Browsing by Subject "Intensive Care"

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    Guideline for the management of acute asthma in adults: 2013 update
    (2013) Lalloo, U G; Ainslie, G M; Abdool-Gaffar, M S; Awotedu, A A; Feldman, C; Greenblatt, M; IRUSEN, E M; Mash, R; Naidoo, S S; O\'Brien, J; Otto, W; Richards, G A; Wong,, M L
    Acute asthma attacks (asthma exacerbations) are increasing episodes of shortness of breath, cough, wheezing or chest tightness associated with a decrease in airflow that can be quantified and monitored by measurement of lung function (peak expiratory flow (PEF) or forced expiratory volume in the 1st second) and requiring emergency room treatment or admission to hospital for acute asthma and/or systemic glucocorticosteroids for management. The goals of treatment are to relieve hypoxaemia and airflow obstruction as quickly as possible, restore lung function, and provide a suitable plan to avoid relapse. Severe exacerbations are potentially life-threatening and their treatment requires baseline assessment of severity, close monitoring, and frequent reassessment using objective measures of lung function (PEF) and oxygen saturation. Patients at high risk of asthma-related death require particular attention. First-line therapy consists of oxygen supplementation, repeated administration of inhaled short-acting bronchodilators (beta-2-agonists and ipratropium bromide), and early systemic glucocorticosteroids. Intravenous magnesium sulphate and aminophylline are second- and third-line treatment strategies, respectively, for poorly responding patients. Intensive care is indicated for severe asthma that is not responsive to first-line treatment. Antibiotics are only indicated when there are definite features of bacterial infection. Factors that precipitated the acute asthma episode should be identified and preventive measures implemented. Acute asthma is preventable with optimal control of chronic asthma.
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    Nosocomial infections in intensive care
    (1993) Hammond, Janet Margaret Justine; Potgieter, Peter; Forder, A A
    The objectives of this thesis are : 1) To provide a review of the literature on the significance, pathogenesis, diagnosis and management of secondary infections in the Intensive Care Unit. 2) To present the findings of a study of the technique of selective parenteral and enteral antisepsis regimen (SPEAR) in the patient population of the Respiratory ICU at Groote Schuur Hospital, aimed at reducing the incidence of secondary infection and, further to evaluate the study in terms of the effect of SPEAR on the incidence of secondary infection and its influence on the mortality due to secondary infection. 3) To present the findings of the effect of SPEAR on patient bacterial colonisation in the ICU, and to evaluate its longterm influence on the microbial flora of the ICU.
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    Outcome prediction in intensive care with special reference to cardiac surgery
    (1995) Turner, John Scott
    The development, use, and understanding of severity of illness scoring systems has advanced rapidly in the last decade; their weaknesses and limitations have also become apparent. This work follows some of this development and explores some of these aspects. It was undertaken in three stages and in two countries. The first study investigated three severity of illness scoring systems in a general Intensive Care Unit (ICU) in Cape Town, namely the Acute Physiology and Chronic Health Evaluation (APACHE II) score, the Therapeutic Intervention Scoring System (TISS), and a locally developed organ failure score. All of these showed a good relationship with mortality, with the organ failure score the best predictor of outcome. The TISS score was felt to be more likely to be representative of intensiveness of medical and nursing management than severity of illness. The APACHE II score was already becoming widely used world-wide and although it performed less well in some diagnostic categories (for example Adult Respiratory Distress Syndrome) than had been hoped, it clearly warranted further investigation. Some of the diagnosis-specific problems were eliminated in the next study which concentrated on the application of the APACHE II score in a cardiothoracic surgical ICU in London. Although group predictive ability was statistically impressive, the predictive ability of APACHE II in the individual patient was limited as only very high APACHE II scores confidently predicted death and then only in a small number of patients. However, there were no deaths associated with an APACHE II score of less than 5 and the mortality was less than 1 % when the APACHE II score was less than 10. Finally, having recognised the inadequacies in mortality prediction of the APACHE II score in this scenario, a study was undertaken to evaluate a novel concept: a combination of preoperative, intraoperative, and postoperative (including APACHE II and III) variables in cardiac surgery patients admitted to the same ICU. The aim was to develop a more precise method of predicting length of stay, incidence of complications, and ICU and hospital outcome for these patients. There were 1008 patients entered into the study. There was a statistically significant relationship between increasing Parsonnet (a cardiac surgery risk prediction score), APACHE II, and APACHE III scores and mortality. By forward stepwise logistic regression a model was developed for the probability of hospital death. This model included bypass time, need for inotropes, mean arterial pressure, urea, and Glasgow Coma Scale. Predictive performance was evaluated by calculating the area under the receiver operating characteristic (ROC) curve. The derived model had an area under the ROC curve 0.87, while the Parsonnet score had an area of 0.82 and the APACHE II risk of dying 0.84. It was concluded that a combination of intraoperative and postoperative variables can improve predictive ability.
