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: Children admitted to paediatric intensive care at Red Cross War Memorial Children’s Hospital with non- accidental injuries (2012 - 2020): A retrospective descriptive study
items: CCSSA Congress Abstracts
items: Fluid tolerance in septic shock: Femoral vein pulsatility versus VExUS score in a cross-sectional study
items: Incidence of nosocomial pneumonia and clinical outcomes of patients requiring non-invasive ventilation: A systematic review and meta-analysis
items: Noise levels in intensive care units at Charlotte Maxeke Johannesburg Academic Hospital
items: High-dose insulin euglycaemic therapy (HIET): How high is high enough and what are the risks?
items: The interdisciplinary fibreoptic endoscopic evaluation of swallowing assessments in ICU patients: A file review
items: Enteral feeding barriers in the intensive care unit of a tertiary hospital in Ghana
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: Provision of physiotherapy services for children in intensive care units in Uganda: A descriptive study
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

Children admitted to paediatric intensive care at Red Cross War Memorial Children’s Hospital with non- accidental injuries (2012 - 2020): A retrospective descriptive study
type: item
description: Background. Violence against children remains common in South Africa (SA). Children sustaining severe non-accidental injuries (NAIs) may require admission to paediatric intensive care units (PICUs), however, their outcomes have not been well described in SA. Objectives. To describe the characteristics and outcomes of patients admitted to the PICU with suspected NAIs at Red Cross War Memorial Children’s Hospital (RCWMCH). Methods. A retrospective descriptive study of routinely collected data from all children admitted to the PICU at RCWMCH with suspected NAIs from 1 January 2012 to 31 December 2020. Results. Of 11 345 children admitted to the PICU, 42 (0.4%) patients with suspected NAI (median (IQR) age 20.3 (7.9 - 62.6) months; 61.9% male) were included in data analysis. Most patients sustained physical injury (n=35; 83.3%) from assaults (n=19; 45.2%), and head injuries were the most common injury site, while 37 (88.1%) received invasive mechanical ventilation for a median (interquartile range) of 2.0 (1.0 - 3.8) days. PICU mortality was 28.6% (n=12), with a risk-adjusted mortality (observed/mean predicted mortality) of 3.6. Of the 30 PICU survivors, 7 (23.3%) were discharged with long-term disability, while the functional outcome of 16 (53.3%) survivors remains unknown. Conclusions. Children who have sustained NAI represent a small proportion of PICU admissions, with high mortality and considerable morbidity.
subject: Research Articles
  topic: section
subject: PICU outcomes
  topic: keywords
subject: Non accidental injuries in children
  topic: keywords
subject: Non accidental injuries
  topic: subjects
subject: PICU outcomes
  topic: subjects
subject: Paediatric Critical Care
  topic: disciplines
subject: Trauma
  topic: disciplines
subject: Social welfare
  topic: disciplines
creator: L Bowes
creator: B Rossouw
creator: B M Morrow
rights: Copyright (c) 2026 L Bowes, B Rossouw, B M Morrow https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-23
publication date: 2026-04-23
starting page: e3260
ending page: e3260
doi: 10.7196/SAJCC.2026.v42i1.3260

