Pub Date : 2016-07-26DOI: 10.7196/SAJCC.2016.V32I1.243
H. Kunzmann, K. Dimitriades, B. Morrow, A. Argent
There has been a decline in ventilator-associated pneumonia (VAP) in the paediatric intensive care units of developed countries. Previous studies at the Red Cross War Memorial Children’s Hospital give an incidence of VAP of >40/1 000 ventilator days, identifying VAP as a priority area for practice improvement. We outline the process and outcome of a practice improvement initiative that implemented an evidence-based bundle of care to reduce VAP. In 2011, this initiative was taken to improve healthcare-associated infections, with the support of the ‘Best Care Always’ project. A task team identified an evidence-based bundle of care aimed at reducing VAP. The bundle consisted of five elements that were adjusted practically to suit the unit. Standardised metrics to measure compliance with the bundle and outcomes of the intervention were instituted and collected prospectively throughout the study period. Following implementation in October 2011, VAP rates decreased from 55/1 000 to 19.1/1 000 ventilator days over the first 5-month period. During this period, compliance remained poor and metrics were poorly collected. With the introduction of a full-time VAP coordinator, compliance improved from 57% to a peak of 83%, with a decrease in VAP to an average of 4/1 000 ventilator days (January 2013 - July 2013). This practice improvement initiative resulted in a significant reduction in VAP. The success of this initiative is attributed equally to the introduction of the bundle of care and driving power of the VAP coordinator.
{"title":"Reducing paediatric ventilator-associated pneumonia – a South African challenge!","authors":"H. Kunzmann, K. Dimitriades, B. Morrow, A. Argent","doi":"10.7196/SAJCC.2016.V32I1.243","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.243","url":null,"abstract":"There has been a decline in ventilator-associated pneumonia (VAP) in the paediatric intensive care units of developed countries. Previous studies at the Red Cross War Memorial Children’s Hospital give an incidence of VAP of >40/1 000 ventilator days, identifying VAP as a priority area for practice improvement. We outline the process and outcome of a practice improvement initiative that implemented an evidence-based bundle of care to reduce VAP. In 2011, this initiative was taken to improve healthcare-associated infections, with the support of the ‘Best Care Always’ project. A task team identified an evidence-based bundle of care aimed at reducing VAP. The bundle consisted of five elements that were adjusted practically to suit the unit. Standardised metrics to measure compliance with the bundle and outcomes of the intervention were instituted and collected prospectively throughout the study period. Following implementation in October 2011, VAP rates decreased from 55/1 000 to 19.1/1 000 ventilator days over the first 5-month period. During this period, compliance remained poor and metrics were poorly collected. With the introduction of a full-time VAP coordinator, compliance improved from 57% to a peak of 83%, with a decrease in VAP to an average of 4/1 000 ventilator days (January 2013 - July 2013). This practice improvement initiative resulted in a significant reduction in VAP. The success of this initiative is attributed equally to the introduction of the bundle of care and driving power of the VAP coordinator.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"5 1","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78679052","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 : 2016-07-26DOI: 10.7196/SAJCC.2016.V32I1.248
H. van Aswegen, M. Lottering
Background. Physiotherapists are integral members of the interprofessional team that provides care and rehabilitation for patients in intensive care units (ICUs). Objectives. To describe the current practice of physiotherapists in ICUs, determine if physiotherapists’ practice has changed since a previous report and determine if practice is evidence based. Methodology. A questionnaire was content validated and made available electronically and in hard copy. Physiotherapists who work in ICUs in public or private sector hospitals or who are members of the South African Society of Physiotherapy were identified and invited to participate. Results. Survey response rate was 33.9%. Patient assessment techniques performed ‘very often’ included ICU chart assessment ( n =90, 83.3%), chest auscultation ( n =94, 81.8%) and cough effort ( n =81, 75%). Treatment techniques performed ‘very often’ included manual chest clearance ( n =101, 93.5%), in-bed mobilisation and positioning ( n =91, 84.3%; n =91, 84.3%, respectively), airway suctioning ( n =89, 82.4%), out-of-bed mobilisation ( n =84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle-strengthening exercises ( n =72, 73.1%). More respondents used intermittent positive pressure breathing (57 v. 28%, p =0.00), used adjustment of mechanical ventilation (MV) settings (30 v. 15%, p =0.01), were involved with weaning patients from MV (42 v. 19%, p =0.00) and used incentive spirometry (76 v. 46%, p =0.00) than reported previously. More respondents performed suctioning (99 v. 70%, p =0.00), extubation (60 v. 25%, p =0.00) and adjustment of MV settings (30 v. 12%, p =0.02) than reported internationally. Conclusion. Physiotherapy practice in ICUs is evidence based. Care focuses largely on mobilisation, exercise therapy and multimodality respiratory therapy.
