Pub Date : 2016-11-10DOI: 10.7196/SAJCC.2016.V32I2.298
J. Beer, P. Brysiewicz
Background . The unexpected admission of a loved one to an intensive care unit (ICU) may have a negative effect on the everyday lives of family members, as they have had little time to adjust. Hence, it is imperative for healthcare professionals to promote optimal outcomes for both the patient and family members during admission for critical illness. Objective . To explore and describe the needs of families during critical illness and to develop methods to provide family care during a critical illness of a loved one. Methods . The Strauss and Corbin grounded theory approach was used. In-depth interviews with 16 intensive care nurses, 6 doctors and 9 family members in private and public settings were completed. Results . Five codes emerged using the characteristic coding in grounded theory. These were identified as information sharing; reassurance; striving for consolation; garnering of resources; and cultural and religious co-operation. Conclusion . This study elicited the needs of family members of ICU patients. Methods tailored around these needs were presented to support family members during a critical illness.
{"title":"The needs of family members of intensive care unit patients : a grounded theory study","authors":"J. Beer, P. Brysiewicz","doi":"10.7196/SAJCC.2016.V32I2.298","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.298","url":null,"abstract":"Background . The unexpected admission of a loved one to an intensive care unit (ICU) may have a negative effect on the everyday lives of family members, as they have had little time to adjust. Hence, it is imperative for healthcare professionals to promote optimal outcomes for both the patient and family members during admission for critical illness. Objective . To explore and describe the needs of families during critical illness and to develop methods to provide family care during a critical illness of a loved one. Methods . The Strauss and Corbin grounded theory approach was used. In-depth interviews with 16 intensive care nurses, 6 doctors and 9 family members in private and public settings were completed. Results . Five codes emerged using the characteristic coding in grounded theory. These were identified as information sharing; reassurance; striving for consolation; garnering of resources; and cultural and religious co-operation. Conclusion . This study elicited the needs of family members of ICU patients. Methods tailored around these needs were presented to support family members during a critical illness.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"2 1","pages":"44-49"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72855133","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 : 2016-11-10DOI: 10.7196/SAJCC.2016.v32i2.304
L. Michell
Burnout syndrome (BOS) is a common problem, affecting 25 60% of healthcare professionals (HCPs) working in the intensive care unit (ICU).[1] Recently an American Critical Care Societies’ collaborative statement called for action to improve the ICU working environment.[2] The core symptoms of BOS are emotional exhaustion, depersonalisations and perceived lack of personal accomplishment.[2] In a previous issue of this journal we published an editorial, ‘Crash and burn’, highlighting the problem of BOS and the closely associated condition of post-traumatic stress disorder in ICU personnel.[3] Several studies have identified stressful interactions with relatives as a factor that adds to the burden of this demanding workplace. The response of burnt-out doctors and nurses is to avoid or minimise contact with the relatives, particularly if they are perceived to be demanding or ‘difficult’. Understanding the needs of families can help us support families and, in doing so, help ourselves. Even when we are managing the most hopeless ICU patient, job satisfaction can be achieved by knowing that we have done the best we could to help a family cope with a stressful situation. In this issue we publish a study which used a grounded theory approach to establish the needs of the families of ICU patients.[4] Common themes that emerged were the need for information sharing, reassurance, consolidation, resources, and cultural and religious awareness. Helping families that have been thrust into an unfamiliar and frightening situation to survive emotionally requires an understanding of the coping mechanisms relatives adopt. Establishing trust between HCPs and relatives is the first essential step. This is not achieved if discordant information is being supplied. De Beer and Brysiewicz’s study[4] highlights the problem of contradictory information being supplied by different members of the ICU team. An earlier study[5] conducted in French ICUs also showed that consistent information was the most important factor associated with family satisfaction. Communication is a two-way street and involves not only informing the relatives of the patient’s condition in an appropriate and compassionate way but also listening to family members and allowing them time to voice their fears and concerns. Family conferences where relatives talk more than the doctor are rated as more satisfactory by the family.[6] The need for reassurance was another key theme that emergend from the study. This is not such a simple need to meet in the critically ill. It is our human instinct to reassure, and families are keen to grasp at any straw offered. Unfortunately, we have all seen apparently improving patients suddenly deteriorate, and the ensuing blame games that may follow. The opposite extreme, of being overly pessimistic, is also not appropriate as we should not deny the ‘right to hope’ as long as there is some justification for this. Perhaps the best approach is one of cautious optimism, while
{"title":"Care or burn in the ICU","authors":"L. Michell","doi":"10.7196/SAJCC.2016.v32i2.304","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.v32i2.304","url":null,"abstract":"Burnout syndrome (BOS) is a common problem, affecting 25 60% of healthcare professionals (HCPs) working in the intensive care unit (ICU).[1] Recently an American Critical Care Societies’ collaborative statement called for action to improve the ICU working environment.[2] The core symptoms of BOS are emotional exhaustion, depersonalisations and perceived lack of personal accomplishment.[2] In a previous issue of this journal we published an editorial, ‘Crash and burn’, highlighting the problem of BOS and the closely associated condition of post-traumatic stress disorder in ICU personnel.[3] Several studies have identified stressful interactions with relatives as a factor that adds to the burden of this demanding workplace. The response of burnt-out doctors and nurses is to avoid or minimise contact with the relatives, particularly if they are perceived to be demanding or ‘difficult’. Understanding the needs of families can help us support families and, in doing so, help ourselves. Even when we are managing the most hopeless ICU patient, job satisfaction can be achieved by knowing that we have done the best we could to help a family cope with a stressful situation. In this issue we publish a study which used a grounded theory approach to establish the needs of the families of ICU patients.