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    Outcomes following admission to paediatric intensive care: A systematic review
    (2020) Procter, Claire; Argent, Andrew; Morrow, Brenda
    Introduction Paediatric Intensive Care has developed rapidly in recent years with a dramatic increase in survival rates. However, there are increasing concerns regarding the impact that admission to a Paediatric Intensive Care Unit (PICU) has on both the child and their family. Following discharge from PICU, children may be living with complex medical problems as well as dealing with the psychosocial impact that their illness has had on them and their family. Objectives To describe the long-term health outcomes of children admitted to a paediatric intensive care unit (PICU). Methods A full literature search was conducted including the databases; MEDLINE via PubMed, Cochrane Central Register of Controlled Trials, (CENTRAL), Scopus, Web of Science, CINAHL, ERIC, Health Source Nursing/Academic, APA PsycInfo. All studies including children under 18 admitted to a PICU were included. Primary outcome was short- and longerterm mortality. Secondary outcomes were neurodevelopment/cognition/school performance; physical function, psychological function/behaviour impact, quality of life outcomes and social/family implications. Studies focused on Neonatal Intensive Care Admission and articles with no English translation were excluded. Results One hundred and five articles were included in the analysis. Mortality in PICU ranged from 1.3% to 50%. Mortality in high income countries reduced over time but the data did not show the same trend for low- and middle-income countries. Higher income countries were found to have lower Standardised Mortality Rates (SMRs) than low- and middle-income countries. Children had an ongoing risk of death for up to 10 years following PICU admission. Children admitted to PICU also have more ongoing morbidity than their healthy counterparts with more cognitive/developmental problems, more functional health issues, poorer quality of life as well as increased psychological problems. Their parents also have an increased risk of Post Traumatic Stress Disorder (PTSD). Discussion Most of the studies identified are from high income countries and only include short-term follow up. More data is needed from low- and middle-income countries and over longer terms. The studies were markedly heterogenous and were all observational. Agreement is needed regarding which outcomes are most important to measure as well as standardised methods of assessing them. Further research is needed to identify the risk factors which cause children to have poorer outcomes as well as to identify predictive and modifiable factors which could be targeted in practice improvement initiatives.
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    Paediatric nonbronchoscopic bronchoalveolar lavage: Overview and recommendations for clinical practice
    (AOSIS, 2006) Morrow, B M; Futter, M J; Argent, A C
    NB-BAL is an effective procedure for the diagnosis of pulmonary disease processes in ventilated infants and children. This procedure is, however, not without risks to both patients and staff. Numerous complications of NB-BAL exist, with hypoxia being the most common. As a result, care should be taken in performing NB-BAL on haemodynamically unstable patients; patients with coagulation defects; and patients with cardiac or brain abnormalities. This paper presents an overview of paediatric nonbronchoscopic bronchoalveolar lavage (NB-BAL) including: the rationale for NB-BAL; the complications associated with the procedure; indications and contraindications. It also recommends an evidence-based clinical guideline for performing the procedure in the paediatric intensive care unit. By following the NB-BAL guidelines presented in this paper, one can ensure that an effective specimen is obtained from the lower respiratory tract, whilst minimising the risk to the patient.