背景。物理治疗师是为重症监护病房(icu)患者提供护理和康复的跨专业团队的重要成员。目标。为了描述icu中物理治疗师的当前实践，确定物理治疗师的实践自之前的报告以来是否发生了变化，并确定实践是否基于证据。方法。对调查表进行了内容验证，并以电子和硬拷贝形式提供。确定并邀请在公立或私营医院重症监护室工作的物理治疗师或南非物理治疗学会成员参加。结果。调查回应率为33.9%。“非常经常”进行的患者评估技术包括ICU图表评估(n =90, 83.3%)、胸部听诊(n =94, 81.8%)和咳嗽力度(n =81, 75%)。“非常常见”的治疗技术包括手动清胸(n =101, 93.5%)，床上活动和定位(n =91, 84.3%;N =91, 84.3%)、气道吸引(N =89, 82.4%)、床下活动(N =84, 77.8%)、深呼吸练习(N =83, 76.9%)和外周肌肉强化练习(N =72, 73.1%)。与之前的报道相比，更多的受访者使用间歇性正压呼吸(57 vs 28%， p =0.00)，使用机械通气(MV)设置调整(30 vs 15%， p =0.01)，参与脱离MV的患者(42 vs 19%， p =0.00)和使用激励肺量计(76 vs 46%， p =0.00)。与国际报道相比，更多的受访者进行了吸痰(99 vs 70%， p =0.00)，拔管(60 vs 25%， p =0.00)和MV设置调整(30 vs 12%， p =0.02)。结论。icu的物理治疗实践是基于证据的。护理主要侧重于活动，运动治疗和多模式呼吸治疗。
{"title":"Physiotherapy practice in South African intensive care units","authors":"H. van Aswegen, M. Lottering","doi":"10.7196/SAJCC.2016.V32I1.248","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.248","url":null,"abstract":"Background. Physiotherapists are integral members of the interprofessional team that provides care and rehabilitation for patients in intensive care units (ICUs). Objectives. To describe the current practice of physiotherapists in ICUs, determine if physiotherapists’ practice has changed since a previous report and determine if practice is evidence based. Methodology. A questionnaire was content validated and made available electronically and in hard copy. Physiotherapists who work in ICUs in public or private sector hospitals or who are members of the South African Society of Physiotherapy were identified and invited to participate. Results. Survey response rate was 33.9%. Patient assessment techniques performed ‘very often’ included ICU chart assessment ( n =90, 83.3%), chest auscultation ( n =94, 81.8%) and cough effort ( n =81, 75%). Treatment techniques performed ‘very often’ included manual chest clearance ( n =101, 93.5%), in-bed mobilisation and positioning ( n =91, 84.3%; n =91, 84.3%, respectively), airway suctioning ( n =89, 82.4%), out-of-bed mobilisation ( n =84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle-strengthening exercises ( n =72, 73.1%). More respondents used intermittent positive pressure breathing (57 v. 28%, p =0.00), used adjustment of mechanical ventilation (MV) settings (30 v. 15%, p =0.01), were involved with weaning patients from MV (42 v. 19%, p =0.00) and used incentive spirometry (76 v. 46%, p =0.00) than reported previously. More respondents performed suctioning (99 v. 70%, p =0.00), extubation (60 v. 25%, p =0.00) and adjustment of MV settings (30 v. 12%, p =0.02) than reported internationally. Conclusion. Physiotherapy practice in ICUs is evidence based. Care focuses largely on mobilisation, exercise therapy and multimodality respiratory therapy.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"30 1","pages":"11-16"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87485770","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 : 2016-07-26DOI: 10.7196/SAJCC.2016.V32I1.232
C. Deepa, S. Kamat, V. Ravindran
Tracheostomy, one of the oldest known surgical procedures in the history of medicine, is regularly performed in modern intensive care units. Acquired ulcerative tracheo-oesophageal fistula (TOF) is an uncommon but potentially fatal complication of tracheostomy. We report a case of ulcerative TOF with an unusual yet characteristic presentation, in a ventilator-dependent tracheostomised patient with Guillain-Barre syndrome. It presented as sudden progressive severe abdominal distension that was rhythmic with each ventilator breath. The predisposing factors, clinical features and preventive measures of post-tracheostomy TOF are discussed in this case report. Regular monitoring of tracheal tube cuff pressures and volumes, along with avoidance and treatment of various predisposing factors, are advisable for the prevention of this serious consequence.
