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

{"title":"Prevalence and independent predictors of in-hospital stroke among patients who developed acute alteration of consciousness in the medical intensive care unit: A retrospective case-control study.","authors":"S Tongyoo,&nbsp;T Viarasilpa,&nbsp;M Vichutavate,&nbsp;C Permpikul","doi":"10.7196/SAJCC.2023.v39i1.558","DOIUrl":"https://doi.org/10.7196/SAJCC.2023.v39i1.558","url":null,"abstract":"<p><strong>Background: </strong>In-hospital stroke is a serious event, associated with poor outcomes and high mortality. However, identifying signs of stroke may be more difficult in critically ill patients.</p><p><strong>Objectives: </strong>This study investigated the prevalence and independent predictors of in-hospital stroke among patients with acute alteration of consciousness in the medical intensive care unit (MICU) who underwent subsequent brain computed tomography (CT).</p><p><strong>Methods: </strong>This retrospective study enrolled eligible patients during the period 2007 - 2017. The alterations researched were radiologically confirmed acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH).</p><p><strong>Results: </strong>Of 4 360 patients, 113 underwent brain CT. Among these, 31% had AIS, while 15% had ICH. They had higher diastolic blood pressures and arterial pH than non-stroke patients. ICH patients had higher mean (standard deviation (SD) systolic blood pressures (152 (48) v. 129 (25) mmHg; p=0.01), lower mean (SD) Glasgow Coma Scale scores (4 (3) v. 7 (4); p=0.004), and more pupillary abnormalities (75% v. 9%; p<0.001) than AIS patients. AIS patients were older (65 (18) v. 57 (18) years; p=0.03), had more hypertension (60% v. 39%; p=0.04), and more commonly presented with the Babinski sign (26% v. 9%; p=0.04). Multivariate analysis found that pupillary abnormalities independently predicted ICH (adjusted odds ratio (aOR) 26.9; 95% CI 3.7 - 196.3; p=0.001). The Babinski sign (aOR 5.1; 95% CI 1.1 - 23.5; p=0.04) and alkalaemia (arterial pH >7.4; aOR 3.6; 95% CI 1.0 - 12.3; p=0.05) independently predicted AIS.</p><p><strong>Conclusion: </strong>Forty-six percent of the cohort had ICH or AIS. Both conditions had high mortality. The presence of pupillary abnormalities predicts ICH, whereas the Babinski sign and alkalaemia predict AIS.</p><p><strong>Contributions of the study: </strong>The present study reports that almost half (46%) of critically ill patients with alterations of consciousness had an acute stroke. Of these, two-thirds had an acute ischaemic stroke (AIS), and one-third had an intracranial haemorrhage (ICH). Multivariate analysis revealed that a pupillary abnormality was a predictor for ICH and the Babinski sign was identified as a predictor of AIS.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/fd/SAJCC-39-1-558.PMC10378195.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9911020","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":"Traumatic brain injury: Association between the Glasgow Coma Scale score and intensive care unit mortality.","authors":"J J Mkubwa,&nbsp;A G Bedada,&nbsp;T M Esterhuizen","doi":"10.7196/SAJCC.2022.v38i2.525","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i2.525","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) prevalence in Botswana is high and this, coupled with a small population, may reduce productivity. There is no previous study in Botswana on the association between mortality from TBI and the Glasgow Coma Scale (GCS) score although global literature supports its existence.</p><p><strong>Objectives: </strong>Our primary aim was to determine the association between the initial GCS score and the time to mortality of adults admitted with TBI at the Princess Marina Hospital, Gaborone, Botswana, between 2014 and 2019. Secondary aims were to assess the risk factors associated with time to mortality and to estimate the mortality rate from TBI.</p><p><strong>Methods: </strong>This was a retrospective cohort design, medical record census conducted from 1 January 2014 to 31 December 2019.</p><p><strong>Results: </strong>In total, 137 participants fulfilled the inclusion criteria, and the majority, 114 (83.2%), were male with a mean age of 34.5 years. The initial GCS score and time to mortality were associated (adjusted hazard ratio (aHR) 0.69; 95% confidence interval (CI) 0.508 - 0.947). Other factors associated with time to mortality included constricted pupil (aHR 0.12; 95% CI 0.044 - 0.344), temperature (aHR 0.82; 95% CI 0.727 - 0.929), and subdural haematoma (aHR 3.41; 95% CI 1.819 - 6.517). Most cases of TBI (74 (54%)) were due to road traffic accidents. The number of deaths was 48 (35% (95% CI 27.1% - 43.6%)), entirely due to severe TBI.