Pub Date : 2018-11-08DOI: 10.7196/SAJCC.2018.V34I2.355
J. Appiah, S. Salie, A. Argent, B. Morrow
Background. Cardiac arrest is a potentially devastating event, associated with death or severe neurological complications in survivors. There is little evidence on paediatric cardiac arrest prevalence, characteristics and outcomes in South Africa (SA). Objective. To describe the characteristics, course and outcomes of children admitted to an SA paediatric intensive care unit (PICU) following cardiac arrest. Methods. Retrospective descriptive study of routinely collected data (January 2010 - December 2011). Results. Of 2 501 PICU admissions, 110 (4.4%) had preceding cardiac arrest. The median (interquartile range (IQR)) age of children was 7.2 (2.5 - 21.6) months. In-hospital arrests accounted for 80.6% of the events. The most common primary diagnostic categories were respiratory (29.1%), cardiovascular (21.4%) and gastrointestinal (21.4%). Twenty-four patients (23.3%) arrested during endotracheal intubation. Cardiopulmonary resuscitation (CPR) was applied for a median (IQR) of 10 (5 - 20) minutes. Duration of CPR for non-survivors and survivors was 17.5 (10 - 30) v. 10 (5 - 15) minutes ( p =0.006). PICU mortality was 38.8%, with half of the deaths occurring within 24 hours of admission. The standardised mortality ratio was 0.7. The median (IQR) length of stay in the PICU and hospital was 3 (1 - 8) and 27 (9 -52) days, respectively. No independent predictors of mortality were identified. Thirty-nine surviving patients (76.5%) had normal neurological function or mild disability at follow-up after hospital discharge. Six (11.8%) survived with severe disability. Conclusion. Mortality was lower than predicted in children admitted to the PICU following cardiac arrest. The majority of survivors had good neurological outcomes.
{"title":"Characteristics, course and outcomes of children admitted to a paediatric intensive care unit after cardiac arrest","authors":"J. Appiah, S. Salie, A. Argent, B. Morrow","doi":"10.7196/SAJCC.2018.V34I2.355","DOIUrl":"https://doi.org/10.7196/SAJCC.2018.V34I2.355","url":null,"abstract":"Background. Cardiac arrest is a potentially devastating event, associated with death or severe neurological complications in survivors. There is little evidence on paediatric cardiac arrest prevalence, characteristics and outcomes in South Africa (SA). Objective. To describe the characteristics, course and outcomes of children admitted to an SA paediatric intensive care unit (PICU) following cardiac arrest. Methods. Retrospective descriptive study of routinely collected data (January 2010 - December 2011). Results. Of 2 501 PICU admissions, 110 (4.4%) had preceding cardiac arrest. The median (interquartile range (IQR)) age of children was 7.2 (2.5 - 21.6) months. In-hospital arrests accounted for 80.6% of the events. The most common primary diagnostic categories were respiratory (29.1%), cardiovascular (21.4%) and gastrointestinal (21.4%). Twenty-four patients (23.3%) arrested during endotracheal intubation. Cardiopulmonary resuscitation (CPR) was applied for a median (IQR) of 10 (5 - 20) minutes. Duration of CPR for non-survivors and survivors was 17.5 (10 - 30) v. 10 (5 - 15) minutes ( p =0.006). PICU mortality was 38.8%, with half of the deaths occurring within 24 hours of admission. The standardised mortality ratio was 0.7. The median (IQR) length of stay in the PICU and hospital was 3 (1 - 8) and 27 (9 -52) days, respectively. No independent predictors of mortality were identified. Thirty-nine surviving patients (76.5%) had normal neurological function or mild disability at follow-up after hospital discharge. Six (11.8%) survived with severe disability. Conclusion. Mortality was lower than predicted in children admitted to the PICU following cardiac arrest. The majority of survivors had good neurological outcomes.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJCC.2018.V34I2.355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44903712","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}
Pub Date : 2018-11-08DOI: 10.7196/SAJCC.2018.V34I2.371
A. Lupton-Smith
CITATION: Lupton-Smith, A. 2018. There’s more to weaning than just the lungs!. Southern African Journal of Critical Care, 34(2):35-36, doi:10.7196/SAJCC.2018.v34i2.371.