{"title":"Post-tracheostomy tracheo-oesophageal fistula - an unusual presentation","authors":"C. Deepa, S. Kamat, V. Ravindran","doi":"10.7196/SAJCC.2016.V32I1.232","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.232","url":null,"abstract":"Tracheostomy, one of the oldest known surgical procedures in the history of medicine, is regularly performed in modern intensive care units. Acquired ulcerative tracheo-oesophageal fistula (TOF) is an uncommon but potentially fatal complication of tracheostomy. We report a case of ulcerative TOF with an unusual yet characteristic presentation, in a ventilator-dependent tracheostomised patient with Guillain-Barre syndrome. It presented as sudden progressive severe abdominal distension that was rhythmic with each ventilator breath. The predisposing factors, clinical features and preventive measures of post-tracheostomy TOF are discussed in this case report. Regular monitoring of tracheal tube cuff pressures and volumes, along with avoidance and treatment of various predisposing factors, are advisable for the prevention of this serious consequence.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"72 1","pages":"32-33"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90005406","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 : 2016-07-26DOI: 10.7196/SAJCC.2016.V32I1.254
D. Morar, H. V. Aswegen
Background. Liberation of patients from mechanical ventilation (MV) is an important goal of patient care, to avoid the complications and risks associated with prolonged MV. Objective. To determine the extent of South African physiotherapists’ involvement in weaning and extubation of patients from MV and whether current practice is evidence based. Method. A survey questionnaire was developed, and content validated and made available electronically and in hard copy. Physiotherapists working in adult intensive care units in public and private sector hospitals in South Africa (SA) were identified and invited to participate. Results. Response rate was 43% (n=184). The majority of respondents (n=135, 73%) ‘never’ or ‘seldom’ got involved in decision-making to wean patients from MV; a minority (n=8, 4%) were ‘routinely’ involved in decision-making. Some respondents (n=54, 29%) performed extubation ‘often’ or ‘routinely’. The majority used exercises (n=149, 81%), early mobilisation out of bed (n=142, 77%) and deep breathing exercises (DBEs) (n=142, 77%) ‘routinely’ to aid in respiratory muscle training. The majority of respondents ‘never’ adjusted ventilator settings other than fraction of inspired oxygen. No association was found between type of physiotherapy degree respondents held and their involvement in weaning (p=0.24). Conclusion. SA physiotherapists’ contributions towards weaning of patients from MV through prescription of exercise therapy, early outof- bed mobilisation and DBEs is evidence based. Involvement in adjustment of MV settings, decision-making regarding patient weaning, development of weaning protocols for their units and extubation is limited.