[4] Common themes that emerged were the need for information sharing, reassurance, consolidation, resources, and cultural and religious awareness. Helping families that have been thrust into an unfamiliar and frightening situation to survive emotionally requires an understanding of the coping mechanisms relatives adopt. Establishing trust between HCPs and relatives is the first essential step. This is not achieved if discordant information is being supplied. De Beer and Brysiewicz’s study[4] highlights the problem of contradictory information being supplied by different members of the ICU team. An earlier study[5] conducted in French ICUs also showed that consistent information was the most important factor associated with family satisfaction. Communication is a two-way street and involves not only informing the relatives of the patient’s condition in an appropriate and compassionate way but also listening to family members and allowing them time to voice their fears and concerns. Family conferences where relatives talk more than the doctor are rated as more satisfactory by the family.[6] The need for reassurance was another key theme that emergend from the study. This is not such a simple need to meet in the critically ill. It is our human instinct to reassure, and families are keen to grasp at any straw offered. Unfortunately, we have all seen apparently improving patients suddenly deteriorate, and the ensuing blame games that may follow. The opposite extreme, of being overly pessimistic, is also not appropriate as we should not deny the ‘right to hope’ as long as there is some justification for this. Perhaps the best approach is one of cautious optimism, while ","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"11 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82972085","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 : 2016-11-01DOI: 10.7196/SAJCC.2016.V32I2.253
P. Jordan, C. Bowers, D. Morton
Background . Evidence-based practices (EBPs) have been promoted to enhance the delivery of patient care, reduce cost, increase patient and family satisfaction and contribute to professional development. Individual and organisational barriers can hamper the implementation of EBP, which can be detrimental to healthcare delivery. Objective . To determine the individual and organisational implementation barriers of EBP among nurses in a private intensive care unit (ICU). Methods . A quantitative research design was used to collect data from nurses in a private ICU in the Eastern Cape Province, South Africa. The structured questionnaire (Cronbach’s alpha: 0.72) was administered to 70 respondents, with a response rate of 93%. Results . Barriers at individual level were identified, and include lack of familiarity with EBP, individual perceptions that underpin clinical decision-making, lack of access to information required for EBP, inadequate sources to access evidence, inability to synthesise the literature available, and resistance to change. Barriers related to organisational support, change and operations were identified. Conclusion . Although the findings were similar to other studies, this study showed that nurses younger than 40 years of age were more familiar with the concepts of EBP. Physicians were perceived as not being very supportive of EBP implementation. In order to enhance healthcare delivery in the ICUs, nurse managers need to take cognisance of the individual and organisational barriers that might hamper the implementation of EBP.
{"title":"Barriers to implementing evidence-based practice in a private intensive care unit in the Eastern Cape","authors":"P. Jordan, C. Bowers, D. Morton","doi":"10.7196/SAJCC.2016.V32I2.253","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.253","url":null,"abstract":"Background . Evidence-based practices (EBPs) have been promoted to enhance the delivery of patient care, reduce cost, increase patient and family satisfaction and contribute to professional development. Individual and organisational barriers can hamper the implementation of EBP, which can be detrimental to healthcare delivery. Objective . To determine the individual and organisational implementation barriers of EBP among nurses in a private intensive care unit (ICU). Methods . A quantitative research design was used to collect data from nurses in a private ICU in the Eastern Cape Province, South Africa. The structured questionnaire (Cronbach’s alpha: 0.72) was administered to 70 respondents, with a response rate of 93%. Results . Barriers at individual level were identified, and include lack of familiarity with EBP, individual perceptions that underpin clinical decision-making, lack of access to information required for EBP, inadequate sources to access evidence, inability to synthesise the literature available, and resistance to change. Barriers related to organisational support, change and operations were identified. Conclusion . Although the findings were similar to other studies, this study showed that nurses younger than 40 years of age were more familiar with the concepts of EBP. Physicians were perceived as not being very supportive of EBP implementation. In order to enhance healthcare delivery in the ICUs, nurse managers need to take cognisance of the individual and organisational barriers that might hamper the implementation of EBP.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"27 1","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88378933","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 : 2016-11-01DOI: 10.7196/SAJCC.2016.V32I2.275
M. Venter, W. Stassen
Background . Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim . The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods . A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample ( n =7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results . After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion . Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.
{"title":"The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study","authors":"M. Venter, W. Stassen","doi":"10.7196/SAJCC.2016.V32I2.275","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.275","url":null,"abstract":"Background . Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim . The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods . A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample ( n =7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results . After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion . Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"96 1","pages":"58-61"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80454048","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.V32I1.243
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}
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