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/

Fluid tolerance in septic shock: Femoral vein pulsatility versus VExUS score in a cross-sectional study
type: item
description: Background. Excessive fluid resuscitation in patients with septic shock is associated with acute organ injury and increased mortality. Accurate assessment of fluid tolerance is therefore essential. Right cardiac chamber fluid tolerance can be evaluated by estimating the right atrial pressure using central venous catheters, inferior vena cava (IVC) measurements, Venous Excess Ultrasound (VExUS) scores and femoral vein pulsatility (FVP). Objectives. To assess the correlation between FVP and VExUS score in evaluating fluid intolerance and venous congestion in patients with septic shock; the correlation of FVP and VExUS score with central venous pressure (CVP); and to evaluate the effect of positive pressure ventilation on the relationship between FVP and VExUS score. Methods. In this observational cross-sectional study, 80 participants were assessed for fluid tolerance using VExUS scores and FVP. CVP, maximum and minimum IVC diameters and IVC dynamicity were regarded as the gold standard and used as reference. Results. FVP showed moderate agreement with VExUS score (Kappa=0.55; p<0.001). Both FVP and VExUS score demonstrated the ability to predict CVP values ≥17 cmH2O with overall accuracies of 70% and 77.5%, respectively (p<0.001). A CVP ≥17.5 cmH2O predicted severely congested femoral veins with a sensitivity of 70% and specificity of 90%, whereas a CVP ≥18.5 cmH2O predicted VExUS grade 3 with a sensitivity of 66.7% and specificity of 83.3%. Maximum IVC diameter accurately predicted abnormal femoral vein Doppler findings, with an overall accuracy of 82.5%. Conclusion. A pulsatile femoral vein pattern indicates fluid intolerance in patients with septic shock, providing an additional marker for assessing fluid status. Doppler assessment of the femoral vein offers advantages of easier anatomical accessibility and a shorter learning curve compared with other methods.
subject: Research Articles
  topic: section
subject: femoral vein pulsatility
  topic: keywords
subject: vexus score
  topic: keywords
subject: systemic congestion
  topic: keywords
subject: femoral vein pulsatilty
  topic: subjects
subject: vexus score
  topic: subjects
subject: fluid overload
  topic: subjects
subject: critical care ultrasound
  topic: disciplines
creator: M A Sahbal
creator: A A Hemeda
creator: S Fawzy
creator: S Gaber
rights: Copyright (c) 2026 M A Sahbal, A A Hemeda, S Fawzy , S Gaber https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-23
publication date: 2026-04-23
starting page: e2816
ending page: e2816
doi: 10.7196/SAJCC.2026.v42i1.2816

Incidence of nosocomial pneumonia and clinical outcomes of patients requiring non-invasive ventilation: A systematic review and meta-analysis
type: item
description: Background. Non-invasive ventilation (NIV) is used for an increasing range of clinical conditions at various levels of care, including intensive care units (ICUs), and has been shown to carry a lower risk of nosocomial pneumonia (NP) compared with invasive mechanical ventilation (IMV). Objectives. To assess the incidence of NP and clinical outcomes (intubation rates and mortality) in patients receiving NIV as initial support. Methods. A systematic search of PubMed, Embase and Scopus for relevant research articles published in English was conducted up to 6 February 2025. Eligible studies included adult patients who received NIV for any respiratory condition and reported the incidence of NP. NP was defined as any new-onset pneumonia occurring at any point during the clinical course and ≥48 hours after initiating NIV. Furthermore, a subset of patients in whom NP was attributed solely to NIV support was defined as NIV-associated pneumonia (NIVAP). Two reviewers independently conducted database searches, data extraction and risk-of-bias assessment. A subgroup analysis was performed based on the indication for NIV, country and study design to identify heterogeneity. Results. We incorporated 30 studies, including 36 049 patients receiving NIV. Of these, 29 studies reported the incidence of NP, while only 22 reported the incidence of NIVAP. Overall, the incidence of NP was 6% (95% confidence interval (CI) 4 - 8; I2=89.4%), and the pooled incidence of NIVAP was 3% (95% CI 2 - 4; I2=32.9%). The rate of intubation was 28% (95% CI 22 - 35; I2=89.3%), and overall mortality was 18% (95% CI 15 - 23; I2=99.0%) among patients receiving NIV. Conclusion. NP, including NIVAP, remains a significant complication in patients receiving NIV. Our findings underscore the need for standardised diagnostic criteria for NP in patients receiving NIV.
subject: Review Articles
  topic: section
subject: Noninvasive ventilation;
  topic: keywords
subject: Nosocomial Pneumonia
  topic: keywords
subject: Invasive ventilation
  topic: keywords
subject: postoperative, respiratory tract infection
  topic: subjects
subject: infectious disease
  topic: disciplines
creator: S Singhal
creator: S K Mudgal
creator: M verma
creator: M Gurjar
creator: R Garg
creator: R K Garg
creator: B P Singh
creator: J Singh
rights: Copyright (c) 2026 S Singhal, S K Mudgal, M verma, M Gurjar, R Garg, R K Garg, B P Singh, J Singh https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-23
publication date: 2026-04-23
starting page: e4031
ending page: e4031
doi: 10.7196/SAJCC.2026.v42i1.4031