{"title":"Physiotherapy contributions to weaning and extubation of patients from mechanical ventilation","authors":"D. Morar, H. V. Aswegen","doi":"10.7196/SAJCC.2016.V32I1.254","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.254","url":null,"abstract":"Background. Liberation of patients from mechanical ventilation (MV) is an important goal of patient care, to avoid the complications and risks associated with prolonged MV. Objective. To determine the extent of South African physiotherapists’ involvement in weaning and extubation of patients from MV and whether current practice is evidence based. Method. A survey questionnaire was developed, and content validated and made available electronically and in hard copy. Physiotherapists working in adult intensive care units in public and private sector hospitals in South Africa (SA) were identified and invited to participate. Results. Response rate was 43% (n=184). The majority of respondents (n=135, 73%) ‘never’ or ‘seldom’ got involved in decision-making to wean patients from MV; a minority (n=8, 4%) were ‘routinely’ involved in decision-making. Some respondents (n=54, 29%) performed extubation ‘often’ or ‘routinely’. The majority used exercises (n=149, 81%), early mobilisation out of bed (n=142, 77%) and deep breathing exercises (DBEs) (n=142, 77%) ‘routinely’ to aid in respiratory muscle training. The majority of respondents ‘never’ adjusted ventilator settings other than fraction of inspired oxygen. No association was found between type of physiotherapy degree respondents held and their involvement in weaning (p=0.24). Conclusion. SA physiotherapists’ contributions towards weaning of patients from MV through prescription of exercise therapy, early outof- bed mobilisation and DBEs is evidence based. Involvement in adjustment of MV settings, decision-making regarding patient weaning, development of weaning protocols for their units and extubation is limited.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"16 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90845374","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 : 2016-07-26DOI: 10.7196/SAJCC.2016.V32I1.270
Kondwani G H Katundu, L. Hill, Lester M. Davids, Ivan A Joubert, Malcolm G A Miller, J. L. Piercy, William L Michelle
Background. Septic shock is associated with endothelial dysfunction and oxidative stress, against which vitamin C plays a protective role, possibly influencing clinical outcome. Hyperglycaemia may lower vitamin C. Objective. To study plasma vitamin C, oxidative stress, hyperglycaemia, endothelial dysfunction and outcome in septic shock. Methods. In a prospective, observational study of 25 adult septic shock patients, serial blood samples were analysed for vitamin C, thiobarbituric acid-reactive substances (TBARS) (a biomarker of oxidative stress), and soluble vascular cell adhesion molecule-1 (sVCAM-1) and E-selectin (markers of endothelial dysfunction). Blood glucose, Sequential Organ Failure Assessment (SOFA) scores and fluid requirements were monitored. Results. Plasma vitamin C was low, while plasma TBARS were high throughout the 7-day study period. Endothelial dysfunction markers (sVCAM-1 and E-selectin) were high at the baseline. VCAM-1 decreased significantly on day 1 and normalised on day 7. E-selectin was unchanged on day 1 compared with baseline, but increased significantly on day 7. Oxidative stress and endothelial dysfunction were associated with increased SOFA score. Increased oxidative stress was associated with increased requirements for intravenous fluids and prolonged duration of vasoconstrictor support. Nine patients died in hospital. At baseline, levels of TBARS were significantly higher in non-survivors than in the survivors of septic shock. Conclusion. In septic shock, clinically relevant oxidative stress was associated with endothelial dysfunction, low vitamin C and high glucoseto- vitamin-C ratios. Markers of oxidative stress and endothelial damage were increased and correlated with resuscitation fluid requirements, vasoconstrictor use, organ failure and mortality.
