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- Volume 31, Issue 1, 2015
Southern African Journal of Critical Care - Volume 31, Issue 1, 2015
Volume 31, Issue 1, 2015
Author S. KlingSource: Southern African Journal of Critical Care 31 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCC.238More Less
The 2015 influenza season officially started during the second week of May, according to the National Institute of Communicable Diseases (NICD). The NICD website explains that the influenza strains in circulation change every year and that this year the 'swine 'flu' strain (influenza A(H1N1)pdm09) is behaving similarly to any of the other influenza strains. However, in 2009 this strain caused an influenza pandemic
Influenza A(H1N1)pdm09 in critically ill children admitted to a paediatric intensive care unit, South AfricaSource: Southern African Journal of Critical Care 31, pp 4 –7 (2015) http://dx.doi.org/http://dx.dio.org/10.7196/SAJCC.202More Less
Objective. To describe the clinical course of critically ill children with confirmed pandemic influenza A(H1N1)pdm09 (H1N1) infection in a southern African paediatric intensive care unit (PICU), and to compare them with a similar group with respiratory virus infections other than H1N1 admitted to the same PICU during the same period.
Methods. A retrospective descriptive study of all patients admitted to a PICU in Cape Town, South Africa, who tested positive for H1N1and other respiratory viruses from 1 August to 30 September 2009.
Results. A total of 19 children in 20 PICU admissions tested positive for H1N1 (Group 1). Of these, 14 (70%) had major comorbidities and 4 tested positive for another respiratory virus. Five (26.3%) children in this group died and seven (36.8%) had nosocomial infection. Eight patients in nine PICU admissions who tested H1N1-negative (Group 2), tested positive for other respiratory viruses. Of these, five (55.6%) had major comorbidities. None in this group died. Children in Group 1 had significantly longer ICU stays, ventilator days and worse indices of organ dysfunction than those in Group 2.
Conclusions. Children admitted to the PICU with confirmed H1N1 tended to have longer ICU stays, prolonged ventilation, more severe organ dysfunction and higher mortality than those with other respiratory viruses. Hospitalisation was identified as a major risk factor for chronically ill children to acquire H1N1 infection requiring intensive care in our setting.
Source: Southern African Journal of Critical Care 31, pp 8 –10 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCC.164More Less
Objective. To determine the characteristics of obstetric patients admitted to the intensive care unit (ICU) at a tertiary hospital in the Limpopo Province, South Africa.
Methods. Hospital files of all obstetric patients admitted to the Pietersburg provincial referral hospital ICU from 1 January 2008 to 31 December 2012 were retrospectively reviewed. Age, parity, admission diagnosis, length of stay, information on the referring hospitals, and maternal outcomes were analysed.
Results. There were 138 obstetric ICU admissions during the study period (6.7% of all ICU admissions and 0.95% of all deliveries). The most common reasons for obstetric ICU admissions were pre-eclampsia or eclampsia (52.9%, n=73/138) and obstetric haemorrhage (18.1%, n=25/138). The mean age of the patients was 28 years, and mean duration of ICU stay was 8 days (range 0 - 163 days). Forty-eight maternal deaths occurred (34.8%), and of these, 27 were referrals from other hospitals (district and regional hospitals). Pre-eclampsia or eclampsia accounted for 25 (52%) of all deaths.
Conclusion. Obstetric patients formed a small proportion of ICU admissions, but mortality among these patients was high. It is recommended that obstetric registrars rotate through a multidisciplinary ICU, and the need for a critical care specialist should be considered.
Source: Southern African Journal of Critical Care 31, pp 12 –15 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCC.185More Less
Background. Infections are common in intensive care units (ICUs) and burns units. Empiric antibiotic therapy is often required, and as such it is important to have a good knowledge of the resident organisms in these departments. Antibiotic resistance is becoming an increasing problem both internationally and in South Africa (SA) and it is important to monitor organism sensitivity.