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

High-dose insulin euglycaemic therapy (HIET): How high is high enough and what are the risks?
type: item
description: Calcium-channel blockers (CCBs) are widely prescribed in South Africa and are frequently implicated in overdose-related morbidity and mortality. We report a case of amlodipine overdose in a teenager. Her management is notable for the exceptionally high dose of insulin used as part of high- dose insulin euglycaemic therapy (HIET), far exceeding standard protocol. Despite the aggressive dosing, no clinically significant hypoglycaemia or hypokalaemia occurred. The patient showed progressive improvement and was discharged from the intensive care unit on day 3, making a full recovery. This case demonstrates that insulin doses significantly exceeding conventional protocols may be safe and effective in resource-limited settings when supported by experienced staff and close monitoring. More research is needed to guide optimal HIET dosing and safe discontinuation protocols.
subject: Short Reports
  topic: section
subject: High-dose Insulin Euglycaemic Therapy
  topic: keywords
subject: HIET
  topic: keywords
subject: Calcium-channel Blocker Overdose
  topic: keywords
subject: OD
  topic: keywords
subject: Overdose
  topic: keywords
subject: Overdose
  topic: subjects
subject: Calcium-channel Blocker Overdose
  topic: subjects
subject: High-dose Insulin Euglycaemic Therapy
  topic: subjects
subject: HIET
  topic: subjects
subject: Toxicology
  topic: disciplines
subject: Critical Care
  topic: disciplines
subject: Emergency Medicine
  topic: disciplines
creator: A Dos Santos
creator: S Feris
creator: Z Farina
rights: Copyright (c) 2026 A Dos Santos, S Feris, Z Farina https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-23
publication date: 2026-04-23
starting page: e3800
ending page: e3800
doi: 10.7196/SAJCC.2026.v42i1.3800

The interdisciplinary fibreoptic endoscopic evaluation of swallowing assessments in ICU patients: A file review
type: item
description: Background. Dysphagia is a complex condition common in critical care settings, often resulting from multifactorial causes such as trauma, neuromuscular weakness, impaired cognition, intubation and the presence of a tracheostomy. Dysphagia can have serious consequences, including aspiration pneumonia and prolonged hospital stays, which need to be avoided in resource-constrained environments such as South Africa (SA). Objective. To investigate the characteristics of dysphagia in critically ill patients using an interdisciplinary assessment approach that utilises both bedside evaluations and fibreoptic endoscopic evaluation of swallowing (FEES). Methods. A retrospective file review was conducted of 68 adult patients who underwent interdisciplinary dysphagia assessments in a private SA hospital between July 2022 and January 2024. Data collected included clinical notes, anatomical and physiological markers, Penetration-Aspiration Scale (PAS) scores and post-assessment diagnoses. Descriptive statistics were employed to analyse variables such as age, gender, comorbidities and dysphagia symptoms. Results. The mean age of participants was 59.5 years (standard deviation (SD) 17.05 years), with the majority presenting with trauma-related injuries or cerebrovascular accidents. Dysphagia was prevalent, with 49% of patients exhibiting significant swallowing difficulties. The mean PAS score was 3.44 (SD 2.82), indicating that material often entered the airway without being ejected. Notably, 17% of patients presented with silent aspiration, highlighting the need for comprehensive interdisciplinary assessment techniques. Common symptoms included pooling, dysphonia and delayed swallow triggers, which may be identified at the bedside and confirmed using FEES. Patients were referred to speech-language therapy (SLT) after a median of 13 days in the intensive care unit (ICU). Conclusion. Dysphagia is a significant concern in critical care, necessitating early and co-ordinated assessment …
subject: Research Articles
  topic: section
subject: Dysphagia, ICU, interdisciplinary, speech language therapy, ear nose and throat
  topic: keywords
subject: Dysphagia,
  topic: subjects
subject: Speech Pathology
  topic: disciplines
creator: K Coutts
creator: N Barber
creator: N Israel
rights: Copyright (c) 2026 K Coutts, N Barber , N Israel https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-23
publication date: 2026-04-23
starting page: 3328
ending page: 3328
doi: 10.7196/SAJCC.2026.v42i1.3328