</p><p><strong>Conclusion: </strong>The study confirmed significant association between GCS and mortality. Males were mainly involved in TBI. These findings lack external validity because of the small sample size, and therefore a larger multicentre study is required for validation.</p><p><strong>Contributions of the study: </strong>This study informs the relevant stakeholders in Botswana about sociodemographics, clinical characteristics, management and outcomes of patients admitted to the ICU with severe TBI on the backdrop of scarce ICU resources. It provides a basis for a larger study to inform its external validation.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/ac/SAJCC-38-2-525.PMC9448257.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40357266","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":"Risk factors associated with unplanned ICU admissions following paediatric surgery: A systematic review.","authors":"S Essa,&nbsp;P Mogane,&nbsp;Y Moodley,&nbsp;P Motshabi Chakane","doi":"10.7196/SAJCC.2022.v38i2.504","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i2.504","url":null,"abstract":"<p><strong>Background: </strong>Unplanned admissions to the intensive care unit (ICU) have important implications in the general management of patients. Research in this area has been conducted in the adult and non-surgical population. To date, there is no systematic review addressing risk factors in the paediatric surgical population.</p><p><strong>Objectives: </strong>To synthesise the information from studies that explore the risk factors associated with unplanned ICU admissions following surgery in children through a systematic review process.</p><p><strong>Methods: </strong>We conducted a systematic review of published literature (PROSPERO registration CRD42020163766), adhering to the Preferred Reporting of Observational Studies and Meta-Analysis (PRISMA) statement. The Population, Exposure, Comparator, Outcome (PECO) strategy used was based on: population - paediatric population, exposure - risk factors, comparator - other, and outcome - unplanned ICU admission. Data that reported on unplanned ICU admissions following paediatric surgery were extracted and analysed. Quality of the studies was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Seven studies were included in the data synthesis. Four studies were of good quality with the Newcastle-Ottawa Scale score ≥7 points. The pooled prevalence (95% confidence interval) estimate of unplanned ICU stay was 2.69% (0.05 - 8.6%) and ranged between 0.06% and 8.3%. Significant risk factors included abnormal sleep studies and the presence of comorbidities in adenotonsillectomy surgery. In the general surgical population, younger age, comorbidities and general anaesthesia were significant. Abdominal surgery and ear, nose and throat (ENT) surgery resulted in a higher risk of unplanned ICU admission. Owing to the heterogeneity of the data, a meta-analysis with risk prediction could not be performed.</p><p><strong>Conclusion: </strong>Significant patient, surgical and anaesthetic risk factors associated with unplanned ICU admission in children following surgery are described in this systematic review. A combination of these factors may direct planning toward anticipation of the need for a higher level of postoperative care. Further work to develop a predictive score for unplanned ICU stay is desirable.</p><p><strong>Contributions of the study: </strong>Unplanned admissions to the intensive care unit (ICU) have been acknowledged as an overall marker of safety.^[1] Awareness of this concept has encouraged research to determine the incidence and risk factors of these occurrences. This research has been interrogated in a systematic review process with beneficial conclusions drawn; however, these studies included adults and non-surgical patients.^[2-4] To date, we have not been able to find a systematic review addressing the risk factors associated with unplanned ICU admissions in paediatric surgical patients.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/a8/SAJCC-38-2-504.PMC9442853.