Objectives. To establish the spectrum and sensitivity of nosocomial pathogens in an SA government referral hospital ICU and burns unit.Methods. We report the findings from a retrospective audit of all cultures sent from the ICU and burns unit of an SA urban hospital for a 6-month period between January and June 2008.
Results. The results showed a prevalence of Gram-negative organisms in the ICU department, in particular Klebsiella pneumoniae and Escherichia coli. There was a prevalence of Gram-positive organisms in the burns unit. Overall resistance to co-amoxiclav and erythromycin was found to be high (49% and 53%, respectively), resistance to ciprofloxacin and gentamicin was moderate (30% and 35%, respectively) and resistance to piperacillin-tazobactam and the carbapenems remained low (21% for piperacillin-tazobactam, 2% for ertapenem and 19% for meropenem). When looking at individual species, it was noted that K. pneumoniae had high resistance to ampicillin (97%), moderate resistance to co-amoxiclav and ciprofloxacin (35% and 43%, respectively) and low resistance to piperacillin-tazobactam, ertapenem, meropenem and colistin (12%, 0%, 5% and 0%, respectively). E. coli was seen to have high resistance to ampicillin (79%), but low resistance to co-amoxiclav (4%), ciprofloxacin (9%), piperacillin-tazobactam (0%), ertapenem (0%), meropenem (4%) and colistin (0%).
Conclusion. This study demonstrates the prevalence of Gram-negative organisms in an SA government hospital ICU. It also demonstrates the presence of resistance mechanisms in the organisms cultured for almost all available classes of antibiotics, albeit some at low levels. The development of multi- and pan-resistant pathogenic organisms is both an SA and worldwide problem. In particular, the threat posed by resistant Gram-negative bacteria is likely to manifest itself in ICUs where septic patients unresponsive to standard antimicrobial regimens will inevitably end up. Frequent assessment of resistance patterns and appropriately designed empirical treatment protocols must remain a priority for all critical care departments.
Incidence and outcome of ventilator-associated pneumonia in Inkosi Albert Luthuli and King Edward VIII Hospital surgical intensive care unitsSource: Southern African Journal of Critical Care 31, pp 16 –18 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCC.227More Less
Background. Ventilator-associated pneumonia (VAP) is one of the most common causes of hospital morbidity and mortality, but has been poorly studied in the South African context.
Objective. To evaluate the incidence and outcome of VAP in the intensive care units (ICUs) of two major centres in the Durban metropolitan area.
Methods. The study was conducted over a period of 6 months with all intubated and mechanically ventilated patients who were screened on admission to ICU. A questionnaire was prepared to note patients' age, gender, date and time of intubation or reintubation. Patients were monitored from date of admission to the date of discharge from ICU or death. A diagnosis of VAP was made on a clinical pulmonary infection score (CPIS) of ≥6.
Results. Of 32 patients evaluated, eight patients (25%) were diagnosed with VAP. Median duration of ventilation in the VAP group was 249 hours v. 65.5 hours in the non-VAP group (p=0.0002). We found no statistically significant association between age or gender with the development of VAP (p=0.28 and p=0.59, respectively). The most common organism isolated was Acinetobacter baumannii, followed by Pseudomonas aeruginosa. Three of the eight (37.5%) patients diagnosed with VAP died in the ICU.
Conclusion. VAP is common in critically ill patients, possibly associated with poor outcome. These results highlight the need for strict adherence to evidence-based preventive measures.
Source: Southern African Journal of Critical Care 31, pp 20 –23 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCC.199More Less
Objective. To explore the methods that can be used to verify endotracheal tube (ETT) placement in adult mechanically ventilated patients.
Methods. An integrative literature search was conducted in 2012 - 2013 of research citations published in English on the topic of discussion. Electronic databases searched were: the Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE, PubMed, the Joanna Briggs Institute (JBI) systematic review library, the Cochrane Library and the National Guidelines Clearinghouse. In addition, reference lists of articles, conference summaries and hand searching was performed. Citations were selected based on the inclusion and exclusion criteria as decided upon by the researchers. The process of critical appraisal was done by the researchers as well as an independent reviewer, all skilled in the research methodology and subject matter related to the topic of discussion. A total of 45 articles were included for critical appraisal. On completion of the critical appraisal, which was done by two independent reviewers, 34 articles were excluded and 11 articles were included in the integrative review analyses. Data were extracted following the critical appraisal process. Owing to the heterogeneity of studies, a metasynthesis could not be done.
