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}
Pub Date : 2015-11-04DOI: 10.7196/SAJCC.2015.V31I2.235
G. Langley, Leah C Kisorio, S. Schmollgruber
Background. Moral distress is experienced when nurses experience conflict while making an ethical decision. This is magnified when the decisions are about withholding or withdrawing life-sustaining treatment. Objective. To explore and describe nurses’ experiences of situations that involve end-of-life care and evoke moral distress in the intensive care units (ICUs) of two public tertiary-level hospitals in South Africa (SA), the personal consequences of these situations and the means employed to manage their distress. Methods. An exploratory, descriptive design was used. A short survey/interview guide was administered to registered and enrolled nurses ( N =100) employed in the ICUs from two academic-affiliated, specialist public hospitals. Results. A total of 65 completed surveys were collected. Of these, 32 responses were judged not to be describing moral distress while 33 clearly described moral distress and were included and analysed by means of initial content analysis. The findings were presented in five major categories: ( i ) collegial incompetence or inexperience; ( ii ) resource constraints; ( iii ) end-of-life issues; ( iv ) lack of consultation, communication and negotiation; and ( v ) support. Conclusion. The study found that nurses experienced considerable moral distress. This is compounded in an environment where gender, professional and social status inhibit the nurses’ assertiveness, ‘voice’ and influence in the healthcare system. Parallels can be drawn between the microcosm of the ICU and the macrocosm of the SA social and ethical character.
{"title":"Moral distress experienced by intensive care nurses","authors":"G. Langley, Leah C Kisorio, S. Schmollgruber","doi":"10.7196/SAJCC.2015.V31I2.235","DOIUrl":"https://doi.org/10.7196/SAJCC.2015.V31I2.235","url":null,"abstract":"Background. Moral distress is experienced when nurses experience conflict while making an ethical decision. This is magnified when the decisions are about withholding or withdrawing life-sustaining treatment. Objective. To explore and describe nurses’ experiences of situations that involve end-of-life care and evoke moral distress in the intensive care units (ICUs) of two public tertiary-level hospitals in South Africa (SA), the personal consequences of these situations and the means employed to manage their distress. Methods. An exploratory, descriptive design was used. A short survey/interview guide was administered to registered and enrolled nurses ( N =100) employed in the ICUs from two academic-affiliated, specialist public hospitals. Results. A total of 65 completed surveys were collected. Of these, 32 responses were judged not to be describing moral distress while 33 clearly described moral distress and were included and analysed by means of initial content analysis. The findings were presented in five major categories: ( i ) collegial incompetence or inexperience; ( ii ) resource constraints; ( iii ) end-of-life issues; ( iv ) lack of consultation, communication and negotiation; and ( v ) support. Conclusion. The study found that nurses experienced considerable moral distress. This is compounded in an environment where gender, professional and social status inhibit the nurses’ assertiveness, ‘voice’ and influence in the healthcare system. Parallels can be drawn between the microcosm of the ICU and the macrocosm of the SA social and ethical character.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"9 1","pages":"36-41"},"PeriodicalIF":0.0,"publicationDate":"2015-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89705963","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.V31I2.249
B. Morrow
Ethical lapses are almost never a case of bad people, doing bad things, for no good reason. More often they are good people, doing bad things, for good reasons. (Marcia Angell, previous Editor-in-Chief (1988 - 2000), New England Journal of Medicine.) Critical illness carries high morbidity and mortality worldwide, with a disproportionate burden of critical illness in low- and middle-income countries, where access to intensive care is particularly limited. Without research in the intensive care unit (ICU) population, we are unlikely to improve our understanding of how to safely and effectively manage a wide range of diseases and injuries, minimise discomfort, reduce organ dysfunction, improve survival, improve quality of life in survivors of critical illness, and ensure rational and equitable use of scarce resources. Clinical research in the critical care environment is therefore essential to inform best practice ('evidence-based care').
