Southern African Journal of Critical Care
type: channel
description: The SAJCC publishes scientific articles related to multidisciplinary critical and intensive medical care and the emergency care of critically ill humans.
publisher: South African Medical Association
language: en
publication name: Southern African Journal of Critical Care
issn: 1562-8264
copyright: Authors retain copyright and grant the journal right of first publication.
items: CCSSA Congress Abstracts
items: Noise levels in intensive care units at Charlotte Maxeke Johannesburg Academic Hospital
items: A retrospective review of advanced life support interfacility transfers of the public sector emergency medical service in the Western Cape Province, South Africa
items: A survey of doctors’ perspectives on critical laboratory result communication in Cape Town, South Africa
items: The clinical profile of abdominopelvic injury and the determinants of length of stay and mortality in the intensive care unit of a tertiary hospital
items: The process of rapid sequence intubation in the prehospital setting: A scoping review
items: Clinical decision-making process of healthcare workers when feeding critically ill adults in public sector ICUs in South Africa
items: Comment on the “Use of intravenous immunoglobulin for the treatment of severe COVID-19”
items: Early mobilisation practices in Windhoek intensive care units: A retrospective review of patient profiles and physiotherapy practice
items: Beyond survival: Functionality and health-related quality of life among a cohort of ICU survivors 6 months after hospital discharge – a single-centre study in the Eastern Cape Province of South Africa
items: Classification and predictive models using supervised machine learning: A conceptual review
items: Ventilation distribution in mechanically ventilated children in response to positioning: An exploratory study
items: Critical Care Congress 2024
items: Making sense of the outcome of a rehabilitation implementation trial in the intensive care unit: Mixed methods
items: Evaluating complications in a South African neurocritical care unit: A 1-year retrospective audit
items: Validating the Measure of Processes of Care for Service Providers (MPOC-SP(A)) tool in adult intensive care units
items: Shock epidemiology and outcomes among internal medicine patients
items: Ventilator-associated pneumonia rates in a level I trauma intensive care unit in KwaZulu-Natal Province, South Africa, compared with international benchmarks
items: Emergency care capacity of private primary healthcare facilities in Gauteng, South Africa
items: Validation of the APACHE‐II scoring system in critically ill patients diagnosed with COVID‐19 and admitted at a regional‐level hospital intensive care unit: A retrospective study
items: Factors influencing knowledge translation into critical care practice: The reality facing intensive care nurses in Limpopo Province
items: Critical pertussis infection in the paediatric intensive care unit: A case series in an outbreak
items: Association between serum procalcitonin levels and outcomes of patients admitted to two tertiary paediatric intensive care units in Bloemfontein: A retrospective analytical study
items: A profile of children with traumatic brain injury admitted to the paediatric intensive care unit of Red Cross War Memorial Children’s Hospital in Cape Town, South Africa, between 2015 and 2019
items: Professor Mochichi Samuel (Sam) Mokgokong
items: Relevance and application of clinical practice guidelines in different settings
items: Outcomes of HIV-exposed infected and HIV-exposed uninfected children admitted to two paediatric intensive care units in South Africa: A retrospective analytical cohort study
items: Bed occupancy and nosocomial infections in the intensive care unit: A retrospective observational study in a tertiary hospital
items: Use of intravenous immunoglobulin for the treatment of severe COVID‐19 in the Chris Hani Baragwanath Academic Hospital intensive care unit, Johannesburg, South Africa
items: Critical care nurses’ orientations to caring for patients and their families at a selected hospital in KwaZulu-Natal

CCSSA Congress Abstracts
type: item
description: -
subject: Abstracts
  topic: section
subject: abstracts
  topic: keywords
creator: Claudia Naidu
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-23
publication date: 2025-09-23
doi: 10.7196/

Noise levels in intensive care units at Charlotte Maxeke Johannesburg Academic Hospital
type: item
description: Background. Noise exposure can negatively affect patients and staff. Patients may experience sleep disturbance, delirium and sympathetic stimulation. Communication may be hampered, and staff may experience alarm fatigue. The World Health Organization (WHO) recommends time-averaged sound levels of 35 dB. Prolonged exposure to noise levels ≥85 dB may damage hearing. Studies on noise levels in adult intensive care units (ICUs) in South Africa are lacking. Objectives. To compare noise levels with WHO recommendations, across ICUs and between recording zones. Methods. A prospective cross-sectional research design was used. A class 2 sound-level meter measured noise levels in six adult ICUs at the central station and a patient cubicle for three 24-hour periods per ICU. Results. Time-weighted sound levels (Leq) ranged between 48 and 65 dB. There was no statistically significant difference when comparing noise levels conditioned to ICU size, layout and between recording zones. Daytime noise levels at the central station were higher than night-time values (p<0.001) but diurnal variation was not appreciated in patient cubicles. All ICUs exceeded WHO recommendations >80% of the time. Noise levels >85 dB were very infrequent. Conclusion. Noise levels consistently exceeded WHO recommendations, ranging between 48 and 65 dB. ICU size and layout do not appear to influence noise levels. Elevated daytime noise levels at central stations may result from increased daytime staff and duties. Noise-protective equipment is unnecessary as noise levels do not exceed 85 dB for >8 hours, but noise-reduction strategies should be broadly implemented to improve critical care.
subject: Research Articles
  topic: section
subject: Critical care
  topic: keywords
subject: decibels
  topic: keywords
subject: intensive care
  topic: keywords
subject: noise levels
  topic: keywords
subject: sound levels
  topic: keywords
subject: intensive care
  topic: subjects
subject: sound
  topic: subjects
subject: noise
  topic: subjects
subject: Critical Care
  topic: subjects
subject: Critical care
  topic: disciplines
subject: anaesthesia
  topic: disciplines
subject: perioperative medicine
  topic: disciplines
creator: D Brancato
creator: M Mer
creator: Z Jooma
rights: Copyright (c) 2025 D Brancato, M Mer, Z Jooma https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: e3169
ending page: e3169
doi: 10.7196/SAJCC.2025.v41i3.3169

A retrospective review of advanced life support interfacility transfers of the public sector emergency medical service in the Western Cape Province, South Africa
type: item
description: Background. The need for critical care transfers (CCTs) has increased in recent years owing to the growing prevalence of high-acuity patients who require access to specialised care and/or resources that are not readily available at the facility where they find themselves. During their transfer from one facility to another, critically ill and injured patients commonly require ongoing care, monitoring and interventions that can only be provided by transfer teams with advanced training and appropriate equipment. In South Africa (SA), these transfers are undertaken mainly by advanced life support (ALS) providers with variable amounts of training. Understanding the demographics and needs of CCT patients in specific contexts is essential to inform training and policy. Objectives. To broadly describe the population of adult patients undergoing CCTs facilitated by the public sector emergency medical service (EMS) in the Western Cape Province, South Africa. Patient demographics (age and gender), time intervals (response time, scene time, transfer time), primary diagnosis (respiratory, cardiovascular, gastrointestinal tract, and others), attachments, and clinical or pharmacological interventions. Methods. A retrospective descriptive analysis was conducted on electronic patient care records (ePCRs) logged in the EMS’s Computer-Aided Dispatch (CAD) database from January 2018 to December 2021. As no universal criteria currently exist for distinguishing a CCT from another transfer, our focus was on cases that required ALS care during the transfer. Results. During the study period, 25 635 adult patients underwent ALS transfers, with a nearly equal gender distribution. The median patient age was 40 (range 18 – 101) years. Sixty percent of patients were triaged as orange upon arrival (for urgent management) and the remainder red (for emergency or immediate management). Average response, preparation, and transport times spent (minutes:seconds) were 7:10, 16:58, and 12:56, respectivel…
subject: Research Articles
  topic: section
subject: Patient Transfer
  topic: keywords
subject: Emergency Medical Services
  topic: keywords
subject: South Africa
  topic: keywords
subject: Patient Population
  topic: keywords
subject: Critical Care Transfer
  topic: subjects
subject: Critical Care Retrieval
  topic: subjects
subject: Patient Transfer
  topic: subjects
subject: Emergency Medical Services
  topic: subjects
subject: Patient Population
  topic: subjects
subject: South Africa
  topic: subjects
subject: Emergency Medical Care
  topic: disciplines
subject: Pre-hospital Emergency Medicine
  topic: disciplines
subject: Public Health
  topic: disciplines
subject: Health Systems
  topic: disciplines
subject: Health Professions Education
  topic: disciplines
subject: Healthcare Qaulity
  topic: disciplines
creator: L C van Rensburg
creator: N Majiet
creator: C Vincent-Lambert
creator: W Stassen
rights: Copyright (c) 2025 L C van Rensburg, N Majiet, C Vincent-Lambert, W Stassen https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: e3282
ending page: e3282
doi: 10.7196/SAJCC.2025.v41i3.3182

