Authors:M L Botes, M Moepeng Pages: 68 - 72 Abstract: Background. Cardiac arrest is among the major causes of sudden deaths globally. Although out-of-hospital cardiac arrest occurs more commonly, in-hospital cardiac arrest is still a major health problem. Critical care areas provide care to critically ill patients who are at risk of cardiac arrest. It is important that nurses are knowledgeable and competent in cardiopulmonary resuscitation (CPR) in order to optimise the patient’s chances of survival and quality of life after cardiac arrest. Objective. To investigate specialist practice nurses’ knowledge of evidence-based guidelines for CPR. Methods. A descriptive cross-sectional survey was utilised. We sampled all critical care registered nurses (N=96) currently working in the adult emergency departments and intensive care units at Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa. A selfadministered instrument, the ‘evaluation questionnaire on CPR knowledge for health personnel from emergency services’ was used. Data were analysed using descriptive and comparative statistics. Results. The mean CPR knowledge score was 46%. A score of 84% was considered adequate for a pass, and no respondents achieved this score. The majority of the respondents (80.85%; n=76) were specialists in the field of intensive care nursing. Conclusion. The CPR knowledge of specialist practice nurses was suboptimal for the care required in high-risk settings. Further training is indicated. PubDate: 2023-04-26 Issue No:Vol. 36, No. 2 (2023)
Authors:A K Atrash, K de Vasconcellos Pages: 74 - 79 Abstract: Background. Albumin is a determinant of plasma colloid oncotic pressure and buffering capacity. It is a carrier protein for drugs and is important for normal functioning of the glycocalyx. Hypoalbuminaemia is common in the critically ill and has been associated with adverse outcomes. The association between hypoalbuminaemia and outcome has not been specifically explored in the South African context. Objectives. To determine whether albumin levels on admission and changes in albumin levels were associated with intensive care unit (ICU) mortality in a heterogenous critically ill population. Methods. This was a retrospective observational study of 247 adult patients who were admitted to a multidisciplinary ICU. Albumin levels were measured on admission and 48 hours later, alongside other biochemical and clinical parameters to determine whether they were predictive of ICU mortality. Results. The lowest level of albumin on admission was 8 g/L and the highest was 43 g/L. The incidence of hypoalbuminaemia (using the laboratory reference range) was 93.9% on admission and 99.4% at 48 hours. Receiver operating characteristic curve analysis provided an optimal albumin cut-off of 18.5 g/L. Using this cut-off, hypoalbuminaemia at admission and at 48 hours was associated with increased ICU mortality. Hypoalbuminaemia at admission was an independent predictor of mortality using multivariable analysis (OR 3.74; 95% confidence interval 1.87 - 4.48). Conclusion. Hypoalbuminaemia is associated with increased ICU mortality. There is currently no evidence to support the use of albumin replacement therapy. Further research is required to determine its role in critically ill patients. PubDate: 2023-04-26 Issue No:Vol. 36, No. 2 (2023)
Authors:M A Khuweldi, D L Skinner, K de Vasconcellos Pages: 80 - 84 Abstract: Background. Acute kidney injury (AKI) in critically ill and resource-limited settings is under investigated. Objectives. To describe the incidence, outcomes and healthcare burden of AKI in a multidisciplinary intensive care unit (ICU) in Durban, South Africa (SA). Methods. All adult patients admitted to the ICU at King Edward VIII Hospital from January 2016 to June 2016, who did not have end-stage renal disease and survived for more than 6 hours after admission were evaluated for AKI using the kidney disease improving global outcomes (KDIGO) creatinine criteria. Potential risk factors for AKI and an association between AKI and outcomes including ICU mortality and length of stay were analysed. Results. We screened 204 patients for inclusion into the study and 26 patients were excluded. About half of the patients (50.5%; n=90/178) who were included in the study were diagnosed with AKI at the time of admission and 16.3% (n= 29/178 developed AKI in the ICU. Among the patients who had AKI on admission, 50% (n=45/90) were classified as KDIGO stage1, 21.1% (n=19/90) as stage 2 and 28.8% (n=26/90) as stage 3. Less than one-third (24.7%; n=44/178) of the patients who developed AKI in the ICU were classified as KDIGO stage 1, 14% (n=25/178) were stage 2, and 28% (n=50/178) were stage 3. The mortality rate for patients with AKI on admission was 40.0% (n=36/90) compared with 39.8% (n=35/88) for those without AKI on admission (p=0.975). The mortality rate for all patients with AKI was 46.2% (n=55/119) compared with 27.1% n=16/59) in patients who did not develop AKI (p=0.014). Conclusion. AKI is common in critically ill patients presenting to a tertiary ICU in Durban, SA. AKI is associated with increased mortality and length of stay in the ICU. Strategies to prevent the development or worsening of AKI must be emphasised. These include prevention or at least early treatment of sepsis, adequate fluid resuscitation, aggressive haemodynamic optimisation and avoidance of nephrotoxins. This is especially important in settings where there is limited access to renal replacement therapy (RRT). PubDate: 2023-04-29 Issue No:Vol. 36, No. 2 (2023)