引用本文:Lupton-Smith, A. 2018。脱机不仅仅是为了肺!南方重症监护杂志，34(2):35-36,doi:10.7196/SAJCC.2018.v34i2.371。
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Pub Date : 2018-08-15DOI: 10.7196/SAJCC.2018.V34I1.361
J. Chausse, L. Malekele, F. Paruk
The occurrence of sepsis in the critically ill population is a dreaded phenomenon when taking into consideration the devastating complications associated with the disease. Despite its high incidence and unacceptably high mortality, this complex syndrome remains poorly understood in terms of defining the disease, detecting the presence or absence of an infection, and therapeutic strategies to optimise immediate and long-term outcomes. Global efforts to address these issues coupled with significant advances in medical technologies and our improved understanding of the pathophysiology of the disease have led to some exciting developments in the domain of adjunctive therapies for sepsis. In particular, interest has focused around immunomodulation strategies and metabolic resuscitation. Some of these therapies sound particularly promising in terms of the early available evidence. The concept of personalised or individualised medicine takes centre stage when considering such therapies, as it is becoming increasingly evident that in order to achieve benefits, we need to introduce appropriate therapies at the right time, the right dose and for an appropriate duration. This review encapsulates a selection of these new adjunctive therapies.
{"title":"Improved understanding of the pathophysiology of sepsis: Setting the scene for potential novel adjunctive therapies","authors":"J. Chausse, L. Malekele, F. Paruk","doi":"10.7196/SAJCC.2018.V34I1.361","DOIUrl":"https://doi.org/10.7196/SAJCC.2018.V34I1.361","url":null,"abstract":"The occurrence of sepsis in the critically ill population is a dreaded phenomenon when taking into consideration the devastating complications associated with the disease. Despite its high incidence and unacceptably high mortality, this complex syndrome remains poorly understood in terms of defining the disease, detecting the presence or absence of an infection, and therapeutic strategies to optimise immediate and long-term outcomes. Global efforts to address these issues coupled with significant advances in medical technologies and our improved understanding of the pathophysiology of the disease have led to some exciting developments in the domain of adjunctive therapies for sepsis. In particular, interest has focused around immunomodulation strategies and metabolic resuscitation. Some of these therapies sound particularly promising in terms of the early available evidence. The concept of personalised or individualised medicine takes centre stage when considering such therapies, as it is becoming increasingly evident that in order to achieve benefits, we need to introduce appropriate therapies at the right time, the right dose and for an appropriate duration. This review encapsulates a selection of these new adjunctive therapies.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2018-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJCC.2018.V34I1.361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44007097","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}
Pub Date : 2018-08-15DOI: 10.7196/sajcc.2018.v34i1.362
L. Michell
{"title":"Abstracts of Scientific Presentations at the 2018 National Annual Conference of the Critical Care Society of Southern Africa","authors":"L. Michell","doi":"10.7196/sajcc.2018.v34i1.362","DOIUrl":"https://doi.org/10.7196/sajcc.2018.v34i1.362","url":null,"abstract":"","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2018-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/sajcc.2018.v34i1.362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44283224","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}
Pub Date : 2018-08-15DOI: 10.7196/SAJCC.2018.V34I1.363
W. Michell
Sepsis is an ever-present foe in the intensive care unit (ICU). Sepsis and septic shock account for 11% of admissions to general ICUs.[1] Mortality exceeds 10% for sepsis, and sits at 40% in patients with septic shock.[2] A further 15% of ICU patients acquire infection in the unit, and have a 32% mortality.[1] Some survivors of sepsis face long-term physical, cognitive and emotional disability.[3] Recently, the terms sepsis and septic shock have been redefined and simplified, doing away with the older terms ‘SIRS’ (systemic inflammatory response syndrome) and ‘severe sepsis’.[2] The Sepsis-3 definition now defines sepsis as a ‘life-threatening organ dysfunction caused by a dysregulated host response to infection’. Evidence-based clinical parameters that predict increased mortality from sepsis were identified from a large electronic database. ICU patients who are likely to have sepsis can be identified by a two-point increase in the Sequential Organ Failure Assessment (SOFA) score. For patients in emergency units or hospital wards, the more convenient but slightly less specific Quick SOFA (qSOFA) score has been developed. The score uses three parameters, and any two of the following are indicative of sepsis and carry a 10% risk of death: hypotension (systolic blood pressure <100 mmHg), a decrease or alteration in the level of consciousness, or an increase in respiration rate of more than 22 breaths per minute.