Audit of acute limb ischaemia in a paediatric intensive care unit

 

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dc.contributor.advisor Hodges, Owen en_ZA
dc.contributor.advisor Thomas, Jenny en_ZA
dc.contributor.author Mumba, Jesse Musokota en_ZA
dc.date.accessioned 2016-07-27T10:15:23Z
dc.date.available 2016-07-27T10:15:23Z
dc.date.issued 2016 en_ZA
dc.identifier.citation Mumba, J. 2016. Audit of acute limb ischaemia in a paediatric intensive care unit. University of Cape Town. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/20838
dc.description.abstract Objective:Iatrogenic acute limb ischaemia in paediatric patients is a well-recognised complication of vascular access. This retrospective review of a paediatric intensive care unit identified patients who developed iatrogenic acute limb ischaemia between January 2008 and July 2013. Methods: The medical records of inpatients diagnosed with acute limb ischaemia during the study period were reviewed. Patients with other causes of acute limb ischaemia were excluded. A descriptive analysis of demographics, primary diagnosis, type of vascular access used, affected anatomical region, clinical presentation, type of therapy, type of block, response to intervention used and outcomes was conducted. Results:A total of 28 patients presented with signs of acute limb ischaemia, of whom 28.6% were aged <30 days, 46.4 % were between one and 12 months and 25% were between one and five years old; 78.6% of the affected limbs were lower limbs. Four patients had resolution of ischaemia upon removal of the vascular access devices. 23 patients received various forms of pharmacological sympathectomy, in addition to conservative therapy. One patient had missing data on the type of sympathectomy that was done. The response to the sympathectomies was: 60.9% good, 8.7% moderate, 8.7% poor and in 21.7% no responses. Documented tissue loss related to the ischaemia occurred in six (21.4%) of the 28 patients. Conclusions: Iatrogenic acute limb ischaemia in children are usually managed without surgical intervention. Pharmacological sympathectomies lead to increased blood flow to the affected limb via vasodilatation of collateral vessels, with an added advantage of reducing ischemic pain. The improved blood flow is postulated to avoid and/or minimise the amount of tissue loss. Pharmacological sympathectomies may, thus, have a role to play in th e management of iatrogenic acute limb ischaemia in the paediatric population. en_ZA
dc.language.iso eng en_ZA
dc.subject.other Anaesthesiology en_ZA
dc.subject.other Paediatric en_ZA
dc.subject.other acute limb ischaemia en_ZA
dc.subject.other complications of arterial cannulation en_ZA
dc.subject.other treatment algorithms en_ZA
dc.subject.other umbilical artery catheter complication en_ZA
dc.title Audit of acute limb ischaemia in a paediatric intensive care unit en_ZA
dc.type Master Thesis
uct.type.publication Research en_ZA
uct.type.resource Thesis en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Anaesthesia en_ZA
dc.type.qualificationlevel Masters
dc.type.qualificationname MMed en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Mumba, J. M. (2016). <i>Audit of acute limb ischaemia in a paediatric intensive care unit</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia. Retrieved from http://hdl.handle.net/11427/20838 en_ZA
dc.identifier.chicagocitation Mumba, Jesse Musokota. <i>"Audit of acute limb ischaemia in a paediatric intensive care unit."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2016. http://hdl.handle.net/11427/20838 en_ZA
dc.identifier.vancouvercitation Mumba JM. Audit of acute limb ischaemia in a paediatric intensive care unit. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/20838 en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Mumba, Jesse Musokota AB - Objective:Iatrogenic acute limb ischaemia in paediatric patients is a well-recognised complication of vascular access. This retrospective review of a paediatric intensive care unit identified patients who developed iatrogenic acute limb ischaemia between January 2008 and July 2013. Methods: The medical records of inpatients diagnosed with acute limb ischaemia during the study period were reviewed. Patients with other causes of acute limb ischaemia were excluded. A descriptive analysis of demographics, primary diagnosis, type of vascular access used, affected anatomical region, clinical presentation, type of therapy, type of block, response to intervention used and outcomes was conducted. Results:A total of 28 patients presented with signs of acute limb ischaemia, of whom 28.6% were aged <30 days, 46.4 % were between one and 12 months and 25% were between one and five years old; 78.6% of the affected limbs were lower limbs. Four patients had resolution of ischaemia upon removal of the vascular access devices. 23 patients received various forms of pharmacological sympathectomy, in addition to conservative therapy. One patient had missing data on the type of sympathectomy that was done. The response to the sympathectomies was: 60.9% good, 8.7% moderate, 8.7% poor and in 21.7% no responses. Documented tissue loss related to the ischaemia occurred in six (21.4%) of the 28 patients. Conclusions: Iatrogenic acute limb ischaemia in children are usually managed without surgical intervention. Pharmacological sympathectomies lead to increased blood flow to the affected limb via vasodilatation of collateral vessels, with an added advantage of reducing ischemic pain. The improved blood flow is postulated to avoid and/or minimise the amount of tissue loss. Pharmacological sympathectomies may, thus, have a role to play in th e management of iatrogenic acute limb ischaemia in the paediatric population. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Audit of acute limb ischaemia in a paediatric intensive care unit TI - Audit of acute limb ischaemia in a paediatric intensive care unit UR - http://hdl.handle.net/11427/20838 ER - en_ZA


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