A survey of doctors’ perspectives on critical laboratory result communication in Cape Town, South Africa
type: item
description: Background. Critical laboratory results indicate that a patient is in imminent danger without timely intervention, and prompt communication can improve patient safety. Our laboratory has been trialling different methods of communication to improve our service, including the patient referral application Vula. Objective. To evaluate clinicians’ perceptions of critical laboratory results reported by the Tygerberg Hospital Chemical Pathology Laboratory in South Africa (SA) at various levels of care to identify current challenges, areas for improvement, and preferred communication methods. Methods. A cross-sectional survey was utilised to explore medical professionals’ perceptions at different levels of health facilities within Cape Town, SA. The electronic survey targeted clinicians employed at the study sites and excluded auxiliary healthcare staff and was distributed from 10 September 2024 to 31 December 2024. The survey collected data on participants’ demographics, experiences, preferences, and expectations regarding critical result communication methods. Results. A total of 76 responses were obtained; 2 were incomplete and excluded. Over half of the respondents had at least 4 years of clinical experience across various disciplines. The majority (n=71, 95.9%) found the communication of critical results to impact patient care. Direct phone calls were favoured by 45.9% (n=34), whereas 44.6% (n=33) preferred mobile methods such as short message service (SMS) or WhatsApp. Conclusion. This study provides insights into clinicians’ perceptions of critical laboratory result reporting in healthcare facilities in Cape Town. The findings will help enhance communication practices and develop a standard operating procedure for the Tygerberg Hospital Chemical Pathology Laboratory.
subject: Research Articles
  topic: section
subject: Laboratory critical results
  topic: keywords
subject: results notification
  topic: keywords
subject: Patient Safety
  topic: keywords
subject: Laboratory critical results
  topic: subjects
subject: Chemical Pathology
  topic: disciplines
creator: A Davids
creator: A Zemlin
creator: E Kruger
rights: Copyright (c) 2025 A Davids, A Zemlin, E Kruger https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: e3259
ending page: e3259
doi: 10.7196/SAJCC.2025.v41i3.3259

The clinical profile of abdominopelvic injury and the determinants of length of stay and mortality in the intensive care unit of a tertiary hospital
type: item
description: Background. Associated with preventable mortality, 50% of abdominopelvic patients require an intensive care unit (ICU). Limited ICU beds in South Africa are significantly impacted by prolonged stays, with 20% of prolonged stays being a result of abdominopelvic injuries. Objective. To describe the clinical profile and the determinants of length of stay and mortality in patients with abdominopelvic injury admitted to a tertiary hospital ICU. Methods. A retrospective analysis of abdominopelvic injury patients admitted to the surgical ICU at Tygerberg Hospital from January 2021 to December 2023. Using REDCap, demographic and clinical profile data were captured from the Electronic Content Management system. Negative binomial and logistic regression models were used to examine the determinants of length of stay and ICU mortality. respectively. Results. Of the 82 eligible participants, 79.3% were male, mean age of 36.5 years (95% confidence interval (CI) 33.8 - 39.1), with isolated abdominal injury accounting for 14.6% of cases. The median length of ICU and hospital stay was 5 days (interquartile range (IQR) 3 - 13), and 19 days (IQR 9 - 40.5), respectively, with age, acute physiology and chronic health evaluation (APACHE II) score, shock index and relook surgery being the key determinants of length of ICU stay. Further to these factors, ICU mortality was associated independently with serum lactate levels (odds ratio 1.37 (95% CI 1.04 - 1.80) with the crude mortality rate (CMR) being 29.3%. Conclusion. The majority of abdominopelvic injuries admitted to the ICU are non-isolated, with age, APACHE II score, shock index and relook surgery key determinants of ICU length of stay. Further, ICU mortality is associated with serum lactate levels. Adequate resuscitation and optimising initial surgery may help reduce patients’ stay in the ICU, and mortality.
subject: Research Articles
  topic: section
subject: APACHE
  topic: keywords
subject: ICU
  topic: keywords
subject: length of stay
  topic: keywords
subject: Abdominopelvic
  topic: keywords
subject: Scoring systems, Severity of illness, Intensive care unit, APACHE-II
  topic: subjects
subject: length of stay
  topic: subjects
subject: ICU
  topic: subjects
subject: mortality rates
  topic: subjects
subject: Critical care
  topic: disciplines
subject: Trauma
  topic: disciplines
creator: Y Kusi-Mensah
creator: T Masuku
creator: R Swai
creator: N Rehman Siddiqui
creator: S Chetty
rights: Copyright (c) 2025 Y Kusi-Mensah, T Masuku, R Swai, N Rehman Siddiqui, S Chetty https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: e3252
ending page: e3252
doi: 10.7196/SAJCC.2025.v41i3.3252

The process of rapid sequence intubation in the prehospital setting: A scoping review
type: item
description: Background. Ensuring that the patient’s airway is secured is one of the essential priorities for emergency care providers in the prehospital setting. Rapid sequence intubation (RSI) intervention allows the administration of induction and paralytic medications that optimise the conditions for insertion of the endotracheal tube. RSI is essential in the management of critically ill patients to address the risks of aspiration of gastric contents and morbidity and premature mortality. Objective. To systematically explore, map, describe, and provide the extent and nature of published research of the most up-to-date evidence-based elements and guidance of RSI in the prehospital setting. Method. This scoping review followed a framework proposed by Arksey and O’Malley and refined by the Joanna Briggs Institute. The following databases were utilised to guide the literature searching process across multiple resources: Scopus, Web of Science and PubMed engines. The articles included were full-text publications written in English, published between 2000 and 2023. A search strategy incorporating different combinations of keywords was developed with the assistance of a librarian. A population, context and concepts (PCC) framework was used to guide the inclusion criteria of identified articles. The selected titles and full-text articles were screened on Rayyan software (Rayyan, USA) and presented on the PRISMA flow diagram. Data were extracted and displayed on an Excel spreadsheet (Microsoft Corp, USA). Concepts were identified, categorised, and grouped into themes through thematic analysis. Results. A total of 2 585 titles and abstracts were screened after duplicates had been removed. Only 138 full-text articles were screened, and 40 articles met eligibility criteria. Categories that were formed from concepts identified were grouped into seven themes, which included: RSI preparations, RSI procedure, training, system requirements, clinical governance, standardisation of RSI, and po…
subject: Review Articles
  topic: section
subject: Prehospital, Rapid Sequence Intubation, Adverse events, safety, checklist, emergency care practitioners.
  topic: keywords
subject: Prehospital, Rapid Sequence Intubation, Adverse events, safety, checklist, emergency care practitioners.
  topic: subjects
subject: Emergency Medical Care
  topic: disciplines
creator: T J Mathobela
creator: N Mshunqane
creator: T S Khoza
rights: Copyright (c) 2025 T J Mathobela, N Mshunqane, T S Khoza https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: e3228
ending page: e3228
doi: 10.7196/SAJCC.2025.v41i3.3228