{"title":"Ethical considerations for critical care research","authors":"B. Morrow","doi":"10.7196/SAJCC.2015.V31I2.249","DOIUrl":"https://doi.org/10.7196/SAJCC.2015.V31I2.249","url":null,"abstract":"Ethical lapses are almost never a case of bad people, doing bad things, for no good reason. More often they are good people, doing bad things, for good reasons. (Marcia Angell, previous Editor-in-Chief (1988 - 2000), New England Journal of Medicine.) \u0000Critical illness carries high morbidity and mortality worldwide, with a disproportionate burden of critical illness in low- and middle-income countries, where access to intensive care is particularly limited. Without research in the intensive care unit (ICU) population, we are unlikely to improve our understanding of how to safely and effectively manage a wide range of diseases and injuries, minimise discomfort, reduce organ dysfunction, improve survival, improve quality of life in survivors of critical illness, and ensure rational and equitable use of scarce resources. Clinical research in the critical care environment is therefore essential to inform best practice ('evidence-based care').","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"37 1","pages":"34-35"},"PeriodicalIF":0.0,"publicationDate":"2015-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88053669","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.V31I2.247
Devon Nel, W. Stassen
Background. Stroke is a potentially life-threatening, time-dependent event that requires urgent management to reduce morbidity and mortality. It has been suggested that earlier recognition by ambulance personnel and transport to stroke centres may significantly reduce treatment delays. For this reason it is vitally important that ambulance personnel are able to accurately diagnose stroke. Methods. A series of vignettes were created that included images, video and audio displaying either signs or symptoms of stroke or those of another condition. Ambulance personnel were asked to review each vignette and state whether the patient described was suffering from a stroke or not. Further investigation was sought by requesting each individual to motivate their answer, mentioning upon what their diagnosis was based. Results. A total of 40 basic life support (BLS) and intermediate life support (ILS) personnel from different sites diagnosed 280 vignettes. BLS personnel were able to diagnose stroke with a sensitivity of 85.3% and a specificity of 89.9% (positive predictive value (PPV) 86.7%, negative predictive value (NPV) 88.8%), while ILS achieved a sensitivity of 98.2% and specificity of 94.0% (PPV 91.7%, NPV 98.8%). The combined sensitivity and specificity were 91.5% and 92.0%, respectively (PPV 89.2%, NPV 93.8%). In order to aid their diagnosis, only 5% of BLS and 18.34% of ILS utilised validated stroke screening tools. Conclusion. Despite not using validated screening tools, the ambulance personnel sampled in this study were able to identify stroke with high accuracy. Further studies should be considered to identify how these diagnoses were reached in order to identify training needs.
{"title":"The accuracy of Johannesburg-based ambulance personnel in identifying stroke","authors":"Devon Nel, W. Stassen","doi":"10.7196/SAJCC.2015.V31I2.247","DOIUrl":"https://doi.org/10.7196/SAJCC.2015.V31I2.247","url":null,"abstract":"Background. Stroke is a potentially life-threatening, time-dependent event that requires urgent management to reduce morbidity and mortality. It has been suggested that earlier recognition by ambulance personnel and transport to stroke centres may significantly reduce treatment delays. For this reason it is vitally important that ambulance personnel are able to accurately diagnose stroke. Methods. A series of vignettes were created that included images, video and audio displaying either signs or symptoms of stroke or those of another condition. Ambulance personnel were asked to review each vignette and state whether the patient described was suffering from a stroke or not. Further investigation was sought by requesting each individual to motivate their answer, mentioning upon what their diagnosis was based. Results. A total of 40 basic life support (BLS) and intermediate life support (ILS) personnel from different sites diagnosed 280 vignettes. BLS personnel were able to diagnose stroke with a sensitivity of 85.3% and a specificity of 89.9% (positive predictive value (PPV) 86.7%, negative predictive value (NPV) 88.8%), while ILS achieved a sensitivity of 98.2% and specificity of 94.0% (PPV 91.7%, NPV 98.8%). The combined sensitivity and specificity were 91.5% and 92.0%, respectively (PPV 89.2%, NPV 93.8%). In order to aid their diagnosis, only 5% of BLS and 18.34% of ILS utilised validated stroke screening tools. Conclusion. Despite not using validated screening tools, the ambulance personnel sampled in this study were able to identify stroke with high accuracy. Further studies should be considered to identify how these diagnoses were reached in order to identify training needs.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"12 1","pages":"58-61"},"PeriodicalIF":0.0,"publicationDate":"2015-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91319222","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.V31I2.233
M. Knight, R. Wise
This report presents an unusual case of limb ischaemia in the critical care setting, the cause of which was elucidated on echocardiography. Evaluation of the case highlights the importance of appropriate and timely investigation, in particular the role of bedside echocardiography. Although atrial myxomas are uncommon, a thorough investigation of patients presenting with acute peripheral ischaemic events should be undertaken to facilitate the diagnosis of this treatable condition.