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40357267","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":"Iatrogenic blood loss in critical care: A prospective observational study conducted at Universitas Academic Hospital in the Free State Province, South Africa.","authors":"J C Adams,&nbsp;C Barrett,&nbsp;M Spruyt","doi":"10.7196/SAJCC.2022.v38i2.539","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i2.539","url":null,"abstract":"<p><strong>Background: </strong>Prevention of iatrogenic blood loss is an essential component of patient blood management (PBM) in intensive care units (ICUs). The amount of iatrogenic blood loss from diagnostic phlebotomy in the ICUs at Universitas Academic Hospital, Free State Province, South Africa, is unknown.</p><p><strong>Objectives: </strong>To quantify diagnostic phlebotomy volumes, and volumes submitted in excess for diagnostic testing in the ICU.</p><p><strong>Methods: </strong>We conducted a prospective descriptive observational study on adults who were admitted to ICUs at a single centre over a period of 14 days. The weight of each filled phlebotomy tube was calculated using the specific gravity of blood and averages of empty phlebotomy tubes, establishing the total volume.</p><p><strong>Results: </strong>Data from 59 participants with a median length of stay at the ICU of 3 days were analysed. The median phlebotomy volume was 7.0 mL day and 13.6 mL/ICU admission. The volume of blood required for analysis daily and ICU admission was 0.7 mL and 2.2 mL, respectively. The median phlebotomy volume in excess of the amount required for analysis daily and ICU admission was 5.05 mL and 12.11 mL, respectively.</p><p><strong>Conclusion: </strong>While the median excess daily phlebotomy volume in this present study may seem insignificant and underestimating the true excess of phlebotomy volume, interventions to reduce phlebotomy volumes and development of a PBM guideline for appropriate phlebotomy volumes and preventing wastage of patients' blood in the ICU is required.</p><p><strong>Contributions of the study: </strong>We determined blood volume requirements for laboratory instrumentation, which allows phlebotomists to be cognisant of the true requirements for diagnostic tests to be undertaken accurately. We established diagnostic blood loss volumes in critical care units at a tertiary hospital in South Africa and we advocate for the introduction of patient blood management practice guidelines at local institutions.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8a/36/SAJCC-38-2-539.PMC9512050.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40383855","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":"Ventilator-associated pneumonia in PICU - how are we doing?","authors":"L van Wyk,&nbsp;J T Applegate,&nbsp;S Salie","doi":"10.7196/SAJCC.2022.v38i2.536","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i2.536","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in children, leading to an increase in morbidity and mortality. A previous study in 2013 showed that VAP rates decreased dramatically after implementation of a VAP bundle and appointing a VAP coordinator. As part of a 'Plan, Do, Study, Act' cycle, it was necessary to evaluate the efficacy of these interventions.</p><p><strong>Objectives: </strong>To evaluate the VAP rate in the paediatric intensive care unit (PICU) over 2 years (2017 - 2018), and to describe the causative organisms and antibiotic sensitivity/resistance patterns during this period.</p><p><strong>Methods: </strong>This was a retrospective, descriptive study using the existing PICU VAP database as well as clinical folders.</p><p><strong>Results: </strong>Over the 2 years, 31 VAP cases were identified. The VAP rate for 2017 was 4.0/1 000 ventilator days and 5.4/1 000 ventilator days for 2018. Compliance with the VAP bundle was 68% in 2017 and 70% in 2018. The median (interquartile range (IQR)) duration of ventilation in 2017 was 9 (6 -12) days and 15 (11 - 28) days in 2018. The median (IQR) length of PICU stay in 2017 was 11 (8 - 22) days and 25 (17 - 37) days in 2018. The most common cultured organism was an extended-spectrum beta-lactamase (ESBL) <i>Klebsiella pneumoniae</i> sensitive to amikacin and carbapenems.</p><p><strong>Conclusion: </strong>Our VAP rate has not decreased since 2013. It is imperative that we improve compliance with the VAP bundle, in order to reduce VAP rates. <i>K. pneumoniae</i> and <i>Pseudomonas aeruginosa</i> were the most common organisms causing VAPs and empiric use of piptazobactam and amikacin is still appropriate.</p><p><strong>Contributions of the study: </strong>This study highlights the need for ongoing evaluation of quality improvement initiatives in PICU, considering that VAP rates remained largely unchanged from 2013 to 2018.