Clinical decision-making process of healthcare workers when feeding critically ill adults in public sector ICUs in South Africa
type: item
description: Background. Feeding critically ill patients is a complex process because swallowing is heterogeneous, and dysphagia in critically ill patients can have multiple causes. Decisions regarding dysphagia in the critically ill need to be made as a team with all possible outcomes and factors taken into account to ensure the best possible outcomes for patients. However, research has shown that in South Africa (SA), the multidisciplinary team (MDT) approach is not generally used when making decisions around feeding. Objectives. To explore the clinical decision-making (CDM) factors in feeding practices in adults of the MDT in public healthcare intensive care units (ICUs) in Johannesburg, SA. Method. A qualitative design with non-probability purposive sampling was used. There were 15 MDT participants across two tertiary hospitals. Data were derived from observations, focus groups, and individual interviews and analysed using a reflective thematic approach. Results. Three themes were reported on, namely decision-making factors in the ICU by the MDT, non-patient-related factors and the meaning and misconception of the word ‘tolerance’. There are no protocols followed in the ICU and decisions are made on an individual basis. Non-patient- related factors impact the decisions and when the MDT collaborates, it positively influences the CDM process. Different MDT members use the word ‘tolerance’ differently in dysphagia, which needs to be considered. Conclusion. Clinical factors were the primary consideration for all MDT members when selecting a feeding method for critically ill patients. Environmental factors were also considered when adaptations were necessary owing to contextual constraints. The findings indicate that a multidisciplinary approach to feeding is not consistently practised in SA public sector ICUs, and there is no standardised feeding protocol in place. This was evident from the infrequent communication and collaboration among MDT members. Improved interdisciplinary …
subject: Research Articles
  topic: section
subject: swallowing,
  topic: keywords
subject: dysphagia
  topic: keywords
subject: ICU
  topic: keywords
subject: decision-making
  topic: keywords
subject: Dysphagia,
  topic: subjects
subject: swallowing
  topic: subjects
subject: decision making
  topic: subjects
subject: Speech Pathology
  topic: disciplines
subject: Speech Therapy
  topic: disciplines
creator: K Coutts
creator: K Eckmann
rights: Copyright (c) 2025 K Coutts, K Eckmann https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: e2741
ending page: e2741
doi: 10.7196/SAJCC.2025.v41i3.2741

Comment on the “Use of intravenous immunoglobulin for the treatment of severe COVID-19”
type: item
description: -
subject: Correspondence
  topic: section
subject: immunogloblulin
  topic: keywords
subject: covid
  topic: keywords
subject: treatment
  topic: keywords
subject: covid
  topic: subjects
subject: infection
  topic: disciplines
creator: H Daungsupawong
creator: V Wiwanitkit
rights: Copyright (c) 2025 H Daungsupawong, V Wiwanitkit https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: e3107
ending page: e3107
doi: 10.7196/SAJCC.2025.v41i3.3107

Early mobilisation practices in Windhoek intensive care units: A retrospective review of patient profiles and physiotherapy practice
type: item
description: Background. Early mobilisation (EM) is safe and feasible with positive patient outcomes in various settings. However, data from Namibia in southern Africa are lacking, and the status of intensive care unit (ICU)-based mobilisation is unknown. Objectives. To describe the mobility practices and profiles of critically ill patients in ICUs in Windhoek, Namibia. Methods. A retrospective, descriptive record review was conducted in two private hospitals in Windhoek. Data were extracted using a self-designed electronic data abstraction form. The primary outcomes were the profile of ICU patients and documented mobility practices. Secondary outcomes included the timing and frequency of mobilisation, physiotherapy techniques used, and adverse events during physiotherapy. Patients with incomplete datasets or illegible records were excluded. Results. The review included charts of 870 adult patients admitted to the participating ICUs between January and December 2016. Patients were predominantly male (61.8%; n=538), with a mean (standard deviation (SD)) age of 56 (14.9) years. Most admissions were planned (66.3%; n=577), mainly for coronary angiograms (20.6%; n=179), cardiac conditions (13.0%; n=113) and cardiac surgery (10.3%; n=90). The mean (SD) length of ICU stay was 3.41 (3.3) days, and the mean duration of mechanical ventilation was 0.7 (2.1) days. The overall ICU mortality rate was 5.2% (n=45). Of the 870 patients, 352 (40.5%) received physiotherapy, with 345 of these (98.0%) being mobilised. The median (interquartile range) length of ICU stay for mobilised patients was 3 (2 - 5) days, compared with 2 (2 - 3) days for non-mobilised patients (p<0.0001). Adverse events during physiotherapy were rare, occurring in only 5 patients (1.4%). Conclusion. EM is often implemented as part of physiotherapy practice in Windhoek ICUs; however, fewer than half of the patients in this study received physiotherapy, highlighting the need for improved implementation of EM protocols and scree…
subject: Research Articles
  topic: section
subject: Early mobilisation; critical illness; patient profile, acute rehabilitation
  topic: keywords
subject: Critical care
  topic: disciplines
subject: Physiotherapy
  topic: disciplines
subject: Intensive Care
  topic: disciplines
creator: I du Plessis
creator: S Francis
creator: B Morrow
rights: Copyright (c) 2025 I du Plessis, S Francis, B Morrow https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-04
publication date: 2025-09-04
starting page: e2494
ending page: e2494
doi: 10.7196/SAJCC.2025.v412.2494

Beyond survival: Functionality and health-related quality of life among a cohort of ICU survivors 6 months after hospital discharge – a single-centre study in the Eastern Cape Province of South Africa
type: item
description: Background. New or worsened impairments in physical, cognitive and/or psychological health may persist after critical care discharge and impact negatively on survivors’ health-related quality of life (HRQOL), functionality and life roles. Objective. To describe functionality, changes in life roles and HRQOL among an Eastern Cape single-centre cohort of ICU survivors, 6 months after hospital discharge. Methods. The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape and enrolled critically ill patients who required organ support and had an ICU stay for at least 48 hours. Patients were assessed at 6 weeks and 6 months post hospital discharge. The Lawton’s Instrumental Activities of Daily Living (IADL) score and employment/educational status were determined. The Rand Short Form- 36 HRQOL questionnaire’s physical and mental component scores (PCS and MCS) were used to determine quality of life at baseline and study visits. Results. A total of 107 patients with a median age of 42, half of whom had COVID-19, completed the 6-month follow-up. At the 6-month follow-up, 17.5% of previously non-frail patients were still unable to complete at least two IADLs, and 24.3% one IADL. Overall, 34% had not returned to their life roles of home making, studying or remunerative work due to ill-health. At 6 months, 58.9% and 62.6% had significantly lower mean PCS and MCS scores, respectively. Overall, 62.6 % of survivors had either a significantly lower PCS and/or MCS at 6 months. Conclusion. This relatively young cohort of ICU survivors, with minimal previous comorbidities, demonstrated a high incidence of significantly lower HRQOL scores at the 6-month follow-up, affecting 6 out of every 10 patients. The proportion of patients who were unable to complete all IADLs at follow-up, explains the reported changes in relation to life roles, including remunerative employment. These findings have implications for the introduction or reengineering of rehabilitation resource…
subject: Research Articles
  topic: section
subject: critical care, health-related quality of life, activities of daily living, functionality, return to work, Post ICU Syndrome
  topic: keywords
subject: critical care, health-related quality of life, activities of daily living, functionality, return to work, Post ICU Syndrome
  topic: subjects
subject: Critical Care
  topic: disciplines
creator: E van der Merwe
creator: L Stroud
creator: G Sharp
creator: N van Vuuren
creator: M Mosola
creator: T Fodo
creator: F Paruk
rights: Copyright (c) 2025 E van der Merwe, L Stroud, G Sharp, N van Vuuren, M Mosola , T Fodo, F Paruk https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-23
publication date: 2025-09-23
starting page: e2940
ending page: e2940
doi: 10.7196/SAJCC.2025.v412.1906

Classification and predictive models using supervised machine learning: A conceptual review
type: item
description: Supervised machine learning models (SMLMs) are likely to be a prevalent approach in the literature on medical machine learning. These models have considerable potential to improve clinical decision-making through enhanced prediction and classification. In this review, we present an overview of SMLMs. We provide a discussion of the conceptual domains relevant to machine learning, model development, validation, and model explanation. This discussion is accompanied by clinical examples to illustrate key concepts.
subject: Research Articles
  topic: section
subject: Supervised machine learning
  topic: keywords
subject: Prediction
  topic: keywords
subject: Classification
  topic: keywords
subject: critical care
  topic: keywords
subject: machine learning
  topic: subjects
subject: classification
  topic: subjects
subject: medicine
  topic: subjects
subject: prediction
  topic: subjects
subject: Machine learning
  topic: disciplines
subject: Data science
  topic: disciplines
subject: medicine
  topic: disciplines
subject: critical care
  topic: disciplines
creator: M A Pienaar
creator: K Naidoo
rights: Copyright (c) 2025 M A Pienaar, K Naidoo https://creativecommons.org/licenses/by-nc/4.0
date: 2025-05-19
publication date: 2025-05-19
starting page: e2937
ending page: e2937
doi: 10.7196/SAJCC.2025.v411.2937