Authors:M N Ntinga, H van Aswegen Pages: 86 - 91 Abstract: Background. In the intensive care unit (ICU) environment, inter-professional team collaborations have direct impact on patient care outcomes. Current evidence shows that providing physiotherapy to ICU patients shortens their length of stay and reduces their incidence of ventilator associated pneumonia and severity of critical illness neuropathy. Physiotherapists’ perceptions of their interactions with nurses and doctors as inter-professional team members in the ICU is important. Objectives. To identify barriers and enablers of physiotherapists’ interactions with inter-professional team members in adult ICU settings, identify solutions to the barriers and determine if perceptions of interactions with ICU team members differ between junior and senior physiotherapists. Methods. A qualitative study was done using semi-structured group discussions. Participants were recruited using convenience sampling. Participants were junior and senior physiotherapists from four private and four public sector hospitals in urban Johannesburg, South Africa. Interviews were audio recorded. Recordings were transcribed and direct content analysis of data was done to create categories, subcategories and themes. Results. Twenty-two junior and 17 senior ICU physiotherapists participated in the study. Barriers raised by physiotherapists regarding communication with inter-professional team members in the ICU were non-ICU trained staff working in ICU, personality types, lack of professional etiquette, and frequent rotation of ICU staff. Enablers of communication with inter-professional team members were presence of team members in ICU during the day, good time management, teamwork approach to care and sharing of knowledge. Differing paradigms of teamwork among health professionals was highlighted as a cause of tension in the ICU inter-professional collaborations. Conclusion. Physiotherapists are important members of the inter-professional ICU team. Exploring their interactions with other team members identified solutions that may improve collaboration between inter-professional team members to facilitate improved patient outcomes. Inter-professional education should inform ICU policies to create an environment that fosters teamwork. Finding creative ways to adequately staff the ICU without losing quality or driving up costs of care are matters that should take priority among policy makers. PubDate: 2023-04-29 Issue No:Vol. 36, No. 2 (2023)
Authors:S M Savarimuthu, C Cairns, N L Allorto, G E Weissman, R Kohn, R D Wise, G L Anesi Pages: 92 - 95 Abstract: Background. Sepsis is a major cause of morbidity and mortality, especially in critical care patients. Developing tools to identify patients who are at risk of poor outcomes and prolonged length of stay in intensive care units (ICUs) is critical, particularly in resource-limited settings. Objective. To determine whether the quick sequential organ failure assessment (qSOFA) score based on bedside assessment alone was a promising tool for risk prediction in low-resource settings. Methods. A retrospective cohort of adult patients admitted to the intensive care unit (ICU) at Edendale Hospital in Pietermaritzburg, South Africa (SA), was recruited into the study between 2014 and 2018. The association of qSOFA with in-ICU mortality was measured using multivariable logistic regression. Discrimination was assessed using the area under the receiver operating characteristic curve and the additive contribution to a baseline model using likelihood ratio testing. Results. The qSOFA scores of 0, 1 and 2 were not associated with increased odds of in-ICU mortality (adjusted odds ratio (aOR) 1.24, 95% confidence interval (CI) 0.86 - 1.79; p=0.26) in patients with infection, while the qSOFA of 3 was associated with in-ICU mortality in infected patients (aOR 2.82; 95% CI 1.91 - 4.16; p<0.001). On the other hand, the qSOFA scores of 2 (aOR 3.25; 95% CI 1.91 - 5.53; p<0.001) and 3 (aOR 6.26, 95% CI 0.38 - 11.62, p<0.001) were associated with increased odds of in-ICU mortality in patients without infection. Discrimination for mortality was fair to poor and adding qSOFA to a baseline model yielded a statistical improvement in both cases (p<0.001). Conclusions. qSOFA was associated with, but weakly discriminant, for in-ICU mortality for patients with and without infection in a resourcelimited, public hospital in SA. These findings add to the growing body of evidence that support the use of qSOFA to deliver low-cost, high-value critical care in resource-limited settings. PubDate: 2023-04-29 Issue No:Vol. 36, No. 2 (2023)
Authors:S Savage-Reid, M S Moeng, T Thomas Pages: 96 - 103 Abstract: Background. Inappropriate empirical antibiotics promote antibiotic resistance. Antibiograms guide empirical antibiotic therapy by outlining the percentage susceptibility of each pathogen to individual antibiotics. In 2016, the Trauma Intensive Care Unit at Charlotte Maxeke Johannesburg Academic Hospital escalated empirical antibiotic therapy for nosocomial infections from piperacillin-tazobactam to imipenem plus amikacin. Objectives. This study assessed the impact of escalation in empirical antimicrobial treatment on organism prevalence and resistance profile. Methods. A retrospective analysis of bacterial and fungal microscopy, culture and susceptibility reports from the laboratory information system of the National Health Laboratory Services, from 1 January 2015 to 31 December 2015 and 1 January 2017 to 31 December 2017, was conducted. Data were de-duplicated according to standard guidelines. Fisher’s