Browsing by Author "Semple, Patrick"

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    A retrospective review of complications in a South African neurocritical care unit over one year
    (2024) Kgaodi, Bakang Abiot; Semple, Patrick; Arnold-Day, Christel
    Background: The establishment of a Neurocritical Care Unit (NCCU) is well described in offering benefits to patients1,2. These units are optimised to care for patients with pathologies involving the brain and spine. Complications peculiar to such units in Low- and Middle-income countries (LMICs) are relatively undocumented. Objectives: To determine the complications in a NCCU at Groote Schuur Hospital (GSH) over 1 year and their association with ICU length of stay (LOS) and mortality. Methods: A retrospective review of complications of patients admitted to the NCCU at GSH from 01 January 2020 to 31 December 2020 as per NCCU patient data registry (HREC: R012/2015). Results: 850 patients, predominantly males (61.2% for HC and 68.1% for ICU), were admitted to the NCCU with a median age of 43 years (HC) and 41 years (ICU). The overall complication incidence rate was 38.2%. The statistically significant complications (p-value <0.05) were metabolic and electrolyte abnormalities as well as infection (including VAPs, SSIs and CLABSIs) and DVTs. The most common complication was metabolic abnormalities (28.2%), specifically derangements in sodium homeostasis. LOS was shown to have a statistically significant association with number of complications. Mortality did not have a statistically significant association with number of complications. Conclusion: Complications in a dedicated NCCU in South Africa are mostly electrolyte disturbances and infections. The complications are associated with increased LOS but not with increased risk of mortality.
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    The Groote Schuur Hospital Neurosurgical Intensive Care Unit: A 2 Year Experience
    (2024) Rashid, Sakina; Semple, Patrick; Joubert Ivan
    Background: At Groote Schuur Hospital (GSH), the Neurosurgical Intensive Care Unit (NsICU) is a 6-bed unit headed by a specialist neurosurgeon with extensive experience in Neuro-Critical Care working in close collaboration with intensivists from the Division of Critical Care. There is currently no detailed analysis of the demographics, diagnosis and management of patients admitted to the NsICU at GSH. Objectives: To provide a detailed descriptive analysis of the demographics, diagnosis and management of patients admitted to the NsICU at GSH from 1st January 2020 to 31st December 2021. Methods: A retrospective descriptive analysis of patients who received treatment in the NsICU from 1st January 2020 to 31st December 2021. Results: A total of 685 patients were admitted to the unit over a two-year period with a male preponderance (68.2%). The average age was 42.5 (±17.2) years. The most common neurosurgical diagnoses were traumatic brain injuries (39.6%), brain tumours (22.6%) and aneurysmal subarachnoid haemorrhages (9.9%). Emergency admissions comprised 76.6% of the total and 86.7% of admissions were admitted post operatively. Three hundred and seventytwo patients required mechanical ventilation (54.3%), 132 patients required both an intracranial pressure monitor (ICP) and brain tissue oxygenation monitor (19.3%), 86 had an external ventricular drain placed (12.5%), 50 patients required placement of a tracheostomy (7.3%) and 16 patients had only an ICP monitor placed (2.3%). The average duration of stay was 5.5 (±1.3) days and ICU mortality over 2 years was 11.1%. Conclusion: The NsICU at GSH manages predominantly male trauma patients and a significant number of admitted patients require specialized invasive intracranial monitoring.
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    Timing of complications following elective craniotomies
    (2021) Claassens, Caren; Reed, Anthony; Semple, Patrick
    Background: Conservative prolonged observation periods after elective craniotomies with admission to neurosurgical higher or intensive care units (ICU) have been the norm for many decades. This practice is neither evidence based nor a cost-effective use of medical resources. This observational audit aimed to establish the incidence and timing of serious complications after elective craniotomies in a low-middle income country context. Methods: The medical records of adult patients who had elective craniotomies for the 2-year period of March 2016-February 2018 at Groote Schuur Hospital were reviewed. Complication incidence and timing was analysed in all patients admitted to either the neurosurgical high care unit (HCU) or ICU post-operatively for the initial 24hr period. The specific complications in our audit was defined as: a decrease in Glascow Coma Scale (GCS) of more than 2 points from the preoperative baseline score, new onset or worsening motor deficit, seizures, diabetes insipidus, haemodynamic instability, severe hypertension, tracheal intubation or noninvasive ventilatory support, and death. Statistical analysis was primarily descriptive. Results: A total of 189 elective craniotomy patients were included in our audit for the 2-year period mentioned. In this study 37/189 (19.6%) patients developed 1 or more major complications during the initial 24 hr post-operative period. Of these 37 patients, 31 (83.8% [95% CI 71.9-95.7]) patients developed their first onset complication within six hours of admission to the HCU or ICU, and the remaining 6 (16.2% [95% CI 4.3-28.1]) in the subsequent 18 hours. All patients who developed life threatening complications (airway, ventilation or haemodynamic support) had their first onset complication (“red flag”) within six hrs of admission. Conclusion: Our audit suggests that consideration should be given to discharge patients to a general neurosurgical ward after an uncomplicated six hour postoperative ICU stay. While a significant amount of first onset complications may occur if a patient is discharged to the neurosurgical ward after this time period, these complications were unlikely to be immediately life threatening and should not require more than standard neurosurgical ward observations to detect.