Ventilation distribution in mechanically ventilated children in response to positioning: An exploratory study
type: item
description: Background. Traditionally, it was understood that children universally show greater ventilation of the non-dependent lung. Recent studies have questioned the understanding of ventilation distribution patterns in the paediatric population. There are no studies examining the effect of body position in mechanically ventilated infants/children. Objectives. To determine the effect of body position on regional ventilation distribution in mechanically ventilated children. Methods. Thoracic electrical impedance tomography (EIT) measurements were taken in left- and right-side lying, supine and prone positions in mechanically ventilated infants/children. Functional EIT images were produced, and regional relative tidal impedance (ΔZ) in the left, right, ventral and dorsal lung regions was calculated. The proportion of ventilation occurring in large lung regions and regional filling were also calculated. Results. Seventeen children (n=8; 47% male) aged 6 months - 6 years are presented. Many of the children (n=8; 47%) consistently showed greater ventilation in the right lung in both side-lying positions, and in the dorsal lung region (n=6; 35%) in both the supine and prone positions. Regional filling was similar between lung regions in the different body positions. Conclusion. Ventilation distribution in mechanically ventilated infants/children with mild lung disease is variable and similar to that of healthy spontaneously breathing infants/children.
subject: Research Articles
  topic: section
subject: Mechanical ventilation
  topic: keywords
subject: ventilation distribution
  topic: keywords
subject: body position
  topic: keywords
subject: paediatrics
  topic: keywords
subject: Electrical Impedance Tomography
  topic: keywords
subject: Paediatric critical care
  topic: subjects
subject: Mechanical Ventilation
  topic: subjects
subject: ventilation distribution
  topic: subjects
subject: EIT
  topic: subjects
subject: Physiotherapy
  topic: disciplines
subject: Paediatric Critical Care
  topic: disciplines
creator: A Lupton-Smith
creator: A Argent
creator: B Morrow
rights: Copyright (c) 2025 A Lupton-Smith, A Argent, B Morrow https://creativecommons.org/licenses/by-nc/4.0
date: 2025-05-19
publication date: 2025-05-19
starting page: e2885
ending page: e2885
doi: 10.7196/SAJCC.2025.v41i1.2885

Critical Care Congress 2024
type: item
description: -
subject: Abstracts
  topic: section
subject: abstracts
  topic: keywords
creator: B Morrow
rights: Copyright (c) 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-11-25
publication date: 2024-11-25
starting page: e2875
ending page: e2875
doi: 10.7196/

Making sense of the outcome of a rehabilitation implementation trial in the intensive care unit: Mixed methods
type: item
description: Background. Evidence for implementation of evidence-based protocols (EBPs) in resource-constrained intensive care units (ICUs) is sparse. Objectives. To evaluate a tailored best-practice multifaceted strategy for implementation of a validated physiotherapy EBP for the management of surgical ICU (SICU) patients. Also, to explore the physiotherapists’ perceptions regarding the implementation process and factors affecting protocol adherence, guided by the Consolidated Framework for Implementation Research. Methods. A type 2 hybrid implementation study design was applied, including all adult patients admitted over 16 months to two (control and experimental) SICUs in Western Cape Province, South Africa. The physiotherapists eligible to participate in the qualitative study (N=17) were those who participated in the implementation process and worked in the experimental SICU. The Therapeutic Index Scoring System-28 (TISS-28) and four process of care indicators (POCIs) were the primary and secondary outcomes, respectively, both analysed in Stata version 15. Thematic content analysis of textual data generated physiotherapists’ perceptions of the implementation process. Results. The intervention strategy did not result in protocol adherence, with no significant difference (p>0.05) in TISS-28 and POCI outcomes during and after implementation in the experimental unit and all phases of the control. Physiotherapists (71%; n=12/17) perceived that the process affected their thinking and clinical decision-making, but not the organisation of physiotherapy services, except for a more multidisciplinary approach to care in the experimental unit. Organisational factors (time constraints, workload/flow barriers) affected adherence, explaining the lack of practice change. Conclusion. The importance of organisational change and support of the physiotherapy departments providing services to ICUs while also addressing the healthcare needs of a diverse group of hospitalised patients is highlight…
subject: Research Articles
  topic: section
subject: implementation
  topic: keywords
subject: multifaceted strategy
  topic: keywords
subject: physiotherapy protocol
  topic: keywords
subject: surgical ICU
  topic: keywords
subject: process of care
  topic: keywords
subject: TISS-28
  topic: keywords
subject: South Africa
  topic: keywords
subject: Adult critical care
  topic: subjects
subject: Implementation Science
  topic: subjects
subject: Physiotherapy protocol implementation
  topic: subjects
subject: surgical intensive care
  topic: subjects
subject: physiotherapy
  topic: disciplines
subject: intensive care
  topic: disciplines
subject: implementation science
  topic: disciplines
creator: F Karachi
creator: J J Maritz
creator: T M Esterhuizen
creator: R Gosselink
creator: S D Hanekom
rights: Copyright (c) 2025 F Karachi, J J Maritz, T M Esterhuizen, R Gosselink, S D Hanekom https://creativecommons.org/licenses/by-nc/4.0
date: 2025-05-19
publication date: 2025-05-19
starting page: e2695
ending page: e2695
doi: 10.7196/SAJCC.2695.v41i1.2695

Evaluating complications in a South African neurocritical care unit: A 1-year retrospective audit
type: item
description: Background. The benefits of setting up a dedicated neurocritical care unit (NCCU) for critically ill neurological patients are well documented. These units are specifically designed to care for individuals with conditions affecting the brain and spine. However, complications particular to these units in low- and middle-income countries are not widely reported. Objectives. To describe the complications observed in an NCCU at a tertiary-level academic hospital over the course of 1 year and examine their link with intensive care unit (ICU) length of stay (LOS) and mortality rates. Methods. The study involved retrospective analysis of complications experienced by critically ill neurological patients admitted to the NCCU between 1 January and 31 December 2020, according to the NCCU patient data registry. Results. A total of 850 patients, most of whom were male (61.2% in the high-care unit (HCU) and 68.1% in the ICU), were admitted to the NCCU, with a median age of 43 years and 41 years in the HCU and the ICU, respectively. The overall rate of complications was 38.2% (n=325/850 patients). Statistically significant complications (p<0.05) included metabolic and electrolyte imbalances, infections (including ventilator-associated pneumonia, surgical site infections and central line-associated bloodstream infections), and deep-vein thrombosis. The most common complication was metabolic disturbances (28.2%), particularly sodium homoeostasis abnormalities. The number of complications significantly affected NCCU LOS (p<0.001), but did not have a statistically significant impact on mortality (p=0.067). Conclusion. Complications occurred in 38.2% of critically ill neurological patients in a specialised NCCU in a tertiary-level academic hospital in South Africa, primarily involving electrolyte disturbances and infections. These complications were linked to longer LOS in the ICU, but did not significantly increase the risk of mortality.
subject: Research Articles
  topic: section
subject: Neuro-critical care, Complications, neurosurgery
  topic: keywords
subject: Neurocritical care
  topic: subjects
subject: neurosurgery
  topic: subjects
subject: complications
  topic: subjects
subject: Critical care
  topic: disciplines
subject: Neurosurgery
  topic: disciplines
creator: B A Kgaodi
creator: C Arnold-Day
creator: S Linde
creator: P Semple
rights: Copyright (c) 2025 B A Kgaodi, C Arnold-Day, S Linde, P Semple https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-23
publication date: 2025-09-23
starting page: e1896
ending page: e1896
doi: 10.7196/SAJCC.2025.v412.1896