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"38 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/4a/SAJCC-38-2-536.PMC9484309.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33467611","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":"Risk factors and outcomes of extubation failure in a South African tertiary paediatric intensive care unit.","authors":"M-C F Kilba,&nbsp;S Salie,&nbsp;B M Morrow","doi":"10.7196/SAJCC.2022.v38i1.513","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i1.513","url":null,"abstract":"<p><strong>Background: </strong>Extubation failure contributes to poor outcome of mechanically ventilated children, yet the prevalence and risk factors have been poorly studied in South African (SA) children.</p><p><strong>Objectives: </strong>To determine the prevalence, risk factors and outcomes of extubation failure in an SA paediatric intensive care unit (PICU).</p><p><strong>Methods: </strong>This was a prospective, observational study of all mechanically ventilated children admitted to a tertiary PICU in Cape Town, SA. Extubation failure was defined as requiring re-intubation within 48 hours of planned extubation.</p><p><strong>Results: </strong>There were 219 episodes of mechanical ventilation in 204 children (median (interquartile range (IQR)) age 8 (1.6 - 44.4) months). Twenty-one of 184 (11.4%) planned extubations (95% confidence interval (CI) 7.2% - 16.9%) failed. Emergency cardiac admissions (adjusted odds ratio (aOR) 7.58 (95% CI 1.90 - 30.29), dysmorphology (aOR 4.90; 95% CI 1.49 - 16.14), prematurity (aOR 4.39; 95% CI 1.24 - 15.57), and ventilation ≥48 hours (aOR 6.42 (95% CI 1.57 - 26.22) were associated with extubation failure. Children who failed extubation had longer durations of ventilation (231 hours (146.0 - 341.0) v. 53 hours (21.7 - 123.0); p<0.0001); longer duration of PICU (15 (9 - 20) days v. 5 (2 - 9) days; p<0.0001) and hospital length of stay (32 (21 - 53) days v. 15 (8 - 27) days; p=0.009); and higher 30-day mortality (28.6% v. 6.7%; p=0.001) than successfully extubated children.</p><p><strong>Conclusion: </strong>Extubation failure was associated with significant morbidity and mortality in our setting. Risk factors for extubation failure identified in our context were similar to those reported in other settings.</p><p><strong>Contributions of the study: </strong>This study provides novel data on the prevalence, risk factors and outcomes associated with extubation failure in a single-centre South African PICU. The results of this study may help identify high-risk groups for extubation failure within our local context, and forms a basis for practice improvement initiatives aimed at decreasing extubation failure rates and improving outcomes.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/ca/SAJCC-38-1-513.PMC9233282.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40468372","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":"Pharmacological management of post-traumatic seizures in a South African paediatric intensive care unit.","authors":"N Yachad, K D Naidoo","doi":"10.7196/SAJCC.2022.v38i1.522","DOIUrl":"10.7196/SAJCC.2022.v38i1.522","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a common cause of paediatric intensive care unit (PICU) admissions in South Africa. Optimal care of these patients includes the prevention and control of post-traumatic seizures (PTS) in order to minimise secondary brain injury.</p><p><strong>Objectives: </strong>To describe the demographics of children admitted to a South African PICU, to describe the characteristics of PTS, and to describe the prophylactic and therapeutic management of PTS within the unit.</p><p><strong>Methods: </strong>A 3-year retrospective chart review was conducted at the PICU of the Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg, from 1 July 2015 to 30 June 2018.</p><p><strong>Results: </strong>Seventy-eight patients were admitted to the PICU, all with severe TBI. A total of 66 patient files were available for analysis. The median age of admission was 6 years (interquartile range (IQR) 4 - 9) with the majority of trauma secondary to mechanical injury (89%). Prophylactic anti-epileptic drugs (AEDs) were initiated in 44 (79%) patients. Early PTS occurred in 11 (25%) patients who received prophylaxis and 4 (33%) who did not. Three (5%) patients developed late PTS, resulting in an overall incidence of PTS of 43%. The most common seizure type was generalised tonic clonic (82%). Children diagnosed with PTS were a median of 2 years younger than those without PTS, with increased prevalence of seizures (83% v. 38%) in children below 2 years of age. Maintenance therapy was initiated in all patients consistent with recommended dosages. Of the total 167 anti-epileptic levels taken during maintenance, only 56% were within target range. Of the initial 78 patients, 8 died (10%). The median length of stay was 7 (IQR 5 - 12) and 8 (IQR 8 - 24) days longer in ICU and hospital respectively, in children with PTS.