{"title":"An observational study on the relationship between plasma vitamin C, blood glucose, oxidative stress, endothelial dysfunction and outcome in patients with septic shock","authors":"Kondwani G H Katundu, L. Hill, Lester M. Davids, Ivan A Joubert, Malcolm G A Miller, J. L. Piercy, William L Michelle","doi":"10.7196/SAJCC.2016.V32I1.270","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.270","url":null,"abstract":"Background. Septic shock is associated with endothelial dysfunction and oxidative stress, against which vitamin C plays a protective role, possibly influencing clinical outcome. Hyperglycaemia may lower vitamin C. Objective. To study plasma vitamin C, oxidative stress, hyperglycaemia, endothelial dysfunction and outcome in septic shock. Methods. In a prospective, observational study of 25 adult septic shock patients, serial blood samples were analysed for vitamin C, thiobarbituric acid-reactive substances (TBARS) (a biomarker of oxidative stress), and soluble vascular cell adhesion molecule-1 (sVCAM-1) and E-selectin (markers of endothelial dysfunction). Blood glucose, Sequential Organ Failure Assessment (SOFA) scores and fluid requirements were monitored. Results. Plasma vitamin C was low, while plasma TBARS were high throughout the 7-day study period. Endothelial dysfunction markers (sVCAM-1 and E-selectin) were high at the baseline. VCAM-1 decreased significantly on day 1 and normalised on day 7. E-selectin was unchanged on day 1 compared with baseline, but increased significantly on day 7. Oxidative stress and endothelial dysfunction were associated with increased SOFA score. Increased oxidative stress was associated with increased requirements for intravenous fluids and prolonged duration of vasoconstrictor support. Nine patients died in hospital. At baseline, levels of TBARS were significantly higher in non-survivors than in the survivors of septic shock. Conclusion. In septic shock, clinically relevant oxidative stress was associated with endothelial dysfunction, low vitamin C and high glucoseto- vitamin-C ratios. Markers of oxidative stress and endothelial damage were increased and correlated with resuscitation fluid requirements, vasoconstrictor use, organ failure and mortality.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"24 1","pages":"21-27"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73203279","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 : 2016-07-26DOI: 10.7196/SAJCC.2016.V32I1.234
Chitra Mehta, Joby V. George, Y. Mehta, M. T. Ali, M. Singh
Background. In Western countries, incidence of thrombocytopenia in intensive care units (ICUs) has been found to be 13 - 44%. We chose to study the incidence, risk factors and transfusion requirements of thrombocytopenia in tertiary care ICUs in northern India. Objective. To study the incidence and risk factors of thrombocytopenia in a mixed ICU. Methods. This prospective observational 6-month cohort study was conducted in two 22-bedded medical-surgical ICUs. Patients aged 18 years or older with an ICU stay of at least 2 days were included. Results. Thrombocytopenia (<150 000/dL) occurred in 190 (38%) of the 500 patients studied. Thrombocytopenia was present on admission in 41 (8%) patients. Of the remaining patients, 149 (32%) developed new-onset thrombocytopenia (NOT) – thrombocytopenia developing in patients with platelet count more than 150 000/U on admission – during ICU stay. Incidence and prevalence were 30% and 38%, respectively. ICU mortality was 13%. Thrombocytopenia was commonly associated with sepsis, disseminated intravascular coagulation, heparin and certain antibiotics. Cause could not be established in 10 patients. Underlying coronary artery disease and sepsis correlated with thrombocytopenia. Mortality was higher in patients with NOT (15.4 v. 8.7%, p=0.003). Compared with non-thrombocytopenic patients, patients with NOT required more blood product transfusions (57.7 v. 38.4%, p=0.000) and mechanical ventilation (23.5 v. 13.5%, p=0.008). No difference was observed in length of hospital stay and bleeding risk between the two groups. Conclusion. We found incidence and prevalence of thrombocytopenia in the ICU comparable with internationally reported figures. NOT was associated with higher mortality and morbidity and may be considered as a marker of disease severity.