Validating the Measure of Processes of Care for Service Providers (MPOC-SP(A)) tool in adult intensive care units
type: item
description: Background. The Measures of Process of Care for Service Providers (MPOC-SP(A)) tool, developed by the CanChild Centre for Childhood Disability Research in Canada, assesses service providers’ perceptions of family-centred care (FCC) in adult rehabilitation. It consists of 27 items categorised into four domains: ‘showing interpersonal sensitivity’, ‘providing general information’, ‘communicating specific information’, and ‘treating people respectfully’. Each domain encompasses a distinct aspect of family-centred care applicable in the intensive care unit (ICU). An earlier version of the tool was previously validated for use in neonatal ICUs. However, this tool has not been validated for use in adult ICUs. Objective. To validate the content validity index of the MPOC-SP(A) tool for healthcare professionals working in adult ICUs in South Africa. Method. Following approval from the Human Research Ethics Committee, a multidisciplinary group of experienced ICU healthcare professionals was invited to review the MPOC-SP(A) tool, rating each item’s relevance on a four-point scale to avoid neutrality. The content validity index (CVI) was calculated for each item (I-CVI) and domain (S-CVI/Ave) using Microsoft Excel. An I-CVI of 0.83 and S-CVI/Ave of 0.9 were deemed acceptable. Items with a CVI below 0.83 were discarded. Results. The scale-level CVI (S-CVI/Ave) for every domain was 0.9 and above, which is acceptable. Two items in domain A and one item in domain B were deleted owing to low I-CVI values. Two items were revised to improve the item’s clarity. Thus, a 24-item MPOC-SP(A) tool applicable to adult ICUs was generated following the content validity analysis. Conclusion. The content experts’ assessment of the instrument’s items is essential to ensure its validity. This study has finalised the content validation process of the MPOC-SP(A) tool for use in the adult ICU. The refined tool is now ready for the next phase of validation focusing on construct and internal consisten…
subject: Research Articles
  topic: section
subject: South Africa
  topic: keywords
subject: intensive care
  topic: keywords
subject: validation studies as Topic
  topic: keywords
subject: Validation Studies as a Topic
  topic: subjects
subject: Family-Centred Care
  topic: subjects
subject: Intensive Care Unit
  topic: subjects
subject: Critical Care Medicine
  topic: disciplines
subject: Intensive Care
  topic: disciplines
creator: C O N Oghenetega
creator: S Chetty
rights: Copyright (c) 2025 C O N Oghenetega, S Chetty https://creativecommons.org/licenses/by-nc/4.0
date: 2025-05-19
publication date: 2025-05-19
starting page: e2662
ending page: e2662
doi: 10.7196/SAJCC.2025.v411.2662

Shock epidemiology and outcomes among internal medicine patients
type: item
description: Background. Shock, characterised by circulatory hypoperfusion and cellular hypoxia, represents a critical medical condition requiring immediate attention. Despite its significance, there are limited data on shock incidence and outcomes, particularly within the context of Thailand. Objectives. This retrospective observational study aimed to investigate the incidence, management and outcomes of shock patients admitted to the internal medicine department of Siriraj Hospital, a referral university hospital in Bangkok, Thailand. Additionally, the study sought to identify factors associated with mortality among these patients. Methods. Medical records of patients admitted were reviewed. Shock cases were identified based on specific diagnostic criteria, and demographic and clinical data were extracted for analysis. Results. A total of 125 patients were included in the study, with septic shock being the most prevalent condition (40.0%), followed by cardiogenic shock (39.2%), hypovolaemic shock (18.4%) and obstructive shock (2.4%). The overall intensive care unit (ICU) admission rate was 46.7%, varying among shock types, with cardiogenic shock patients exhibiting the highest rate. The overall 28-day mortality rate was 23.7%, with septic shock patients admitted to the ICU demonstrating the highest mortality rate (50.0%). The multivariate analysis identified factors associated with mortality, including colloid resuscitation (adjusted odds ratio (aOR) 3.10 (1.08 - 8.9), p=0.036); vasopressor dose of more than 0.2 μg/kg/min (aOR 4.38 (1.39 - 13.74), p=0.011); and renal replacement therapy (aOR 3.43 (1.04 - 11.28), p=0.043). Conclusions. This study provides significant insights into shock incidence, management and outcomes in a tertiary referral hospital in Thailand. It also highlights challenges related to ICU bed availability and identifies predictors of mortality. Early recognition and tailored interventions are crucial for improving outcomes in shock patients.
subject: Research Articles
  topic: section
subject: cardiogenic shock
  topic: keywords
subject: hypovolaemic shock
  topic: keywords
subject: septic shock
  topic: keywords
subject: internal medicine
  topic: subjects
subject: cardiogenic shock
  topic: subjects
subject: septic shock
  topic: subjects
subject: hypovolaemic shock
  topic: subjects
subject: intensive care unit
  topic: subjects
subject: critical care medicine
  topic: disciplines
subject: internal medicine
  topic: disciplines
creator: C Maluangnon
creator: B Joyjumroon
creator: C Phawanawichian
creator: S Tongyoo
rights: Copyright (c) 2025 C Maluangnon, B Joyjumroon, C Phawanawichian, S Tongyoo https://creativecommons.org/licenses/by-nc/4.0
date: 2025-05-19
publication date: 2025-05-19
starting page: e2453
ending page: e2453
doi: 10.7196/SAJCC.2025.v41i1.2453

Ventilator-associated pneumonia rates in a level I trauma intensive care unit in KwaZulu-Natal Province, South Africa, compared with international benchmarks
type: item
description: Background. Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critically ill patients in intensive care units (ICUs) worldwide. Despite the huge healthcare economic burden and the significant negative morbidity and mortality impact of VAP, its incidence and outcomes in the trauma ICU (TICU) population were poorly documented in South Africa (SA). Objectives. To determine the incidence of VAP in a level I trauma centre at Inkosi Albert Luthuli Central Hospital in Durban, SA, compared with international benchmarks. Determining mortality rates, the average length and cost of ICU stay, ventilator days and antibiotic consumption was a secondary objective. Methods. This retrospective chart review of the trauma registry at the centre examined the incidence of VAP and secondary outcomes over the period January 2017 - December 2019. A data pro forma was used with VAP diagnoses as per the 2015 Centers for Disease Control and Prevention definitions. The comparator was international literature-based benchmark VAP rates in TICUs. Results. The study included 395 patients, of whom 143 (36.2%) were diagnosed with VAP. The VAP rate was calculated to be 35.6 per 1 000 ventilator days. Thirty-one patients with VAP (21.7%) died in the ICU, a similar figure to that for the non-VAP group (22.6%). There were no statistically significant differences in age, sex, mechanism of injury or Injury Severity Score between the VAP and non-VAP groups (p>0.05). There were statistically significant differences between the two groups in number of days on mechanical ventilation, ICU length of stay and ICU cost. The VAP group had a median of 12 ventilation days v. 5 days for the non-VAP group (p<0.001), and spent a median of 7 days longer in the ICU (p<0.001). The median cost of ICU stay for VAP patients was almost double that for non-VAP patients (p<0.001). Conclusion. VAP rates in this local TICU were similar to international rates. Trauma patients, especially those with traumati…
subject: Research Articles
  topic: section
subject: benchmark; vap; trauma; icu; outcome
  topic: keywords
creator: B Ngxabi
creator: T C Hardcastle
rights: Copyright (c) 2024 B Ngxabi, T C Hardcastle https://creativecommons.org/licenses/by-nc/4.0
date: 2024-11-25
publication date: 2024-11-25
starting page: e1967
ending page: e1967
doi: 10.7196/SAJCC.2024.v40i3.1967