</p><p><strong>Conclusion: </strong>PTS is a frequent complication of severe TBI in children. There was considerable variation in the approach to both prophylaxis and maintenance therapy of PTS in terms of choice of agent, dosage, frequency of drug monitoring and approach to subtherapeutic levels. It is clear that more high-level studies are required in order to better inform these practices.</p><p><strong>Contributions of the study: </strong>To the best of our knowledge, this article represents the first description of incidence and management practices of paediatric post traumatic seizures.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/3a/SAJCC-38-1-522.PMC9275334.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40549427","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":"Professional quality of life of nurses in critical care units: Influence of demographic characteristics.","authors":"E Ndlovu,&nbsp;C Filmalter,&nbsp;J Jordaan,&nbsp;T Heyns","doi":"10.7196/SAJCC.2022.v38i1.517","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i1.517","url":null,"abstract":"<p><strong>Background: </strong>Professional quality of life, measured as compassion satisfaction, is a prerequisite for nurses working in intensive care units where patients rely on their care. Nurses who experience compassion satisfaction, or good professional quality of life, engage enthusiastically with all work activities and render quality patient care. In contrast, compassion fatigue eventually leads to disengagement from work activities and unsatisfactory patient outcomes. In this study, we described the demographic factors influencing professional quality of life of intensive care nurses working in public hospitals in Gauteng, South Africa (SA), during the first wave of the COVID-19 pandemic.</p><p><strong>Objectives: </strong>To describe the demographic factors associated with professional quality of life of critical care nurses working in Gauteng, SA.</p><p><strong>Methods: </strong>In this cross-sectional study, we used total population sampling and invited all nurses who had worked for at least 1 year in one of the critical care units of three selected public hospitals in Gauteng to participate. One-hundred and fifty-four nurses responded and completed the ProQol-5 tool during the first wave of the COVID-19 pandemic. Data were analysed using descriptive and inferential statistics.</p><p><strong>Results: </strong>The nurses' average age was 45 years, and 59.1% (n=91) had an additional qualification in critical care nursing. Most of the nurses had a diploma (51.3%; n=79), with a mean work experience of 12.56 years. The main demographic variables that influenced professional quality of life were years of work experience (p=0.047), nurses' education with specific reference to a bachelor's degree (p=0.006) and nurse-patient ratio (p<0.001).</p><p><strong>Conclusion: </strong>Nurses working in critical care units in public hospitals in Gauteng experienced low to moderate compassion satisfaction, moderate to high burnout and secondary traumatic stress, suggesting compassion fatigue. The high workload, which may have been associated with the COVID-19 pandemic, influenced nurses' professional quality of life.</p><p><strong>Contributions of the study: </strong>This study reports on the important problem of compassion fatigue and burnout amongst South African ICU nurses working in the public sector. Associated factors were identified, which should be addressed to improve nurses' wellbeing.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/7a/SAJCC-38-1-517.PMC9258033.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40491467","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":"Prediction of in-hospital mortality: An adaptive severity-of-illness score for a tertiary ICU in South Africa.","authors":"S Pazi,&nbsp;G Sharp,&nbsp;E van der Merwe","doi":"10.7196/SAJCC.2022.v38i1.532","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i1.532","url":null,"abstract":"<p><strong>Background: </strong>A scoring system based on physiological conditions was developed in 1984 to assess the severity of illness. This version, and subsequent versions, were labelled Simplified Acute Physiology Scores (SAPS). Each extension addressed limitations in the earlier version, with the SAPS III model using a data-driven approach. However, the SAPS III model did not include data collected from the African continent, thereby limiting the generalisation of the results.