[2] In this issue of SAJCC, Chausse et al.[4] review the complex pathophysiology of sepsis, and then go on to discuss several promising therapeutic options, as well as several controversial old therapies. Understanding the pathology of a condition is the scientific basis for developing any new therapy. Over the past six decades, numerous molecules and devices have been developed and tested in an attempt to find the ‘magic bullet’ that would stop sepsis in its tracks.[5] However, when these treatments were studied using multi-centred, prospective, randomised controlled trials, the results were disappointing. This could be because the complex network of mediator activation is too advanced by the time patients present for treatment to allow a single therapy to block the inflammatory process, or because these large trials are too heterogeneous to detect an outcome difference.[5] However, all is not lost. Recent studies have shown a reduction in mortality due to sepsis. The Australian and New Zealand Intensive Care Society adult ICU patient database showed a steady reduction in mortality due to severe sepsis: from 35% in 2000 to 18.4% in 2018.[6] Progress is being made in the earlier detection of sepsis, and in implementing evidence-based bundles of care. One hospital managed to reduce sepsis mortality from 29% to 21% by implementing nurseled screening and detection, followed by protocol-guided intervention delivered by nurse practitioners.[7] The Surviving Sepsis Campaign guidelines were first published in 2004, and have been updated every 4 year
{"title":"Sepsis – follow the guidelines","authors":"W. Michell","doi":"10.7196/SAJCC.2018.V34I1.363","DOIUrl":"https://doi.org/10.7196/SAJCC.2018.V34I1.363","url":null,"abstract":"Sepsis is an ever-present foe in the intensive care unit (ICU). Sepsis and septic shock account for 11% of admissions to general ICUs.[1] Mortality exceeds 10% for sepsis, and sits at 40% in patients with septic shock.[2] A further 15% of ICU patients acquire infection in the unit, and have a 32% mortality.[1] Some survivors of sepsis face long-term physical, cognitive and emotional disability.[3] Recently, the terms sepsis and septic shock have been redefined and simplified, doing away with the older terms ‘SIRS’ (systemic inflammatory response syndrome) and ‘severe sepsis’.[2] The Sepsis-3 definition now defines sepsis as a ‘life-threatening organ dysfunction caused by a dysregulated host response to infection’. Evidence-based clinical parameters that predict increased mortality from sepsis were identified from a large electronic database. ICU patients who are likely to have sepsis can be identified by a two-point increase in the Sequential Organ Failure Assessment (SOFA) score. For patients in emergency units or hospital wards, the more convenient but slightly less specific Quick SOFA (qSOFA) score has been developed. The score uses three parameters, and any two of the following are indicative of sepsis and carry a 10% risk of death: hypotension (systolic blood pressure <100 mmHg), a decrease or alteration in the level of consciousness, or an increase in respiration rate of more than 22 breaths per minute.[2] In this issue of SAJCC, Chausse et al.[4] review the complex pathophysiology of sepsis, and then go on to discuss several promising therapeutic options, as well as several controversial old therapies. Understanding the pathology of a condition is the scientific basis for developing any new therapy. Over the past six decades, numerous molecules and devices have been developed and tested in an attempt to find the ‘magic bullet’ that would stop sepsis in its tracks.[5] However, when these treatments were studied using multi-centred, prospective, randomised controlled trials, the results were disappointing. This could be because the complex network of mediator activation is too advanced by the time patients present for treatment to allow a single therapy to block the inflammatory process, or because these large trials are too heterogeneous to detect an outcome difference.[5] However, all is not lost. Recent studies have shown a reduction in mortality due to sepsis. The Australian and New Zealand Intensive Care Society adult ICU patient database showed a steady reduction in mortality due to severe sepsis: from 35% in 2000 to 18.4% in 2018.[6] Progress is being made in the earlier detection of sepsis, and in implementing evidence-based bundles of care. One hospital managed to reduce sepsis mortality from 29% to 21% by implementing nurseled screening and detection, followed by protocol-guided intervention delivered by nurse practitioners.[7] The Surviving Sepsis Campaign guidelines were first published in 2004, and have been updated every 4 year","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2018-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7196/SAJCC.2018.V34I1.363","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47223827","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}
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