Emergency care capacity of private primary healthcare facilities in Gauteng, South Africa
type: item
description: Background. Strengthening emergency care at the primary healthcare (PHC) level has been identified as a strategy for improving the emergency care system, which should include the private sector as well. As the National Health Insurance Act will soon come into effect, more non-medical aid users are expected to access private healthcare facilities. There is a great need for further assessment of the emergency care capacity at private primary healthcare facilities. Objective. To use a standardised facility-based assessment tool to assess if private PHC facilities in Gauteng have the capacity to deliver emergency care services using the HEAT (Hospital Emergency Unit Assessment Tool). Method. The Hospital Emergency Unit Assessment Tool (HEAT) – a standardised tool – was used for quantitative description of the critical functions and structure of an emergency unit (EU) at any facility level of PHC facilities in a private healthcare group. Results. More than half (n/N=10/19) of the facilities participated in the study. Facilities demonstrated adequate equipment, resources and staffing for basic emergency care despite a lack of specific skills and specialised protocols. Conclusion. All private primary healthcare facilities met the listed infrastructure and essential equipment requirements for emergency care, including a resuscitation area; however, none of the facilities had an area specifically for triage. Common barriers to performing emergency care procedures across most facilities were due to a lack of training in emergency protocols and procedures.
subject: Research Articles
  topic: section
subject: emergency care
  topic: keywords
subject: capacity
  topic: keywords
subject: primary health care
  topic: keywords
subject: Emergency care
  topic: subjects
subject: capacity
  topic: subjects
subject: primary health care
  topic: subjects
subject: capacity assessment
  topic: subjects
subject: emergency care
  topic: disciplines
creator: M Cluff
creator: M L Botes
rights: Copyright (c) 2025 M Cluff, M L Botes https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-04
publication date: 2025-09-04
starting page: e2067
ending page: e2067
doi: 10.7196/SAJCC.2025.v412.2067

Validation of the APACHE‐II scoring system in critically ill patients diagnosed with COVID‐19 and admitted at a regional‐level hospital intensive care unit: A retrospective study
type: item
description: Background. The use of the Acute Physiology and Chronic Health Evaluation II (APACHE-II) scoring system to predict mortality in the intensive care unit (ICU) has not been validated for use in the coronavirus-19 (COVID-19) pandemic in the South African context. Objectives. To provide data on the outcomes and clinical characteristics of ICU patients in a regional hospital diagnosed with COVID-19. The primary objective was to measure the validity of the APACHE-II scoring system in predicting mortality in these patients. Secondary objectives included the description of clinical characteristics, potential risk factors for mortality and length of ICU stay. Methods. This study was a single-centre, retrospective, observational cohort study conducted from 2020 to 2022. Data were obtained from electronic databases and patient records to determine diagnosis of COVID-19, demographics, comorbidities, history, clinical parameters and patient outcome. A receiver operating characteristic (ROC) analysis was performed to assess the discriminative power of the APACHE-II score in predicting mortality. Results. A total of 96 patients with confirmed COVID-19 diagnoses had sufficient data to calculate the APACHE-II score. The observed in-hospital mortality was 57.3%, while the APACHE-II score predicted a mortality of 25%. An ROC analysis showed poor discrimination (area under the ROC curve 0.58). Patients who had increased odds of death were those with increased age: odds ratio (OR) 1.01 (confidence interval (CI) 1.00 - 1.02), and those who were peripartum: OR 4.35 (CI 1.06 - 29.30). Other factors were not significantly associated with mortality. The median (interquartile range) length of hospital stay was 5.00 (4.00 - 9.25) days. Conclusion. The APACHE-II scoring system is a poor discriminator between death and survival in this cohort of COVID-19 ICU patients. ICU patients who were diagnosed with COVID-19 were more likely to die despite a relatively low APACHE-II score. Information regar…
subject: Research Articles
  topic: section
subject: COVID-19
  topic: keywords
subject: critical care
  topic: keywords
subject: APACHE
  topic: keywords
subject: mortality
  topic: keywords
subject: South Africa
  topic: keywords
subject: Critical care
  topic: disciplines
subject: anaesthesia
  topic: disciplines
creator: Y-C Chang
creator: J Invernizzi
creator: T Mcizana
rights: Copyright (c) 2025 Y-C Chang, J Invernizzi, T Mcizana https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-23
publication date: 2025-09-23
starting page: e1522
ending page: e1522
doi: 10.7196/SAJCC.2025.v412.1522

Factors influencing knowledge translation into critical care practice: The reality facing intensive care nurses in Limpopo Province
type: item
description: Background. Nurses working in intensive care units (ICUs) must incorporate new knowledge and evidence-based practice (EBP) into their daily routines to enhance patient outcomes. However, this integration often falls short in ICU settings. Weekly clinical audits reveal incidents where ICU nurses neglect evidence-based interventions, impacting patient outcomes and ICU stays. Objective. To explore the factors influencing the translation of knowledge into ICU practice. Methods. We conducted exploratory, qualitative research to investigate ICU nurses’ perspectives on knowledge translation into ICU practices. The study employed purposive sampling to select ICU nurses. We used paired interviews and group discussions to gather insights from ICU nurses regarding the factors influencing the translation of knowledge into ICU practices. Data analysis was performed using Boomer and McCormack’s nine steps of creative hermeneutic data analysis. Results. One main theme, ‘We are just surviving’ emerged, encompassing two sub-themes: management and workplace culture. Under management, participants described barriers, such as resource scarcity, behaviour, outdated evidence-informed protocols and workload. Under workplace culture, participants mentioned negative attitudes and a lack of teamwork, contributing to poor-quality care. Conclusion. In ICUs, nurses are expected to integrate new knowledge and scientific evidence into their daily practice, yet they face challenges in doing so. Interventions should be implemented to address management and workplace culture.
subject: Research Articles
  topic: section
subject: knowledge translation
  topic: keywords
subject: evidence based practice
  topic: keywords
subject: intensive care unit
  topic: keywords
creator: M R Kgadima
creator: I M Coetzee
creator: T Heyns
rights: Copyright (c) 2024 M R Kgadima, I M Coetzee, T Heyns https://creativecommons.org/licenses/by-nc/4.0
date: 2024-07-17
publication date: 2024-07-17
starting page: e1282
ending page: e1282
doi: 10.7196/SAJCC.2024.v40i2.1282

Critical pertussis infection in the paediatric intensive care unit: A case series in an outbreak
type: item
description: Background. Bordetella pertussis is a highly infectious disease associated with increased mortality in young infants. Critical pertussis is defined as pertussis disease resulting in paediatric intensive care unit admission or death. Objective. This study describes the clinical profile, morbidity, mortality and management of children with critical pertussis admitted to a South African paediatric intensive care unit (PICU). Study design. A retrospective analysis of children with critical pertussis admitted to the PICU over 1 year (January 2022 - December 2022). Results. There were 1 273 PICU admissions during the study period, of which 101 (7.9%) were tested and 19 (1.5%) tested positive for B. pertussis. Of those, 13 (68.4%) were completely unimmunised, mainly owing to young age (n=9). The median (interquartile range) total duration of ventilation was 7.0 (3.0 - 21.0) days, with a maximum of 35 days. Mortality was 36.8% (n=7) in those with B. pertussis; with more deaths in HIV-exposed patients (n=3/7,42.9% v. n=3/12, 25%; p<0.001) and preterm infants (n=4/7,57.1% v. n=4/12, 33.3%; p<0.001), as well as those with septic shock (n=7/7, 100% v. n=4/7, 33.3%; p = 0.02) and acute kidney injury (n=6/7, 85.7% v. n=2/12, 16.7%; p<0.001). The maximum white cell count was significantly lower in survivors (27.75 v. 76.32; p<0.001). None of the variables was independently associated with mortality on multivariable regression. Conclusion. Critical B. pertussis infection is associated with significant morbidity and mortality in this setting. The low rate of vaccination is a concern, and advocacy is needed to promote access to vaccination during the third trimester of pregnancy as well as strengthening current immunisation programmes. Further research is required to identify the prevalence of critical pertussis and risk factors for poor outcomes in resource-limited settings.
subject: Research Articles
  topic: section
subject: bordetella pertussis
  topic: keywords
subject: critical pertussis
  topic: keywords
subject: PICU outcomes
  topic: keywords
subject: critical pertussis
  topic: subjects
subject: PICU
  topic: subjects
subject: PICU
  topic: disciplines
creator: H Crichton
creator: N Nkado
creator: S Salie
creator: C Procter
rights: Copyright (c) 2025 H Crichton, N Nkado, S Salie, C Procter https://creativecommons.org/licenses/by-nc/4.0
date: 2025-05-19
publication date: 2025-05-19
starting page: e2049
ending page: e2049
doi: 10.7196/SAJCC.2025.v41i1.2049