</p><p><strong>Objectives: </strong>To propose a scoring system for assessing severity of illness at intensive care unit (ICU) admission and a model for prediction of in-hospital mortality, based on the severity of illness score.</p><p><strong>Methods: </strong>This is a prospective cohort study which included patients who were admitted to an ICU in a South African tertiary hospital in 2017. Logistic regression modelling was used to develop the proposed scoring system, and the proposed mortality prediction model.</p><p><strong>Results: </strong>The study included 829 patients. Less than a quarter of patients (21.35%; n=177) died during the study period. The proposed model exhibited good calibration and excellent discrimination.</p><p><strong>Conclusion: </strong>The proposed scoring system is able to assess severity of illness at ICU admission, while the proposed statistical model may be used in the prediction of in-hospital mortality.</p><p><strong>Contributions of the study: </strong>This study is the first to develop a model similar to the SAPS III model, based on data collected in South Africa. In addition, this study provides a potential starting point for the development of a model that can be used nationally.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/81/4e/SAJCC-38-1-532.PMC9295203.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40546890","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 impact of government- and institution-implemented COVID-19 control measures on tertiary- and regional-level intensive care units in Pietermaritzburg, KwaZulu-Natal Province, South Africa.","authors":"K Rangai,&nbsp;A Ramkillawan,&nbsp;M T D Smith","doi":"10.7196/SAJCC.2022.v38i1.515","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i1.515","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has had a significant impact on healthcare systems globally as most countries were not equipped to deal with the outbreak. To avoid complete collapse of intensive care units (ICUs) and health systems as a whole, containment measures had to be instituted. In South Africa (SA), the biggest intervention was the government-regulated national lockdown instituted in March 2020.</p><p><strong>Objectives: </strong>To evaluate the effects of the implemented lockdown and institutional guidelines on the admission rate and profile of non-COVID-19 patients in a regional and tertiary level ICU in Pietermaritzburg, KwaZulu-Natal Province, SA.</p><p><strong>Methods: </strong>A retrospective analysis of all non-COVID-19 admissions to Harry Gwala and Greys hospitals was performed over an 8-month period (1 December 2019 - 31 July 2020), which included 4 months prior to lockdown implementation and 4 months post lockdown.</p><p><strong>Results: </strong>There were a total of 678 non-COVID-19 admissions over the 8-month period. The majority of the admissions were at Greys Hospital (52.4%; n=355) and the rest at Harry Gwala Hospital (47.6%; n=323). A change in spectrum of patients admitted was noted, with a significant decrease in trauma and burns admissions post lockdown implementation (from 34.2 - 24.6%; p=0.006). Conversely, there was a notable increase in non-COVID-19 medical admissions after lockdown regulations were implemented (20.1 - 31.3%; p<0.001). We hypothesised that this was due to the gap left by trauma patients in an already overburdened system.</p><p><strong>Conclusion: </strong>Despite the implementation of a national lockdown and multiple institutional directives, there was no significant decrease in the total number of non-COVID-19 admissions to ICUs. There was, however, a notable change in spectrum of patients admitted, which may reflect a bias towards trauma admissions in the pre COVID-19 era.</p><p><strong>Contributions of the study: </strong>We describe the impact of the COVID-19 pandemic on critical care services in a resource-limited setting. We also demonstrate the ongoing need for intensive care unit beds within the public sector.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c8/ae/SAJCC-38-1-515.PMC9252134.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40491468","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}