The Southern African journal of critical care : the official journal of the Critical Care Society最新文献

Background: The critical illness of a loved one can negatively affect all family members (FMs), leading to the interruption of family functioning and integrity. Hospitalisation is a stressful, unplanned event for both the patient and FMs and is associated with psychological disturbances, emotional distress and altered family roles and functioning.

Objectives: To develop a theory of family care in critical care units (CCUs) for the South African setting.

Methods: Grounded theory, based on Strauss and Corbin's school of thought, was used. Audio-recorded in-depth interviews were conducted with 32 participants (9 FMs, 17 critical care nurses and 6 doctors) at a private hospital (3 CCUs) and a state hospital (10 CCUs). Data analysis involved open, axial and selective coding.

Results: The theory of family care during critical illness was identified. The core concept of the theory is empowerment, informed by the underlying constructs of information sharing, proximity, garnering resources, and cultural and religious cooperation.

Conclusion: The concepts of this theory can equip healthcare professionals in CCUs to provide appropriate family care for meeting the needs of patients' FMs and, in so doing, contribute to families having a more manageable critical care experience during the illness of their loved one.

Contributions of the study: This study adds to the limited body of knowledge regarding family care within the South African context. The study provides a theory to promote therapeutic partnerships between health care professionals, patients and FMs that will provide support for both the patient and FMs.It is further anticipated that the findings of the study will contribute not only to nurses' critical care curriculum, which currently includes very limited family support content, but also be helpful to doctors working in intensive care units.

Background: High-frequency oscillatory ventilation (HFOV) remains an option for the management of critically ill children when conventional mechanical ventilation fails. However, its use is not widespread, and there is wide variability reported with respect to how it is used.

Objectives: To describe the frequency, indications, settings and outcomes of HFOV use among paediatric patients with a primary respiratory disorder admitted to a tertiary paediatric intensive care unit (PICU).

Methods: The study was a 2-year, single-centre, retrospective chart review.

Results: Thirty-four (32.7%) patients were managed with HFOV in the PICU during the study period. Thirty-three of the 34 patients had paediatric acute respiratory distress syndrome. Indications for HFOV were inadequate oxygenation in 17 patients (50%), and refractory respiratory acidosis in 15 patients (44.1%) (2 patients did not fit into either category). Approaches to the setting of HFOV varied considerably, particularly with respect to initial pressure around the airways. HFOV was effective at improving both oxygenation, with a median (interquartile range (IQR)) decrease in oxygenation index of 6.34 (5.0 - 9.5), and ventilation with a the median decrease in PaCO₂ of 67.6 (46.2 - 105.7) mmHg after 24 hours. Overall mortality was 29.4% in the HFOV group, which is consistent with other studies.

Conclusion: HFOV remains an effective rescue ventilatory strategy, which resulted in rapid and sustained improvement in gas exchange in patients with severe hypoxaemia and/or severe respiratory acidosis, particularly in the absence of extracorporeal support. However, the variability in practice and the adverse effects described highlight the need for future high-quality randomised controlled trials to allow for development of meaningful guidelines to optimise HFOV use.

Contributions of the study: This study describes the use and outcomes of high-frequency oscillatory ventilation (HFOV) in a South African paediatric intensive care unit, thus addressing a local knowledge gap and providing evidence of the continued efficacy of HFOV for severe hypoxaemia and refractory respiratory acidosis in settings without access to extracorporeal technologies.

Background: Rapid sequence intubation (RSI) involves inducing unconsciousness and paralysis in rapid succession in order to facilitate endotracheal tube placement. RSI has recently been introduced to the scope of practice of South African prehospital emergency care practitioners (ECPs). Despite this, there remains limited evidence supporting the efficacy and safety of RSI within this context. While in-hospital studies have shown that it can take 20 minutes or more to perform an RSI, little is known about the time taken to perform the procedure in the prehospital setting.

Objectives: To measure the time taken to perform an RSI in a simulated prehospital environment.

Methods: A sample of final-year ECP students were video-recorded performing RSIs on a mannequin within a simulated prehospital environment. Data were gathered through an analysis of the recordings, allowing for the capturing of times taken to complete each of the phases of a RSI.

Results: A mean time of 15 minutes 5 seconds was recorded to complete the procedure. This was shorter than times reported for in-hospital studies.

Conclusion: RSI is a potentially harmful procedure if improperly performed and has the potential to create delays in transport that may not always be in the patient's best interest. With a mean time of 15 minutes 5 seconds, the performance of RSI by ECP students in the simulated prehospital environment was faster than expected. Further research is recommended to explore the relationship between the performances observed in this mannequin-based study with those in authentic prehospital settings.

Contributions of the study: This study adds to a currently limited body of knowledge surrounding the performance of out-of-hospital anaesthesia by emergency care practitioners in the African context. The study highlights the fact that while prehospital rapid sequence intubation may be a lifesaving procedure, anaesthetising patients in an uncontrolled prehospital environment is not without risk. An important consideration that needs to be taken into account when making a decision on whether or not to perform the procedure within the prehospital setting is the potential delay this might have on transport time and arrival at the receiving facility.

Background: Recent evidence shows that early mobilisation of patients in an intensive care unit (ICU) is feasible, safe and associated with improvement in patients' clinical outcomes. However, its successful implementation is dependent on several factors, which include ICU structure and organisational practices.

Objectives: To evaluate the structure and organisational practices of Zimbabwean government hospital ICUs and to describe early mobilisation practices of adult patients in these units.

Methods: A cross-sectional survey was conducted in all government hospitals in Zimbabwe. Data collected included hospital and ICU structure, adult patient demographic data and mobilisation activities performed in the ICU during the 24 hours prior to the day of the survey.

Results: A total of five quaternary level hospitals were surveyed, with each hospital having one adult ICU. Four of the units were open-type ICUs. The majority of the units (n=3; 60%) reported that they had a permanent physiotherapist who covered their unit, but none of the physiotherapists worked solely in the ICU. The nurse-to-patient ratio across all units was 1:1. None of the units utilised a standardised sedation scoring system or a standardised outcome measure to assess patient mobility status. Only one ICU (20%) had a patient eligibility guideline for early mobilisation in place. Across the ICUs, 40 patients were surveyed. The median (interquartile range) age was 33 (23.3 - 38) years and 24 (60%) were mechanically ventilated. Indications for admission into the ICU included acute respiratory failure (n=12; 30%) and postoperative care (n=10; 25%). Mobilisation activities performed in the previous 24 hours included turning the patient in bed (n=39; 97.5%), sitting over the edge of the bed (n=10; 25%) and walking away from the bedside (n=2; 5%). The main reason listed for treatment performed in bed was patients being sedated and unresponsive (n=13; 32.5%).

Conclusion: Out-of-bed mobilisation activities were low and influenced by patient unresponsiveness and sedation, staffing levels and lack of rehabilitation equipment in ICU.