exact test was used to determine p-values. Results. Organism prevalence shifted between the years, with a 2.7% increase in streptococci (p=0.0199), 1.7% increase in Candida auris (p=0.0031) and 4.6% and 4.4% reduction in Acinetobacter baumannii (p=0.0508) and Pseudomonas aeruginosa (p=0.0196), respectively. Similarly, there was a change in the resistance profile, with a 28.9% reduction in multi-drug resistant (MDR) A. baumannii (p=0.0001), 60.4% reduction in MDR P. aeruginosa (p=0.0001) and a 6.5% increase in carbapenem-resistant Enterobacterales (p=0.007). The predominant specimen type differed between the years, with significantly more pus, tissue and fluid samples and fewer respiratory samples sent for investigation in 2017 than 2015. Conclusion. Escalation in the use of empirical antibiotics showed a change in organism prevalence and an improvement in the susceptibility profile of MDR non-fermenters. PubDate: 2023-04-29 Issue No:Vol. 36, No. 2 (2023)
Authors:W Emmamally, O Chiyangwa Pages: 104 - 108 Abstract: Background. Moral distress resulting from frequent and intense exposures to morally challenging encounters with critically ill patients, their families and other healthcare professionals negatively impacts on the personal and professional wellbeing of critical care nurses. Objective. To determine the frequency, intensity and overall severity of moral distress among critical care nurses working in the critical care environment of a private hospital in the eThekwini district of KwaZulu-Natal Province, South Africa. Methods. A descriptive survey was conducted using a 21-item moral distress scale revised questionnaire. We assessed the influence of sociodemographic variables of the respondents on the moral distress composite scores. Results. The moral distress composite scores of the 74 critical care nurses who completed the questionnaires ranged from 0 - 303 out of a possible 336. The mean (standard deviation (SD)) composite moral distress score was 112.12 (73.21). Analysis of the relationship between sociodemographic variables and the moral distress composite scores revealed that female respondents experienced higher distress scores than males (p=0.013). There was an inverse relationship between composite scores and an increase in age (p=0.009) and years of service (p=0.022). Conclusion. The mean composite score of the critical care nurses was suggestive of moderate levels of moral distress. Counselling services and empowerment skills training are advocated to support critical care nurses to manage moral distress. PubDate: 2023-04-29 Issue No:Vol. 36, No. 2 (2023)
Authors:S Murphy, E Bruckmann, L G Doedens, A B Khan, A Salloo, S Omar Pages: 109 - 113 Abstract: Background. High-flow humidified oxygen (HFHO) therapy has demonstrated benefit in infants with bronchiolitis. Objectives. To investigate the efficacy of HFHO in infants with moderate to severe viral bronchiolitis, when used outside the paediatric intensive care unit (PICU), in a hospital with limited PICU resources. Methods. A randomised controlled trial, which enrolled 28 infants between 1 month and 2 years of age, with a clinical diagnosis of acute viral bronchiolitis and moderate to severe respiratory distress. Participants were randomised to receive HFHO 2L/kg/min or oxygen by nasal cannula/face mask. Respiratory rate, heart rate, oxygen saturations, and modified TAL (M-TAL) score were measured at baseline, 60 - 90 minutes after starting therapy and at 6- and 12-hourly intervals. The primary outcome evaluated was the improvement in respiratory distress (M-TAL score). The secondary outcome assessed was the need for intubation and ventilation. Results. There was a significant improvement in respiratory distress (M-TAL score), in infants who received HFHO therapy. Additionally, there was also a reduction in heart rate in the HFHO group as well as a trend to lower intubation rates. Conclusion. HFHO is a beneficial therapy for infants with moderate-severe viral bronchiolitis. It can be safely used outside the PICU and could potentially reduce the need for intubation and admission to PICU in resource-limited settings. PubDate: 2023-04-29 Issue No:Vol. 36, No. 2 (2023)
Authors:M Nienkemper, J Malherbe, C Barrett Pages: 114 - 119 Abstract: Background. Haemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome if not recognised and managed early. It involves an uncontrolled pathological activation of the immune system, and it is either genetic or acquired. It presents with clinical and laboratory features of severe inflammation. Early initiation of effective therapy may reduce mortality from 95% to 35%. Objective. To raise awareness of HLH among healthcare professionals, particularly intensivists. Methods. We report nine cases of secondary HLH seen at tertiary hospitals in Bloemfontein, South Africa. Results. All patients presented with fever, hypertriglyceridaemia, hyperferritinaemia, transaminitis and cytopenia. Haemophagocytosis was noted on bone marrow biopsy in 66.7% (n=6/9) of the patients. More than one-third (44.4%; n=4/9) of the cases were triggered by a lymphoma, 44% (n=4/9) were associated with infection and 11% (n=1/9) were associated HIV. Finally, 11.1% (n=1) of the patients were triggered by an underlying autoimmune disease. More than half (55.6%; n=5/9) of the cases had a fatal outcome. Conclusion. A high index of suspicion may promote the accurate diagnosis of HLH in patients presenting with fever, transaminitis and unexplained cytopenia. PubDate: 2023-04-29 Issue No:Vol. 36, No. 2 (2023)
Open Access journal
[261 journals]