Association between serum procalcitonin levels and outcomes of patients admitted to two tertiary paediatric intensive care units in Bloemfontein: A retrospective analytical study
type: item
description: Background. Procalcitonin (PCT) is used in the diagnosis of sepsis. Its capability as a prognostic marker is unclear. The association between PCT and paediatric intensive care unit (PICU) outcomes has not been investigated in the South African setting. Objectives. To determine the association between admission PCT, and trends within 72 hours of admission, and outcomes of patients admitted to the PICU at two tertiary academic hospitals. Methods. The study was a two-year, double centre, retrospective, analytical cross-sectional medical record review. Results. A total of 381 participants were included in the study; 55 died and 220 required mechanical ventilation. Non-survivors had a higher median admission PCT than survivors (p<0.0001, 95% confidence interval (CI) 1.28 - 15.12). Non-survivors had a higher median PCT at 48 - 72 hours than survivors (p<0.0001, 95% CI 2.50 - 21.72). Non-survivors had less of a median decrease in PCT than survivors (p=0.22, 95% CI -0.59 - 4.72). The area under the receiver operating characteristics curve (AUROCC) for admission PCT to discriminate for mortality was 0.6702 and for the 48 - 72 hour PCT it was 0.7369. There was a positive correlation between PCT and number of ventilator days (Spearman correlation co-efficient =0.1477, p=0.0138). There was no correlation between the length of PICU stay and admission PCT (p=0.7579) or PCT change (p=0.2034). Conclusion. Single PCT measurements display some ability to discriminate for PICU mortality. Serial PCT measurements provide greater prognostic information. Non-survivors had a significantly greater median admission PCT, median PCT at 48 - 72 hours and a lower median PCT decrease than survivors.
subject: Research Articles
  topic: section
subject: Biomarkers
  topic: keywords
subject: Procalcitonin
  topic: keywords
subject: Mortality
  topic: keywords
subject: PICU
  topic: keywords
subject: Paediatric Critical Care
  topic: disciplines
creator: A M Luyo Sanchez
creator: M A Pienaar
rights: Copyright (c) 2025 A M Luyo Sanchez, M A Pienaar https://creativecommons.org/licenses/by-nc/4.0
date: 2025-05-19
publication date: 2025-05-19
starting page: e2247
ending page: e2247
doi: 10.7196/SAJCC.2025.v41i1.2247

A profile of children with traumatic brain injury admitted to the paediatric intensive care unit of Red Cross War Memorial Children’s Hospital in Cape Town, South Africa, between 2015 and 2019
type: item
description: Background. Paediatric traumatic brain injury (TBI) is a public health problem with high morbidity and mortality. Objectives. To highlight risk factors and describe associated morbidity and mortality of children admitted with TBI to the Paediatric Intensive Care Unit (PICU) at Red Cross War Memorial Children’s Hospital, Cape Town. Methods. We retrospectively documented the hospitalisation of all children with TBI admitted into our PICU between 2015 and 2019. Results. Of 320 children identified, 314 were enrolled: 267 (85%) had severe TBI (Glasgow Coma Scale (GCS) ≤8), 36 (11.5%) moderate TBI (GCS 9 - 12) and 11 (3.5%) mild TBI (GCS ≥13). Median age was 6.5 (interquartile range (IQR) 3.5 - 8.9) years; 194 (61.8%) were male. Motor vehicle collisions accounted for 75% (235) of injuries. Two hundred and seventy-nine (88.9%) children were invasively ventilated for a median of 4.5 (IQR 1 - 8) days; 13.9% (38/273) had a failed extubation and 10.8% (30/277) required tracheostomies. One hundred and sixty-three children (52.2%, n=312) had intracranial pressure monitoring. Almost a third (81/257) required vasopressor support. Approximately 40% (113/286) developed trauma-related seizures; 15.4% (44/286) required a thiopentone infusion and 6% (17/280) a decompressive craniectomy. Common complications were as follows: 12.2% developed post-extubation stridor (34/279), 10.5% a hemiparesis (33/314) and 6.4% diabetes insipidus (19/298). Median PICU stay was 4 (IQR 1 - 10) days, and hospitalisation 11 (IQR 5 - 21) days. Ninety-three (29.6%) children were transferred for further rehabilitation; 38 (12.1%) died. Conclusion. Children admitted to our PICU with TBI had considerable morbidity and mortality, but this is a marked improvement since the 1990s. Enhanced primary preventive strategies, especially for motor vehicle collisions, are imperative to prevent TBI in children.
subject: Research Articles
  topic: section
subject: traumatic brain injury
  topic: keywords
subject: Paediatric TBI
  topic: keywords
subject: Children
  topic: keywords
subject: Morbidity
  topic: keywords
subject: Mortality
  topic: keywords
subject: traumatic brain injury
  topic: subjects
subject: Children
  topic: subjects
subject: Morbidity and mortality
  topic: subjects
subject: Severe TBI
  topic: subjects
subject: Paediatric Critical Care
  topic: disciplines
subject: neurosurgery
  topic: disciplines
subject: Trauma
  topic: disciplines
subject: Paediatrics
  topic: disciplines
creator: E Du Plooy
creator: S Salie
creator: A A Figaji
rights: Copyright (c) 2024 E Du Plooy, S Salie, A A Figaji https://creativecommons.org/licenses/by-nc/4.0
date: 2024-11-25
publication date: 2024-11-25
starting page: e2212
ending page: e2212
doi: 10.7196/SAJCC.2024.v40i3.2212

Professor Mochichi Samuel (Sam) Mokgokong
type: item
description: -
subject: Obituary
  topic: section
subject: obit
  topic: keywords
creator: G Richards
rights: Copyright (c) 2024 G Richards https://creativecommons.org/licenses/by-nc/4.0
date: 2024-04-23
publication date: 2024-04-23
starting page: e2156
ending page: e2156
doi: 10.7196/SAJCC.2024.v40i1.2156

Relevance and application of clinical practice guidelines in different settings
type: item
description: -
subject: Editorial
  topic: section
subject: clinical practice guidelines
  topic: keywords
creator: R Blaauw
rights: Copyright (c) 2024 R Blaauw https://creativecommons.org/licenses/by-nc/4.0
date: 2024-04-23
publication date: 2024-04-23
starting page: e2155
ending page: e2155
doi: 10.7196/SAJCC.2024.v40i1.2155

Outcomes of HIV-exposed infected and HIV-exposed uninfected children admitted to two paediatric intensive care units in South Africa: A retrospective analytical cohort study
type: item
description: Background. Reduced vertical transmission of HIV has led to an increased proportion of HIV-exposed uninfected children (HEU) in South Africa. Increased infective morbidity and mortality creates a need to better understand outcomes and morbidity in this population. Objectives. To describe and compare critical care outcomes in terms of survival and disease severity between HIV-unexposed children (HUU), HIV-exposed infected children (HEI) and HEU. Methods. A retrospective analytical cohort study was carried out from 1 January 2017 to 31 December 2021. Paediatric intensive care unit admissions of children aged 1 month - 5 years were included. Outcomes for HEU and HEI were compared with those of HUU, with a significance threshold set at p=0.05. Multivariate logistic regression analysis was conducted. Results. Of 1 015 children, 633 (62.4%) were HUU, 318 (31.3%) were HEU and 64 (6.3%) were HEI. Mortality was higher in HEU (15.8%; p=0.1) and HEI (17.2%; p=0.4) compared with HUU (11.4%), but this was not statistically significant. HEU and HEI were younger (p<0.001) and more frequently underweight (p<0.001). HEU (and HEI) had an increased risk of acute kidney injury (AKI) (odds ratio 1.19; 95% confidence interval 1.07 - 1.81; p=0.014) and a lower minimum estimated glomerular filtration rate (p<0.001) compared with HUU. Septic shock was more frequent in HEU (28.6%; p=0.001) and HEI (43.8%; p<0.001) compared with HUU (20.1%). HEI had more frequent mechanical ventilation (p=0.003), more prolonged mechanical ventilation (p<0.001) and lower admission haemoglobin concentrations (p<0.001) than HUU. Conclusion. Compared with HUU, both HEU and HEI demonstrated a trend towards increased mortality, but this was not statistically significant. HEU and HEI experienced increased AKI and other morbidity.
subject: Research Articles
  topic: section
subject: HIV
  topic: keywords
subject: HEU
  topic: keywords
subject: PICU
  topic: keywords
subject: Outcomes
  topic: keywords
subject: HIV
  topic: subjects
subject: HEU
  topic: subjects
subject: Outcomes
  topic: subjects
subject: PICU
  topic: subjects
subject: Paediatric Critical Care
  topic: disciplines
creator: M van der Merwe
creator: J B Sempa
creator: M A Pienaar
rights: Copyright (c) 2025 M van der Merwe, J B Sempa, M A Pienaar https://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-04
publication date: 2025-09-04
starting page: e1825
ending page: e1825
doi: 10.7196/SAJCC.2025.v412.1825