Enteral feeding barriers in the intensive care unit of a tertiary hospital in Ghana
type: item
description: Background. Enteral nutrition (EN) is an important aspect of patient management in the intensive care unit (ICU). However, various barriers have been reported that limit the provision of EN, with implications for patient care and outcomes. Objective. To evaluate the perceived barriers to the provision of EN among ICU healthcare professionals in our resource-limited setting, as a preliminary step toward developing tailored quality improvement interventions in our unit. Methods. A cross-sectional survey of 21 ICU healthcare professionals (17 nurses and 4 doctors) was conducted. The Revised Barriers to Feeding Critically Ill Patients questionnaire was used to evaluate barriers to the provision of EN in our ICU. A Likert scale was used to assess perceived barriers, with each factor rated from 0 to 6; 0 indicating ‘not at all’ and 6 indicating ‘an extreme amount’. Descriptive statistics were used to describe the data as medians, interquartile ranges, counts and proportions. The Wilcoxon-Mann-Whitney test was used to evaluate differences in medians between doctors and nurses, given the skewed distribution of data. Likert-based responses were used to generate a stacked bar chart. Statistical significance was set at p<0.05. Results. The main barriers to the provision of EN were related to dietitian support, ICU resources and EN delivery. Dietitian-related barriers included insufficient coverage on weekends, evenings and holidays (median 5), delayed nutritional assessments (median 3) and limited time dedicated to education and training on optimal feeding (median 3). ICU resource constraints included the absence or shortage of feeding pumps and the unavailability of enteral formulas (median 3 for both). Barriers to EN delivery included delayed initiation of motility agents in patients with feeding intolerance (median 3). Conclusion. These findings underscored the importance of developing context-specific quality improvement initiatives to address local barriers to the provisi…
subject: Research Articles
  topic: section
subject: Enteral nutrition
  topic: keywords
subject: Barriers to feeding
  topic: keywords
subject: Intensive care unit
  topic: keywords
subject: Ghana
  topic: keywords
creator: E K Anku
creator: L T Hill
creator: M A Agyarko
creator: O E Ekor
creator: G Akafity
creator: S A Amoo
creator: S O Lamptey
creator: N Kumi
rights: Copyright (c) 2026 E K Anku, L T Hill, M A Agyarko, O E Ekor, G Akafity, S A Amoo, S O Lamptey, N Kumi https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-23
publication date: 2026-04-23
starting page: e3661
ending page: e3661
doi: 10.7196/SAJCC.2026.v42i1.3661

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

Provision of physiotherapy services for children in intensive care units in Uganda: A descriptive study
type: item
description: Background. No prior studies have described physiotherapy practices for critically ill and injured children admitted to intensive care units (ICUs) in Uganda, a low-income African country with high childhood morbidity and mortality. Objectives. To describe the patient profile and physiotherapy practices of children admitted to Ugandan ICUs. Methods. Routinely collected data were extracted for all infants and children admitted to three participating Ugandan ICUs on two study days per week over six months. Demographic and clinical admission data were collected, as well as data on physiotherapy service provision, including referral practices, frequency of treatment and modalities used. Results. A total of 326 patients (49.4% male) were enrolled in the study, on median (interquartile range (IQR)) ICU Day 4.0 (2.0 - 8.0). Most children (63.5%) were >2 years of age. Physiotherapy had been provided to 190 (58.2%) children during their ICU admission. Physiotherapy referrals were made by the attending doctor in 80.5% of cases. Chest physiotherapy – percussions (89.6%) and vibrations (88.8%) – was the most common technique, followed by passive limb exercises in bed (63.4%). Active out-of-bed mobilisation activities were provided in <20% of cases, mostly among children >6 years of age (p<0.05) and those with minimal or no respiratory support requirements (p<0.001). No invasively mechanically ventilated children were actively mobilised out of bed. Conclusion. Over 40% of children admitted to Ugandan ICUs did not receive any physiotherapy contact during their admission, suggesting missed opportunities. Most physiotherapy techniques were passive; active out-of-bed activities were seldom implemented and were reserved for older, non-ventilated patients.
subject: Research Articles
  topic: section
subject: Paediatrics
  topic: keywords
subject: Intensive Care Unit
  topic: keywords
subject: Physiotherapy
  topic: keywords
subject: Uganda
  topic: keywords
subject: Paediatric critical care
  topic: subjects
subject: Physiotherapy
  topic: subjects
subject: Intensive care unit
  topic: subjects
subject: Paediatrics and Child health
  topic: disciplines
subject: Physiotherapy
  topic: disciplines
creator: I Sendagala
creator: B M Morrow
rights: Copyright (c) 2026 I Sendagala, B M Morrow https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-23
publication date: 2026-04-23
starting page: e2889
ending page: e2889
doi: 10.7196/SAJCC.2026.v42i1.2889

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