背景。在西方国家，重症监护病房(icu)的血小板减少症发病率为13 - 44%。我们选择研究印度北部三级icu中血小板减少症的发生率、危险因素和输血需求。目标。目的:探讨混合ICU患者血小板减少的发生率及危险因素。方法。这项为期6个月的前瞻性观察队列研究是在两个22个床位的内科-外科icu中进行的。患者年龄≥18岁，ICU住院时间≥2天。结果。500例患者中有190例(38%)发生血小板减少症(< 150000 /dL)。41例(8%)患者入院时出现血小板减少。在其余患者中，149例(32%)出现新发血小板减少症(NOT)——入院时血小板计数超过15万/U的患者在ICU住院期间出现血小板减少症。发病率和患病率分别为30%和38%。ICU死亡率为13%。血小板减少症通常与败血症、弥散性血管内凝血、肝素和某些抗生素有关。10例患者病因不明。潜在的冠状动脉疾病和败血症与血小板减少症相关。NOT患者的死亡率更高(15.4% vs 8.7%， p=0.003)。与非血小板减少患者相比，非血小板减少患者需要更多的血液制品输注(57.7 vs 38.4%， p=0.000)和机械通气(23.5 vs 13.5%， p=0.008)。两组患者住院时间和出血风险无差异。结论。我们发现ICU中血小板减少症的发生率和患病率与国际上报道的数据相当。NOT与较高的死亡率和发病率相关，可视为疾病严重程度的标志。
{"title":"Incidence and risk factors for thrombocytopenia in the intensive care units of a tertiary hospital in northern India","authors":"Chitra Mehta, Joby V. George, Y. Mehta, M. T. Ali, M. Singh","doi":"10.7196/SAJCC.2016.V32I1.234","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.234","url":null,"abstract":"Background. In Western countries, incidence of thrombocytopenia in intensive care units (ICUs) has been found to be 13 - 44%. We chose to study the incidence, risk factors and transfusion requirements of thrombocytopenia in tertiary care ICUs in northern India. Objective. To study the incidence and risk factors of thrombocytopenia in a mixed ICU. Methods. This prospective observational 6-month cohort study was conducted in two 22-bedded medical-surgical ICUs. Patients aged 18 years or older with an ICU stay of at least 2 days were included. Results. Thrombocytopenia (<150 000/dL) occurred in 190 (38%) of the 500 patients studied. Thrombocytopenia was present on admission in 41 (8%) patients. Of the remaining patients, 149 (32%) developed new-onset thrombocytopenia (NOT) – thrombocytopenia developing in patients with platelet count more than 150 000/U on admission – during ICU stay. Incidence and prevalence were 30% and 38%, respectively. ICU mortality was 13%. Thrombocytopenia was commonly associated with sepsis, disseminated intravascular coagulation, heparin and certain antibiotics. Cause could not be established in 10 patients. Underlying coronary artery disease and sepsis correlated with thrombocytopenia. Mortality was higher in patients with NOT (15.4 v. 8.7%, p=0.003). Compared with non-thrombocytopenic patients, patients with NOT required more blood product transfusions (57.7 v. 38.4%, p=0.000) and mechanical ventilation (23.5 v. 13.5%, p=0.008). No difference was observed in length of hospital stay and bleeding risk between the two groups. Conclusion. We found incidence and prevalence of thrombocytopenia in the ICU comparable with internationally reported figures. NOT was associated with higher mortality and morbidity and may be considered as a marker of disease severity.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"1 1","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79821041","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 : 2016-07-26DOI: 10.7196/SAJCC.2016.V32I1.289
L. Michell
{"title":"Abstracts of scientific presentations at the 2016 Annual National Conference of the Critical Care Society of Southern Africa","authors":"L. Michell","doi":"10.7196/SAJCC.2016.V32I1.289","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.289","url":null,"abstract":"","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"63 1","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85770025","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 : 2016-07-26DOI: 10.7196/SAJCC.2016.V32I1.293
S. Hanekom
While physiotherapy has been recommended by scientific societies as integral to the management of critically ill patients, great variation has been reported in the role of the physiotherapist in the intensive care unit (ICU), the service provided and the techniques used.[1] Clearly, this may impact on patient outcome. In a bid to address these variations, ICU physiotherapists have taken the initiative to drive a research agenda and to standardise clinical pathways to facilitate optimal patient outcome.
