- A-Z Publications
- Southern African Journal of Critical Care
- Previous Issues
- Volume 23, Issue 1, 2007
Southern African Journal of Critical Care - Volume 23, Issue 1, 2007
Volume 23, Issue 1, 2007
Source: Southern African Journal of Critical Care 23 (2007)More Less
The past year has been a challenging one as we have struggled to deal with the pressures of providing critical care within southern Africa. There are major problems in both the organisation of critical care and the availability of trained and skilled personnel. However, as we approach the annual congress, there are a number of developments that we can celebrate.
Author W.L. MichellSource: Southern African Journal of Critical Care 23 (2007)More Less
This edition of the Journal includes a number of articles on the theme of nutrition, the abdomen and metabolic control. This is an often-neglected area of critical care and these articles should provide not only 'food for thought' but practical guidelines for both nurses and doctors practising in the critical care environment.
Author Eric HodgsonSource: Southern African Journal of Critical Care 23, pp 6 –8 (2007)More Less
Enterocytes are among the most metabolically active cells in the body but are the least well supplied with blood even under resting conditions. Maintaining function of enterocytes has benefits that are becoming apparent in terms of improved outcomes from such diverse diseases as colorectal cancer and pneumonia.
Source: Southern African Journal of Critical Care 23, pp 10 –14 (2007)More Less
Background. The Centers for Disease Control and Prevention (CDC) have recommended that the head of the bed of mechanically ventilated patients be elevated to between 30° and 45° to decrease the risk of ventilator-associated pneumonia (VAP) Compliance with this recommendation may be affected by nurses' knowledge of the recommendation and their accuracy in estimating the backrest elevation.
Objectives. To determine the difference between nurses' estimation of backrest angle and the actual measured angle; to determine the relationship between nurses' demographic characteristics and the accuracy of estimation; to determine nurses' knowledge of why this recommendation has been made.
Methods. A convenience sample of 39 nurses working in the selected ICUs of the study hospital was used. The angles of elevation were preselected in each area. Estimated angles were correlated with measured angles and this was correlated with demographic characteristics.
Results. Forty-two per cent of the nurses were accurate in their estimation of bedrest angle (correlation, 0.6232). Demographic characteristics had little effect on accuracy.
Conclusion. Nurses could benefit from assistance in accurately estimating backrest elevation angle, as well as from education regarding strategies to decrease the incidence of ventilator-associated pneumonia.
Source: Southern African Journal of Critical Care 23, pp 17 –23 (2007)More Less
The phenomenon of intra-abdominal hypertension (IAH) and its progression to abdominal compartment syndrome (ACS) is a common and frequently under-recognised condition in critically ill patients. IAH is defined as an intra-abdominal pressure (IAP) greater than 12 mmHg. The ACS occurs once IAH is associated with organ dysfunction.
Early detection is the cornerstone of management in the critically ill patient and the regular measurement of IAP in patients at risk for developing raised IAP is encouraged. The intravesical technique of measurement is relatively non-invasive and provides excellent correlation with direct measurement of IAP. The consequences of ACS are multi-systemic, resulting in organ dysfunction. The respiratory, cardiovascular, renal and gastrointestinal systems are particularly affected. The vicious cycle of organ dysfunction may be perpetuated by excessive fluid resuscitation. Early intervention is essential to prevent complications, which carry significant morbidity and, if untreated, possible mortality. Definitive management of this condition is the prompt surgical decompression of the abdomen followed by temporary abdominal closure.
Insulin administration for the control of blood glucose in the adult ICU - an evidence-based guideline : guidelineAuthor Roseanne E. TurnerSource: Southern African Journal of Critical Care 23, pp 24 –30 (2007)More Less
The South African Critical Care Nurses Forum identified the development of practice guidelines as an urgent priority. This guideline, which marks the beginning of this process, aims to present evidence-based recommendations for the administration of continuous infusions of intravenous insulin for the control of blood glucose in critically ill adult patients.
A wide range of databases was searched including Medline, CINAHL and the Cochrane database. Further references were obtained from the reference lists of relevant articles and Lilly Laboratories provided data relating to the stability of insulin in solution and storage recommendations. Expert knowledge and experience were also considered. The data were graded according to the strength of evidence and recommendations made for clinical practice.
These recommendations include using isotonic saline as the carrier, not preparing solutions in advance, remixing every 12 hours and priming the syringe and tubing before use. The use of a protocol is advisable but this is dependent on accurate measurement of blood glucose by properly trained staff. Capillary blood is adequate for most patients except for those who are in shock and on vasopressors. The signs of hypoglycaemia and hypokalaemia and the management of these complications are included.
South African Critical Care Society Congress, Sun City, 14 - 17 August 2007 - oral presentations : abstractSource: Southern African Journal of Critical Care 23, pp 31 –48 (2007)More Less