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- Southern African Journal of Critical Care
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- Volume 29, Issue 1, 2013
Southern African Journal of Critical Care - Volume 29, Issue 1, 2013
Volume 29, Issue 1, 2013
Author W.L. MichellSource: Southern African Journal of Critical Care 29 (2013) http://dx.doi.org/10.7196/SAJCC.170More Less
Welcome to Durban for the first World Federation of Societies of Critical Care Medicine Congress to be held in Africa. We hope that this event will trigger a landslide of local research in critical care. While the clinical practice of intensive care is well established in South Africa, research output in this field is relatively limited. As the leading scientific journal covering critical care medicine and nursing in Africa, we look forward to publishing your forthcoming original papers.
Source: Southern African Journal of Critical Care 29, pp 3 –5 (2013) http://dx.doi.org/10.7196/SAJCC.165More Less
Extracorporeal membrane oxygenation (ECMO) is an advanced modality of life support for neonatal, paediatric and adult patients with cardiopulmonary compromise resistant to conventional critical care management. This edition of SAJCC features a position statement proposing guidelines for the use of ECMO in South Africa.
Source: Southern African Journal of Critical Care 29, pp 7 –9 (2013) http://dx.doi.org/10.7196/SAJCC.161More Less
Extracorporeal membrane oxygenation (ECMO) is increasingly being employed in South African intensive care units for the management of patients with refractory hypoxaemia and for haemodynamic support, particularly following cardiothoracic procedures. ECMO is expensive, however, and there is a danger that this rescue modality may be abused or utilised unnecessarily or in situations where further intensive therapy is futile. This brief review provides an overview of the techniques available, and the recommended indications and exclusions for venovenous ECMO in particular.
Author L.T. HillSource: Southern African Journal of Critical Care 29, pp 11 –15 (2013) http://dx.doi.org/10.7196/SAJCC.148More Less
Gastrointestinal dysfunction is a common problem in the critically ill patient, and is commonly observed in the intensive care unit (ICU). It is recognised that a functional gastrointestinal tract is an important factor in the clinical outcome of patients in the ICU. The difficulty in clinical practice has been the lack of an objective or unified definition or understanding of what gastrointestinal dysfunction in the critically ill means. Additionally, gut problems in ICU may often be fairly occult and challenging to classify by degree. Critical illness-associated gut dysfunction is implicated in aetiological processes that drive critical illness, and is further linked to negative nutritional and infectious consequences and poor clinical outcomes. There is currently no complete, unified pathophysiological model of the phenomenon, and cross-disciplinary research opportunities therefore exist both to clarify the mechanisms and to develop treatments.
The impact of antioxidant supplementation on clinical outcomes in the critically ill : a meta-analysis : researchSource: Southern African Journal of Critical Care 29, pp 18 –26 (2013) http://dx.doi.org/10.7196/SAJCC.149More Less
Background. Critical illness is associated with increased oxidative stress that can influence outcome. Many studies have investigated the effects of exogenous antioxidant supplementation, without showing significance owing to the small patient populations.
Methodology. A systematic review and meta-analysis of the English literature was performed to determine the effect of antioxidant micronutrient supplementation on clinically important outcomes in the critically ill. Pubmed, Google Scholar and Science Direct electronic databases were searched for papers published between January 1990 and June 2010.
Selection criteria. Randomised controlled trials were selected for inclusion if they investigated the effects of antioxidant supplementation in the critically ill and reported on clinically significant endpoints.
Data collection and analysis. The data were analysed using a random effects model in Comprehensive Meta-analysis Version 2 (Biostat, USA) to obtain the odds ratio (OR) with a 95% confidence interval (CI) and statistical significance of p<0.05.
Results. Twelve studies met the inclusion criteria. Selenium supplementation was associated with a trend towards decreased mortality (OR=0.717, p=0.106, CI 0.48 - 1.07). Mixed antioxidant supplementation was associated with reduced hospital length of stay (OR= 0.710, p=0.002, CI 0.57 - 0.83), reduced infectious complications (OR=0.494, p=0.024, CI 0.28 - 0.98) and reduced mechanical ventilation (OR=0.259, p=0.023, CI 0.08 - 0.83).
Conclusion. A combination of antioxidant micronutrients might be associated with improved clinical outcome in the critically ill.
Survey of ethical dilemmas facing intensivists in South Africa in the admission of patients with HIV infection requiring intensive care : articleSource: Southern African Journal of Critical Care 29, pp 28 –32 (2013) http://dx.doi.org/10.7196/SAJCC.153More Less
Background. Maturing of the burgeoning HIV epidemic in South Africa has resulted in an increased demand for intensive care.
Objectives. To investigate the influence of ethical dilemmas facing South African intensivists on decisions about access to intensive care for patients with HIV infection in resource-limited settings.
Methods. A cross-sectional, descriptive, quantitative, analytical, anonymous attitudes-and-perception questionnaire survey of 90 intensivists. The main outcome measure was the rating of factors influencing decisions on admission to intensive care and responses to 5 hypothetical clinical scenarios.
Results. The number of intensivists who considered the prognosis of the acute disease and of the underlying disease to be most important was 87.9% (n=74). Most (71.6%; n=63) intensivists cited availability of an intensive care unit (ICU) bed as influencing the decision to admit. Intensivists comprising 26.8% (n=22) of the total group rated as probably important or least important the 'resources available'; 'bed used to the prejudice of another patient' was stated by 16.4% (n=14); and 'policy of the intensive care unit' by 17% (n=14). Nearly two-thirds (65.9%; n=58) would respect an informed refusal of treatment. A similar number would comply with a written 'Do not resuscitate' (DNR) order. In patients with no real chance of recovering a meaningful life, 81.6% (n=71) of intensivists would withhold sophisticated therapy (e.g. not start mechanical ventilation or dialysis etc.) and 75.9% (n=63) would withdraw sophisticated therapy (e.g. discontinue mechanical ventilation, dialysis etc.).
Conclusions. A combination of factors was identified as influencing the decision to admit patients to intensive care. Prognosis and disease status were identified as the main factors influencing admission. Patients with HIV/AIDS were not discriminated against in admission to intensive care.