scoring system in predicting mortality in these patients. Secondary objectives included the description of clinical characteristics, potential risk factors for mortality and length of ICU stay.</p><p><strong>Methods: </strong>This study was a single-centre, retrospective, observational cohort study conducted from 2020 to 2022. Data were obtained from electronic databases and patient records to determine diagnosis of COVID-19, demographics, comorbidities, history, clinical parameters and patient outcome. A receiver operating characteristic (ROC) analysis was performed to assess the discriminative power of the APACHE-II score in predicting mortality.</p><p><strong>Results: </strong>A total of 96 patients with confirmed COVID-19 diagnoses had sufficient data to calculate the APACHE-II score. The observed in-hospital mortality was 57.3%, while the APACHE-II score predicted a mortality of 25%. An ROC analysis showed poor discrimination (area under the ROC curve 0.58). Patients who had increased odds of death were those with increased age: odds ratio (OR) 1.01 (confidence interval (CI) 1.00 - 1.02), and those who were peripartum: OR 4.35 (CI 1.06 - 29.30). Other factors were not significantly associated with mortality. The median (interquartile range) length of hospital stay was 5.00 (4.00 - 9.25) days.</p><p><strong>Conclusion: </strong>The APACHE-II scoring system is a poor discriminator between death and survival in this cohort of COVID-19 ICU patients. ICU patients who were diagnosed with COVID-19 were more likely to die despite a relatively low APACHE-II score. Information regarding clinical characteristics of these ICU patients and their outcomes provides some insight into the nature of the COVID-19 pandemic.</p><p><strong>Contribution of the study: </strong>While mortality prediction models such as the APACHE-II score are valuable in general ICU populations, their applicability to novel diseases may be limited, as evidenced during the COVID-19 pandemic. Our findings highlight the limitations of these generalized prognostic tools when applied to future emerging diseases.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 2","pages":"e1522"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12622879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552278","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":"Emergency care capacity of private primary healthcare facilities in Gauteng, South Africa.","authors":"M Cluff, M L Botes","doi":"10.7196/SAJCC.2025.v412.2067","DOIUrl":"10.7196/SAJCC.2025.v412.2067","url":null,"abstract":"<p><strong>Background: </strong>Strengthening emergency care at the primary healthcare (PHC) level has been identified as a strategy for improving the emergency care system, which should include the private sector as well. As the National Health Insurance Act will soon come into effect, more non-medical aid users are expected to access private healthcare facilities. There is a great need for further assessment of the emergency care capacity at private primary healthcare facilities.</p><p><strong>Objectives: </strong>To use a standardised facility-based assessment tool to assess if private PHC facilities in Gauteng have the capacity to deliver emergency care services using the Hospital Emergency Unit Assessment Tool (HEAT).</p><p><strong>Methods: </strong>The HEAT - a standardised tool - was used for quantitative description of the critical functions and structure of an emergency unit (EU) at any facility level of PHC facilities in a private healthcare group.</p><p><strong>Results: </strong>More than half (n/N=10/19) of the facilities participated in the study. Facilities demonstrated adequate equipment, resources and staffing for basic emergency care despite a lack of specific skills and specialised protocols.</p><p><strong>Conclusion: </strong>All private primary healthcare facilities met the listed infrastructure and essential equipment requirements for emergency care, including a resuscitation area; however, none of the facilities had an area specifically for triage. Common barriers to performing emergency care procedures across most facilities were due to a lack of training in emergency protocols and procedures.</p><p><strong>Contribution of the study: </strong>This study assessed the emergency care capacity of private primary healthcare facilities in Gauteng, South Africa, finding that while facilities had adequate infrastructure and equipment for basic emergency care, they lacked specialised triage areas and staff training in emergency protocols, highlighting gaps that need addressing as more patients are expected to access private healthcare under the National Health Insurance Act.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 2","pages":"e2067"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12622882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552290","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":"Early mobilisation practices in Windhoek intensive care units: A retrospective review of patient profiles and physiotherapy practice.","authors":"I du Plessis, S Francis, B Morrow","doi":"10.7196/SAJCC.2025.v412.2494","DOIUrl":"10.7196/SAJCC.2025.v412.2494","url":null,"abstract":"<p><strong>Background: </strong>Early mobilisation (EM) is safe and feasible with positive patient outcomes in various settings. However, data from Namibia in southern Africa are lacking, and the status of intensive care unit (ICU)-based mobilisation is unknown.</p><p><strong>Objectives: </strong>To describe the mobility practices and profiles of critically ill patients in ICUs in Windhoek, Namibia.</p><p><strong>Methods: </strong>A retrospective, descriptive record review was conducted in two private hospitals in Windhoek. Data were extracted using a self-designed electronic data abstraction form. The primary outcomes were the profile of ICU patients and documented mobility practices. Secondary outcomes included the timing and frequency of mobilisation, physiotherapy techniques used, and adverse events during physiotherapy. Patients with incomplete datasets or illegible records were excluded.</p><p><strong>Results: </strong>The review included charts of 870 adult patients admitted to the participating ICUs between January and December 2016. Patients were predominantly male (61.8%; n=538), with a mean (standard deviation (SD)) age of 56 (14.9) years. Most admissions were planned (66.3%; n=577), mainly for coronary angiograms (20.6%; n=179), cardiac conditions (13.0%; n=113) and cardiac surgery (10.3%; n=90). The mean (SD) length of ICU stay was 3.41 (3.3) days, and the mean duration of mechanical ventilation was 0.7 (2.1) days. The overall ICU mortality rate was 5.2% (n=45). Of the 870 patients, 352 (40.5%) received physiotherapy, with 345 of these (98.0%) being mobilised. The median (interquartile range) length of ICU stay for mobilised patients was 3 (2 - 5) days, compared with 2 (2 - 3) days for non-mobilised patients (p<0.0001). Adverse events during physiotherapy were rare, occurring in only 5 patients (1.4%).</p><p><strong>Conclusion: </strong>EM is often implemented as part of physiotherapy practice in Windhoek ICUs; however, fewer than half of the patients in this study received physiotherapy, highlighting the need for improved implementation of EM protocols and screening for readiness to mobilise.</p><p><strong>Contribution of the study: </strong>This study provides insights into intensive care unit (ICU) patient profiles and physiotherapy mobility practices in Windhoek, Namibia, demonstrating that early mobilisation is feasible and can be integrated into routine care. It highlights areas for improvement, including increasing physiotherapy referrals and implementing mobilisation screening. These findings can inform the development of more comprehensive, evidence-based ICU care protocols.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 2","pages":"e2494"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12622880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552244","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}