Bed occupancy and nosocomial infections in the intensive care unit: A retrospective observational study in a tertiary hospital
type: item
description: Background. Healthcare-associated infections (HAI) are a major problem globally, contributing to prolonged hospital admissions and poor outcomes. Objective. To examine HAI incidence and risk factors in an intensive care unit (ICU) during high v. low occupancy periods. Methods. This retrospective, descriptive analysis investigated HAI incidence among adult patients admitted to the ICU at Chris Hani Baragwanath (CHBH) during a high (H2019) and low (L2020) occupancy. Data were extracted from the clinical records of 440 eligible patients. Results. We found an increased risk of HAI during H2019 compared with L2020 (relative risk (RR) 1.42, 95% confidence interval (CI) 1.03 - 1.94). The overall frequency density of HAI was 25/1 000 ICU days. There was no difference in the distribution of the site of infection (blood v. other) (p=0.27) or bacterial category (Gram stain) (p=0.62). Five organisms accounted for 89% of pathogens: Klebsiella (26%), Staphylococcus (21%), Acinetobacter (16%), Candida (16%) and Enterobacter (10%). The incidence of multidrug-resistant/extensively drug-resistant (MDR/XDR) organisms was 4.2-fold higher (95% CI 1.3 - 13.4) during H2019 compared with L2020. Logistic regression analysis revealed two independent predictors of nosocomial infection: ICU length of stay (odds ratio (OR) 1.12, 95% CI 1.02 - 1.22) and intercostal drain duration in days (OR 1.27, 95% CI 1.09 - 1.47). Conclusion. High occupancy in the ICU was associated with an increased risk of HAI and a greater incidence of MDR and XDR pathogens. Increasing ICU length of stay and invasive device duration were independent predictors of HAI.
subject: Research Articles
  topic: section
subject: nosocomial
  topic: keywords
subject: hospital-acquired
  topic: keywords
subject: risk factor
  topic: keywords
subject: bed occupancy
  topic: keywords
subject: ICU
  topic: keywords
subject: Intensive care
  topic: keywords
creator: T Wilson
creator: D Nolte
creator: S Omar
rights: Copyright (c) 2024 T Wilson, D Nolte, S Omar https://creativecommons.org/licenses/by-nc/4.0
date: 2024-07-17
publication date: 2024-07-17
starting page: e1906
ending page: e1906
doi: 10.7196/SAJCC.2024.v40i2.1906

Use of intravenous immunoglobulin for the treatment of severe COVID‐19 in the Chris Hani Baragwanath Academic Hospital intensive care unit, Johannesburg, South Africa
type: item
description: Background. COVID‐19 infection has a variable clinical presentation, with a small subgroup of patients developing severe disease, requiring intensive care with mechanical ventilation, with an increased mortality rate. South Africa (SA) has experienced multiple waves of this pandemic, spanning the pre‐vaccine and vaccine periods. The method and initiation of treatment is a debated topic, changing according to evolving research and the literature. The present study investigated the use of high‐dose intravenous immunoglobulin (IVIg) as a salvage therapy after initial medical treatment failure. Objectives. To compare disease progression among critically ill COVID‐19 pneumonia patients receiving IVIg therapy with that in patients receiving standard of care (SoC), in respect of inflammation, organ dysfunction and oxygenation. Methods. This was a single‐centre, retrospective study of patients admitted to the intensive care unit (ICU) at Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, during the pre‐vaccine COVID‐19 pandemic. Demographics, inflammatory markers (C‐reactive protein (CRP)), organ function (Sequential Organ Failure Assessment (SOFA) score), oxygenation (ratio of partial pressure of oxygen in arterial blood to fraction of inspiratory oxygen (P/F ratio)), overall mortality and complications (nosocomial infections and thromboembolism) were recorded and compared. Results. We included 113 eligible patients in the study. The IVIg cohort had a significantly lower initial P/F ratio than the SoC cohort (p=0.01), but the change in P/F ratio was similar (p=0.54). Initial CRP and changes in CRP were similar in the two groups (p=0.38 and p=0.75, respectively), as were initial SOFA score and changes in SOFA score (p=0.18 and p=0.08, respectively) and vasopressor dose on day 0 and day 5 (p=0.97 and p=0.93, respectively). Duration of mechanical ventilation did not differ significantly between the IVIg group and the SoC group (p=0.13). There were no significant diff…
subject: Research Articles
  topic: section
subject: COVID-19, Intravenous immunoglobulin (IVIg), Standard of Care (Soc), Intensive Care Unit, Sequential Organ Failure Assessment Score (SOFA), C-reactive protein (CRP), Horowits ratio (P/F ratio).
  topic: keywords
subject: COVID-19
  topic: subjects
subject: critically-ill
  topic: subjects
subject: immunoglobulin
  topic: subjects
subject: pneumonia
  topic: subjects
subject: inflammation
  topic: subjects
subject: Critical care
  topic: disciplines
subject: infectious disease
  topic: disciplines
creator: G Mensky
creator: A van Blydenstein
creator: J Damelin
creator: S Omar
rights: Copyright (c) 2024 G Mensky, A van Blydenstein, J Damelin, S Omar https://creativecommons.org/licenses/by-nc/4.0
date: 2024-11-25
publication date: 2024-11-25
starting page: e1897
ending page: e1897
doi: 10.7196/SAJCC.2024.v40i3.1897

Critical care nurses’ orientations to caring for patients and their families at a selected hospital in KwaZulu-Natal
type: item
description: Background. Caring in a critical care environment may be conceptualised differently compared with other nursing disciplines because of the patient’s critical condition and the specialised staffing categories and skills. However, critical care nurses who prioritise caring can meaningfully connect with critically ill patient and their families, resulting in positive healthcare outcomes. Objective. To assess critical care nurses’ orientations to caring for critically ill patient and their families. Methods. A quantitative, descriptive, cross-sectional study was conducted with 139 purposively sampled critical care nurses working in a tertiary referral hospital in KwaZulu-Natal, South Africa. Data were collected using the Caring Assessment for Caregivers questionnaire, and analysis included descriptive and comparative statistics. Results. The overall mean score of critical care nurses’ orientations to caring was 116.01 (range of 25 - 125). Of the five subscales (dimensions), the dimension of ‘Maintaining belief ’ had the highest mean score of 24.25 and the dimension of ‘Being with’ had the lowest mean score of 22.70 (range 5 - 25). Conclusion. While critical care nurses reported high overall orientations to caring, lower mean scores on the subscale ‘Being with’ suggest that there are areas for critical care nurses to grow in their role as carers. Further research using qualitative approaches may shed valuable insights into how the critical care environment impacts the caring orientations of critical care nurses.
subject: Research Articles
  topic: section
subject: Caring; critical care nurses; patients; families; orientation.
  topic: keywords
creator: W Emmamally
creator: M Jugroop
rights: Copyright (c) 2024 W Emmamally, M Jugroop https://creativecommons.org/licenses/by-nc/4.0
date: 2024-07-17
publication date: 2024-07-17
doi: 10.7196/SAJCC.2024.v40i2.1905