{"title":"Physiotherapy in the intensive care unit","authors":"S. Hanekom","doi":"10.7196/SAJCC.2016.V32I1.293","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.293","url":null,"abstract":"While physiotherapy has been recommended by scientific societies as integral to the management of critically ill patients, great variation has been reported in the role of the physiotherapist in the intensive care unit (ICU), the service provided and the techniques used.[1] Clearly, this may impact on patient outcome. In a bid to address these variations, ICU physiotherapists have taken the initiative to drive a research agenda and to standardise clinical pathways to facilitate optimal patient outcome.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"64 1","pages":"3-4"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89235597","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 : 2015-11-04DOI: 10.7196/SAJCC.2015.V31I2.246
I. Kara, F. Yıldırım, B. Bilaloğlu, Dilek Karamanlıoğlu, Esra Kayacan, M. Dizbay, M. Turkoglu, G. Aygencel
Objective. To investigate whether there was a difference in mortality, clinical response and bacterial eradication between colistin monotherapy and colistin combination therapies for the treatment of nosocomial pneumonia/ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii in a medical intensive care unit (ICU). Methods. This retrospective, observational and single-centre study included all patients who were in the medical ICU of Gazi University Medical Faculty Hospital and diagnosed with nosocomial pneumonia/VAP caused by A. baumannii between January 2009 and September 2014. Results. The median age of the 134 patients was 68 years and 53.3% were male. The most common causes of admission were respiratory insufficiency (66.7%) and sepsis/septic shock (54.8%). In patients with nosocomial pneumonia/VAP caused by A. baumannii , on median day 5 of admission, colistin monotherapy was used in 23 (21.6%) patients, a carbapenem combination was used in 80 (59.7%) patients, sulbactam-ampicillin combination was used in 42 (31.4%) patients, tigecycline combination was used in 26 (19.4%) patients, and sulbactam-cefoperazone combination was used in 17 (12.7%) patients. Median ICU stay of the patients was 15.5 days, and 112 (83.6%) patients died. Colistin monotherapy and combination therapies had no superiority over each other in clinical response for the treatment of A. baumannii -associated nosocomial pneumonia/VAP. Mortality was found to be higher in patients receiving the colistin-carbapenem combination (64.3% v. 36.4%, p =0.016). Discharge/day-of-death Sequential Organ Failure Assessment score (odds ratio (OR) 2.017, 95% confidence interval (CI) 1.330 - 3.061) and vasopressor use (OR 9.014, 95% CI 1.360 - 59.464) were independent risk factors for ICU mortality. Conclusion. Colistin monotherapy and combination therapies have no superiority over each other for clinical response in the treatment of nosocomial pneumonia/VAP caused by multidrug-resistant A. baumannii . Colistin-SAM was associated with improved microbiological eradication and colistin-carbapenem combination was associated with increased mortality.