Results. Based on the reviewed studies, various methods have been identified to verify ETT placement in adult mechanically ventilated patients, namely ultrasonography, the use of centimetre scale printed on the ETT, manual cuff palpation, bilateral auscultation of chest and palpation of symmetrical chest movements, oesophageal detector devices, visualisation of the ETT, use of chest X-ray, pulse oximetry and capnography. Both ultrasonography and capnography had excellent sensitivity and specificity in verifying ETT placement.
Conclusion. Although there are various methods reported for ETT verification, the review results recommended ultrasonography and capnography as the most accurate and reliable verification methods.
Abstracts of presentations at the congress of the Critical Care Society of Southern Africa, July 2015 : oral & poster presentationsSource: Southern African Journal of Critical Care 31, pp 24 –28 (2015) http://dx.doi.org/http://dx.doi.org/10 7196/SAJCC 237More Less
Intensivists' practices and perceptions of HIV testing in South African intensive care units
A review of transplantation activity in South Africa (1991 - 2011)
The effect of body position on regional distribution of ventilation and muscle activity in infants and children
Parent perception of quality of care in a South African paediatric intensive care unit (PICU)
Screening critically ill patients with an adapted early mobility readiness protocol ensures safety of a therapeutic early mobility position
Plasma glutamine levels in adult intensive care unit patients
Hypoxaemia on arrival in a multidisciplinary intensive care unit
The physiotherapy management of thoracotomy patients: A survey of current practice in Gauteng
Use of proton pump inhibitors in the ICUs of three academic hospitals in Johannesburg
Outcome and severity of surgical patients admitted to a non-tertiary multidisciplinary critical care unit
A comparison of excess fluid to be removed in haemodialysis patients,as estimated by haemodialysis staff versus multiple frequency bio electrical impedance analysis
Outcome of children admitted to a combined paediatric/neonatal ICU in a low to middle income country
Predicting mortality rates: Hospital Standardised Mortality Ratio v. APACHE IV
Profile of ICU bed requests at Helen Joseph Hospital
Are weight estimation methods applicable for rural African children? A comparative study
Patient perceptions of ICU care: A scoping review
Articulating the nature of clinical specialist nurse practice
Postoperative internal iliac artery embolisation as salvage therapy for bleeding in an HIV-positive patient with giant cell tumour of bone : case reportSource: Southern African Journal of Critical Care 31, pp 30 –31 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCC.177More Less
Giant cell tumour of bone (GCTB) is a highly vascular tumour, sporadically complicated by massive bleeding during surgery. We report a rare case of GCTB in an HIV-positive patient who suffered massive blood loss intra- and postoperatively. The patient was a 46-year-old HIV-positive female with symptoms and signs of a pelvic mass, and ultrasound evidence of an ovarian mass. Surgery was performed,and a highly vascular retroperitoneal mass originating from her sacrum was identified. Massive blood loss occurred, which required aggressive resuscitation and transfusion of blood products. Damage control surgery was performed, and bleeding was ultimately only controlled postoperatively using bilateral internal iliac artery radiological embolisation. The patient suffered acute kidney injury, which was multifactorial in aetiology, which recovered within 6 days. She was discharged from ICU in a stable condition 7 days postoperatively.
Source: Southern African Journal of Critical Care 31 (2015)More Less
Max Klein died unexpectedly on 27 January 2015 while riding his bicycle with friends near Stellenbosch.
Max grew up in the country districts, and came to Cape Town as a schoolboy at South African College Schools (SACS). He went to medical school at the University of Cape Town, where his experience included a bout of meningococcal meningitis, which profoundly affected his view of patient care.