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

{"title":"Organ donation in South Africa – a call to action","authors":"D. Thomson","doi":"10.7196/352","DOIUrl":"https://doi.org/10.7196/352","url":null,"abstract":"In this issue of the SAJCC, Crymble et al.[1] correctly point out that there is a desperate need for organ donors in South Africa (SA). Their article highlights the integral role of nurses in the organ donation process,[2] and elegantly shows that nurses would welcome a greater role, while at the same time noting that expanded education efforts are desperately needed. Despite our place in history for performing the first heart transplant,[3] SA organ donation rates do not compare well with other countries. Our deceased donor rate is <3 per million population. Spain is the world leader in deceased organ donation, with a rate approaching 40 per million population and Brazil achieves a rate of 14 per million population.[4] Many people see living-related donation as the way forward, yet living-related donation is only an option for certain organ transplants. The majority of patients in need of an organ do not have a suitable living donor. Living donation also exposes donors to a degree of risk which deceased donors by definition do not have, since they are always certified legally dead through a rigorous testing process. Under SA law, certification of brain death is required to be performed by two doctors, of whom one is required to have >5 years of experience and both should be completely independent of the transplant team.[5] The reasons for SA’s low deceased donation rate are multiple. The lack of awareness and knowledge among both the public and medical professionals about brain death and organ donation needs to be addressed.[6] Free, open-access online educational resources, such as the University of Cape Town’s course ‘Organ Donation: From Death to Life’, have been developed to improve training and awareness about brain death and organ donation.[7] The SA government’s healthcare policy, which is rightly focused on primary healthcare interventions as a cost-effective strategy to improve the health of the population,[8] should not neglect transplantation. Although it is not prioritised as a major health need, transplantation activity is a reflection of the whole healthcare system. One can only be assessed as a potential organ donor when all treatment options have been exhausted and the clinical team has left no stone unturned. The family can only be approached for consent for donation when they have been adequately counselled about the clinical situation. If this is not done well, consent will not be given and without consent there can be no organ donation. As such, organ donation rates can and should be used as a measurable healthcare outcome. In SA, the consent rate for deceased organ donation at Groote Schuur Hospital for 2017 was 18% at the time of publication of this editorial, in other words 82% of families opt not to support organ donation. Even in countries where consent is presumed, the family is always counselled. Spain has a 16% refusal rate based on family objections. It is important to note that signing onto the organ donor registry ","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"30 1","pages":"36-38"},"PeriodicalIF":0.0,"publicationDate":"2017-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89746291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic stewardship – it starts with you!","authors":"Malcolm G A Miller","doi":"10.7196/351","DOIUrl":"https://doi.org/10.7196/351","url":null,"abstract":"","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"6 1","pages":"34-35"},"PeriodicalIF":0.0,"publicationDate":"2017-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86189567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of damping characteristics of arterial catheter blood pressure monitoring in a large intensive care unit","authors":"W. Rook, J. Turner, T. Clutton-Brock","doi":"10.7196/300","DOIUrl":"https://doi.org/10.7196/300","url":null,"abstract":"Background. For many reasons, the invasive measurement of systolic and diastolic blood pressure should be accurate. Accuracy is determined, in part, by the damping characteristics of the arterial catheter blood pressure monitoring system. Objectives . To ascertain the damping characteristics of arterial catheter blood pressure monitoring in a large tertiary intensive care unit (ICU) and to elicit any causes of under- or over-damping of the measurement systems. Methods. A cross-sectional, observational study of arterial line measurements in a large general ICU. The coefficient of damping (CoD) was calculated from the waveform generated from a ‘fast flush’. Results . Thirty systems (19%) were adequately damped (CoD 0.4 - 0.8), 56 (37%) were overdamped, and 68 (44%) were underdamped. We did not find that poor damping characteristics were associated with the age of the arterial catheter or the type of catheter used. Conclusion. Most systems observed in this study were inappropriately damped, which would result in the inaccurate display of the waveform and systolic and diastolic pressures.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"30 1","pages":"8-10"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85520824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sugar, Pressure and Pregnancy","authors":"W. L. Michell","doi":"10.7196/SAJCC.337","DOIUrl":"https://doi.org/10.7196/SAJCC.337","url":null,"abstract":"","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"67 1","pages":"2-2"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85665384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The need for setting standards in critical care transfers","authors":"M. Venter, D. Stanton, N. Conradie, L. Jordaan, C. Venter, W. Stassen","doi":"10.7196/SAJCC.2017.V33I1.319","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.319","url":null,"abstract":"1 Netcare 911, Netcare (Pty) Ltd., Midrand, South Africa 2 Critical Care Transport Unit, Department of Health, Gauteng Provincial Government, South Africa 3 Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa 4 Department of Emergency Medical Care, Faculty of Health Sciences, Cape Peninsula University of Technology, Cape Town, South Africa 5 Critical Care Retrieval Services, ER24, Johannesburg, South Africa","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"29 1","pages":"32-32"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86226087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between different methods of intra-abdominal pressure monitoring in varying intra-abdominal hypertension models","authors":"R. Wise, R. Rodseth, L. Correa-Martín, F. M. S. Margallo, P. Becker, G. Castellanos, M. Malbrain","doi":"10.7196/SAJCC.2017.V33I1.327","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.327","url":null,"abstract":"Grant from Extremadura Regional \u0000 Government through the Plan Regional de Investigacion de Extremadura \u0000 (PRI09A161 to Minimally Invasive Surgery Center Jesus Uson).","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"46 1","pages":"15-18"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72510892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric patients admitted to the intensive care unit of Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa","authors":"M. Motiang","doi":"10.7196/279","DOIUrl":"https://doi.org/10.7196/279","url":null,"abstract":"Background . Pregnancy is a natural physiological process that normally ends uneventfully. However, there are instances where admission to an intensive care (ICU) is required. Objectives . To determine the spectrum of disease requiring ICU admission in obstetric patients, condition on discharge, maternal mortality, and the cause of maternal death. Methods . A retrospective study of all pregnant and postpartum patients admitted from January 2008 to December 2011 was conducted. Outcome measures were the spectrum of disease, ICU interventions, and maternal outcomes. Results . In total, 210 patients were reviewed. The mean age was 28.15 (standard deviation (SD) 6.97) years. Twelve (5.7%) patients were admitted at a mean (SD) gestational age of 25.33 (6.56) weeks, 94.2% ( n =198) were postpartum, and 88.6% ( n =186) were post-caesarean section. Pre-existing cardiac disease (44.3%, n =93), eclampsia and preeclampsia (20%, n =42), obstetric haemorrhage (16.2%, n =34), and pulmonary oedema (6.2%, n =13) were the most common causes of admission. Sixty-one percent ( n =128) of patients received ventilatory support. The median length of ICU stay was 24 hours (range 1 - 17 days). Eighty-seven percent ( n =183) of the patients were haemodynamically stable. Maternal mortality was 9% ( n =19). Conclusion . Cardiac disease in pregnancy was the most common diagnosis in patients admitted to our ICU, followed by eclampsia and preeclampsia. Most of the patients (87.1%) were haemodynamically stable and needed minimal intervention, as confirmed by their short periods of stay in ICU. Although the mortality rate in our institution was higher than that observed in developed countries, it was lower than rates reported in other South African studies. This study has found that many of the patients were admitted to ICU for monitoring purposes only and did not require ICU level of care.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"7 1","pages":"12-14"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84911025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lived experiences of Rwandan ICU nurses caring for patients with a do-not-resuscitate order","authors":"E. Nankundwa, P. Brysiewicz","doi":"10.7196/281","DOIUrl":"https://doi.org/10.7196/281","url":null,"abstract":"Background. Do not resuscitate (DNR) is the policy and practice of deliberately not attempting to resuscitate a person whose heart has stopped beating. Research on nursing care for patients designated with DNR orders has been conducted since the late 1980s; however, no study appears to have been carried out in the Rwandan setting. Purpose . The purpose of this study was to explore the lived experiences of nurses caring for a patient with a DNR order in an intensive care unit (ICU) in Kigali, Rwanda, in order to suggest nursing recommendations. Methods. Using a phenomenological approach, two semi-structured interviews were conducted with each participant to explore their lived experiences of caring for patients with DNR orders. The sample comprised six nurses from an ICU in a large tertiary-level hospital in Kigali, Rwanda. Results . The data were organised into categories based on a review of the data from the interviews of the six participants. The categories were: feeling emotional distress; barrier to optimal care; and not part of decision-making. Conclusion . DNR orders are a fairly new concept in Rwanda and the practice of DNR orders in ICU is very demanding for the staff, especially the ICU nurses. Additional education about DNR orders as well as policies to guide its implementation could assist ICU nurses in their difficult work.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"32 1","pages":"19-22"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86939151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap","authors":"D. Maharaj, H. Perrie, J. Scribante, F. Paruk","doi":"10.7196/SAJCC.2017.V33I1.280","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.280","url":null,"abstract":"Background . Glycaemic control constitutes an important component in the management of critically ill patients. As such, all healthcare workers involved in the management of critically ill patients need to ensure that it is achieved adequately. To avoid glucose variability and to maintain normoglycaemia, evidence-based protocols are implemented to guide clinical care. However, it has been suggested that with the use of protocoldirected therapy, protocol-practice gaps are common and therefore protocol adherence must be audited regularly. The aim of this study was to evaluate adherence to the glucose control protocol by nurses in the cardiothoracic intensive care unit (ICU) at a tertiary academic hospital. Methods . A retrospective study involving the review of ICU charts of all post-cardiac surgery patients ≥16 years admitted to the cardiothoracic ICU during March 2011. A convenience sampling method was used. Results . A total of 741 glucose readings for 22 patients were evaluated. The median (interquartile range) glucose reading was 7.8 mmol/L (6.7 - 9.3 mmol/L). Overall, 411 (55.5%) protocol violations were recorded and 629 (84.9%) of the total readings were abnormal. Protocol violations were similar between the day and night staff; 188 (54.7%) and 223 (58.5%) were recorded, respectively ( p =0.256). Of the readings, 464 (62.6%) were conducted by ICU-trained nurses and 245 (33.2%) by non-ICU-trained nurses. There were fewer protocol violations recorded by the ICU-trained nurses compared with the non-ICU-trained nurses, i.e. 53.3% and 63.7%, respectively ( p <0.05). Conclusion . Adherence to the glucose-control protocol was suboptimal. These results may suggest that the training and education of healthcare workers in implementing protocols is an ongoing and dynamic process, and that there is a need for the regular evaluation of protocol adherence in order to identify protocol-practice gaps.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"8 1","pages":"4-7"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73161357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The treatment of autonomic dysfunction in tetanus","authors":"T. V. D. Heever, M. Spruyt","doi":"10.7196/SAJCC.2017.V33I1.274","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.274","url":null,"abstract":"We report a case of generalised tetanus in a 50-year-old female patient after sustaining a wound to her right lower leg. She developed autonomic dysfunction, which included labile hypertension alternating with hypotension and sweating. The autonomic dysfunction was treated successfully with a combination of morphine sulphate infusion, magnesium sulphate, and clonidine. She also received adrenaline and phenylephrine infusions as needed for hypotension. We then discuss the pathophysiology, clinical features and treatment options of autonomic dysfunction.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"25 1","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73024042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}