{"title":"Atrial myxoma-related embolism resulting in acute limb ischaemia in a critical care patient","authors":"M. Knight, R. Wise","doi":"10.7196/SAJCC.2015.V31I2.233","DOIUrl":"https://doi.org/10.7196/SAJCC.2015.V31I2.233","url":null,"abstract":"This report presents an unusual case of limb ischaemia in the critical care setting, the cause of which was elucidated on echocardiography. Evaluation of the case highlights the importance of appropriate and timely investigation, in particular the role of bedside echocardiography. Although atrial myxomas are uncommon, a thorough investigation of patients presenting with acute peripheral ischaemic events should be undertaken to facilitate the diagnosis of this treatable condition.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"55 1","pages":"62-63"},"PeriodicalIF":0.0,"publicationDate":"2015-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78904910","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.V31I2.252
L. Hill
Background. Nutrition support of the critically ill can positively affect clinical outcomes. International audit data of nutrition practices in intensive care units (ICUs) suggest that inconsistent application of recommended nutrition support practices (NSPs) occurs. There are no data on NSPs in South African (SA) ICUs. Objective. To perform a national pilot survey of NSPs in private SA adult ICUs. Methods. A descriptive, observational, cross-sectional survey was performed among prescribers of nutrition support in private ICU facilities. Participants were targeted through non-randomised convenience sampling and invited to complete a 51-item electronic questionnaire covering ICU demographics, profile of nutrition prescribers, and nutrition assessment support, delivery and monitoring practices. Results. Responses were received from 125 practitioners in 60% of representative private hospitals with ICU facilities, mainly general/mixed ICUs. Forty-six percent of respondents reported structured nutrition support teams and 61% reported that practices were governed by formal nutrition support protocols. Enteral nutrition was reported to be based upon published guidelines by 72% of dietitians, while parenteral nutrition decisions were reportedly based mainly on clinical judgement (43%). For both enteral and parenteral feeding practices, compliance with guidelines was inconsistent. There was a disjuncture between various NSPs as reported by dietitians and by nurses. Nurses generally appeared unaware of published nutrition guidelines. Conclusion. Various disparities in reported nutrition practices were revealed, suggesting that the organisation and operations of teams and the implementation of protocols informed by published nutrition guidelines may not be well established in private SA ICUs.
{"title":"Nutrition support practices in South African ICUs: Results from a nationwide pilot survey","authors":"L. Hill","doi":"10.7196/SAJCC.2015.V31I2.252","DOIUrl":"https://doi.org/10.7196/SAJCC.2015.V31I2.252","url":null,"abstract":"Background. Nutrition support of the critically ill can positively affect clinical outcomes. International audit data of nutrition practices in intensive care units (ICUs) suggest that inconsistent application of recommended nutrition support practices (NSPs) occurs. There are no data on NSPs in South African (SA) ICUs. Objective. To perform a national pilot survey of NSPs in private SA adult ICUs. Methods. A descriptive, observational, cross-sectional survey was performed among prescribers of nutrition support in private ICU facilities. Participants were targeted through non-randomised convenience sampling and invited to complete a 51-item electronic questionnaire covering ICU demographics, profile of nutrition prescribers, and nutrition assessment support, delivery and monitoring practices. Results. Responses were received from 125 practitioners in 60% of representative private hospitals with ICU facilities, mainly general/mixed ICUs. Forty-six percent of respondents reported structured nutrition support teams and 61% reported that practices were governed by formal nutrition support protocols. Enteral nutrition was reported to be based upon published guidelines by 72% of dietitians, while parenteral nutrition decisions were reportedly based mainly on clinical judgement (43%). For both enteral and parenteral feeding practices, compliance with guidelines was inconsistent. There was a disjuncture between various NSPs as reported by dietitians and by nurses. Nurses generally appeared unaware of published nutrition guidelines. Conclusion. Various disparities in reported nutrition practices were revealed, suggesting that the organisation and operations of teams and the implementation of protocols informed by published nutrition guidelines may not be well established in private SA ICUs.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"74 1","pages":"42-50"},"PeriodicalIF":0.0,"publicationDate":"2015-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79963410","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}
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.
{"title":"Incidence and outcome of ventilator-associated pneumonia in Inkosi Albert Luthuli and King Edward VIII Hospital surgical intensive care units","authors":"A. Behari, Nicky Kalafatis","doi":"10.7196/SAJCC.227","DOIUrl":"https://doi.org/10.7196/SAJCC.227","url":null,"abstract":"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.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"2 1","pages":"16-18"},"PeriodicalIF":0.0,"publicationDate":"2015-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87469951","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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