目标。探讨在重症监护病房(ICU)治疗由鲍曼不动杆菌引起的院内性肺炎/呼吸机相关性肺炎(VAP)时，粘菌素单药治疗与联合治疗在死亡率、临床反应和细菌根除方面是否存在差异。方法。这项回顾性、观察性、单中心研究纳入了2009年1月至2014年9月期间在加齐大学医学院附属医院内科ICU诊断为鲍曼不动杆菌引起的院内性肺炎/VAP的所有患者。结果。134例患者中位年龄为68岁，男性53.3%。最常见的入院原因是呼吸功能不全(66.7%)和脓毒症/感染性休克(54.8%)。鲍曼不动杆菌引起的院内肺炎/VAP患者中位入院第5天，23例(21.6%)患者使用粘菌素单药治疗，80例(59.7%)患者使用碳青霉烯类药物联合治疗，42例(31.4%)患者使用舒巴坦-氨苄西林联合治疗，26例(19.4%)患者使用替加环素联合治疗，17例(12.7%)患者使用舒巴坦-头孢哌酮联合治疗。患者住院时间中位数为15.5 d，死亡112例(83.6%)。粘菌素单药治疗和联合治疗在鲍曼不动杆菌相关医院性肺炎/VAP的临床疗效上没有优势。接受粘菌素-碳青霉烯联合治疗的患者死亡率更高(64.3% vs 36.4%， p =0.016)。出院/死亡当日顺序器官衰竭评估评分(优势比(OR) 2.017, 95%可信区间(CI) 1.330 ~ 3.061)和血管加压药使用(OR 9.014, 95% CI 1.360 ~ 59.464)是ICU死亡率的独立危险因素。结论。粘菌素单药治疗和联合治疗在治疗多药鲍曼不动杆菌引起的院内性肺炎/VAP的临床反应上没有优势。粘菌素- sam与改善微生物根除有关，粘菌素-碳青霉烯联合使用与死亡率增加有关。
{"title":"Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii","authors":"I. Kara, F. Yıldırım, B. Bilaloğlu, Dilek Karamanlıoğlu, Esra Kayacan, M. Dizbay, M. Turkoglu, G. Aygencel","doi":"10.7196/SAJCC.2015.V31I2.246","DOIUrl":"https://doi.org/10.7196/SAJCC.2015.V31I2.246","url":null,"abstract":"Objective. To investigate whether there was a difference in mortality, clinical response and bacterial eradication between colistin monotherapy and colistin combination therapies for the treatment of nosocomial pneumonia/ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii in a medical intensive care unit (ICU). Methods. This retrospective, observational and single-centre study included all patients who were in the medical ICU of Gazi University Medical Faculty Hospital and diagnosed with nosocomial pneumonia/VAP caused by A. baumannii between January 2009 and September 2014. Results. The median age of the 134 patients was 68 years and 53.3% were male. The most common causes of admission were respiratory insufficiency (66.7%) and sepsis/septic shock (54.8%). In patients with nosocomial pneumonia/VAP caused by A. baumannii , on median day 5 of admission, colistin monotherapy was used in 23 (21.6%) patients, a carbapenem combination was used in 80 (59.7%) patients, sulbactam-ampicillin combination was used in 42 (31.4%) patients, tigecycline combination was used in 26 (19.4%) patients, and sulbactam-cefoperazone combination was used in 17 (12.7%) patients. Median ICU stay of the patients was 15.5 days, and 112 (83.6%) patients died. Colistin monotherapy and combination therapies had no superiority over each other in clinical response for the treatment of A. baumannii -associated nosocomial pneumonia/VAP. Mortality was found to be higher in patients receiving the colistin-carbapenem combination (64.3% v. 36.4%, p =0.016). Discharge/day-of-death Sequential Organ Failure Assessment score (odds ratio (OR) 2.017, 95% confidence interval (CI) 1.330 - 3.061) and vasopressor use (OR 9.014, 95% CI 1.360 - 59.464) were independent risk factors for ICU mortality. Conclusion. Colistin monotherapy and combination therapies have no superiority over each other for clinical response in the treatment of nosocomial pneumonia/VAP caused by multidrug-resistant A. baumannii . Colistin-SAM was associated with improved microbiological eradication and colistin-carbapenem combination was associated with increased mortality.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"5 1","pages":"51-58"},"PeriodicalIF":0.0,"publicationDate":"2015-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75213280","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 : 2015-11-04DOI: 10.7196/SAJCC.2015.V31I2.251
A. Lupton-Smith
{"title":"Cardiopulmonary Physiotherapy in Trauma: An Evidence-based Approach","authors":"A. Lupton-Smith","doi":"10.7196/SAJCC.2015.V31I2.251","DOIUrl":"https://doi.org/10.7196/SAJCC.2015.V31I2.251","url":null,"abstract":"","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"11 1","pages":"64-64"},"PeriodicalIF":0.0,"publicationDate":"2015-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90082381","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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