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- Southern African Journal of Critical Care
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- Volume 25, Issue 1, 2009
Southern African Journal of Critical Care - Volume 25, Issue 1, 2009
Volume 25, Issue 1, 2009
Pattern of admissions to the University of Port Harcourt Teaching Hospital intensive care unit - a 10-year analysisSource: Southern African Journal of Critical Care 25, pp 10 –15 (2009)More Less
Objective. To determine the admission pattern and outcome of patients in the Intensive Care Unit (ICU) of University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria.
Method. A retrospective review of all patients admitted to the ICU at the UPTH from 1996 to 2005 was carried out. Data were obtained from the ICU admission and discharge registers and nurses' handover records.
Results. A total of 1 447 patients were admitted from 15 departments. There were 658 males and 789 females (male/female ratio 1:1.2). Ages ranged from 4 months to 90 years, the median age was 30 years and the mean age was 31.7±5.6 years. The highest proportion of admissions (48.7%) was from the Department of Obstetrics and Gynaecology, and the lowest from Ophthalmology and Anaesthesia (0.1%). Postoperative cases made up 62.1% of total admissions, with post-caesarean section (CS) contributing 65.7% of these. Non-availability of beds in the ward was the reason for the majority of the post-CS admissions. Up to 41.5% of the patients admitted to the ICU had no justifiable reason for admission. Average length of stay was 8.1±2.8 days, median 4.5 days. One patient was manually ventilated for 5 hours, none was mechanically ventilated, and none had invasive cardiac monitoring. Three children had peritoneal dialysis for acute renal failure. Unconscious patients were fed enterally through a nasogastric tube, while conscious patients ate orally. Analysis of outcomes showed that 597 patients (41.3%) were transferred to the wards, while 352 (24.3%) were discharged home. The outcome was not indicated in 128 cases (8.8%), 16 patients (1.1%) left the ICU against medical advice, 1 patient (0.1%) was referred to another tertiary institution and 1 (0.1%) absconded. Three hundred and fifty-two patients died, giving a mortality rate of 24.3%.
Conclusion. The highest percentage of admissions to the ICU was from the Department of Obstetrics and Gynaecology. The majority of the patients did not require intensive care but were admitted because there was no bed in the wards.
An audit of unplanned postoperative intensive care unit admissions in Enugu, Nigeria : causes and outcomeAuthor U.V. OkaforSource: Southern African Journal of Critical Care 25, pp 16 –19 (2009)More Less
Objective. To carry out an audit of unplanned postoperative (anaesthetic and surgical) intensive care unit (ICU) admissions in our hospital. It was hoped that this would serve as a tool to assess the peri-operative management of surgical patients in our centre.
Materials and methods. The hospital records of unbooked or unplanned post-surgical/anaesthetic admissions to our ICU from March 2003 to February 2007 were reviewed. Patient demographics, surgical and anaesthetic records, duration of stay in the unit, interventions and patient outcome were noted. Obstetric patients were not included.
Results. There were a total of 497 ICU post-surgical/anaesthetic admissions to our ICU during the 4-year study period, of which 26 were unplanned. There were 6 581 anaesthetics/operations in the general operating theatre during the study period, giving an unplanned postoperative ICU admission rate of 3.9/1 000 anaesthetics or 0.39%. Six admissions were related to anaesthetic complications and 20 to surgical complications. The average duration of stay was 3.2 days.
There were 8 deaths, giving a mortality rate of 1.2/1 000 anaesthetics/operations. Of the deaths 2 were associated with anaesthetic complications and 6 with surgical complications (there were 3 deaths after thyroidectomy, 2 after rigid bronchoscopy and 1 due to massive haemorrhage).
Conclusion. The majority of the admissions to the ICU followed head and neck surgery. These findings will modify practice in that more senior surgeons and anaesthetists will be involved in procedures involving the head and neck, and the necessary modern equipment will be acquired. Meticulous pre-operative assessment may detect potentially difficult cases, which should be managed by the most experienced hands.
Source: Southern African Journal of Critical Care 25, pp 20 –26 (2009)More Less
We describe a case of post-extubation stridor in a 3-year-old child who had suffered multiple trauma. Post-extubation stridor is a not uncommon sequel of intubation in children. We review the literature on this complication and give recommendations on its prevention, prediction and management. Unplanned extubations, high 'cuff' pressures and movement of the tube in the trachea are the important risk factors. Although the 'cuff-leak test' has been proposed to predict post-extubation stridor, this test is unreliable in the younger child. Management has been by racemic adrenaline and steroids, but evidence to support this practice is lacking.
Source: Southern African Journal of Critical Care 25, pp 28 –32 (2009)More Less