Southern African Journal of Critical Care <p>This Journal publishes scientific articles related to multidisciplinary critical and intensive medical care and the emergency care of critically ill humans.</p><p>Other websites related to this journal: <a title="" href="" target="_blank"></a></p> en-US Use of editorial material is subject to the Creative Commons Attribution – Non Commercial Works License (CC BY-NC 4.0). Copyright remains in the Author’s name. Authors are required to complete and sign an Author Agreement form that outlines Author and Publisher rights and terms of publication. (Claudia Naidu) (Editor: A/Prof W L Michell) Mon, 11 Mar 2019 14:29:46 +0000 OJS 60 Editorials <p><strong>Family-centred care in intensive care units</strong></p><p><strong>There’s more to weaning than just the lungs!</strong></p> Portia Jordan, A Lupton-Smith Copyright (c) Mon, 11 Mar 2019 00:00:00 +0000 Family-centred practices of healthcare professionals in three emergency departments in KwaZulu-Natal, South Africa <p><strong>Background.</strong> Emergency healthcare professionals can practise family-centred care (FCC) by engaging in active partnerships with families. In a chaotic environment, which challenges communication and supportive behaviours, responding to and acknowledging families’ individuality enhance positive family outcomes.</p><p><strong>Objective.</strong> To describe the adherence of emergency healthcare professionals to family-centred practices in some emergency departments in KwaZulu-Natal, South Africa.</p><p><strong>Methods.</strong> A quantitative survey was conducted among healthcare professionals in three emergency departments. A previously published checklist was used to collect data on adherence to relational and participatory family-centred practices.</p><p><strong>Results.</strong> A total of 77 completed questionnaires were received from the 79 participants surveyed, giving a response rate of 97.5%. Analysis showed that healthcare professionals endeavour to practise FCC, but that their implementation of practice indicators of family-centred care is inconsistent. Results suggested that healthcare professionals used relational practices to a larger extent than participatory practices.</p><p><strong>Conclusion.</strong> In the emergency department, collaboration and partnering with families should be emphasised to ensure that principles of FCC are practised as a standard.</p><p><strong>Keywords.</strong> Family, health care professionals, emergency department, relational practices, participatory practices</p> W Emmamally, P Brysiewicz Copyright (c) Mon, 11 Mar 2019 00:00:00 +0000 Muscle strength and endurance to predict successful extubation in mechanically ventilated patients: A pilot study evaluating the utility of upper-limb muscle strength and ergometry <p><strong>Background.</strong> Successful extubation of mechanically ventilated patients is essential for the physiotherapist to succeed in respiratory rehabilitation of the patient. Delay in the weaning process increases the complication rate of mechanical ventilation. A variety of parameters are used as predictors of extubation readiness, but the association between muscle strength (deltoid, neck flexor muscle group and trapezius), endurance and extubation readiness has not been determined.</p><p><strong>Objectives.</strong> The aim of the study was to determine if muscle strength and endurance can be used as possible predictors of successful extubation in mechanically ventilated patients. The objectives were to determine if muscle strength measured with the Oxford grading scale can be used as a possible predictor, and if muscle endurance measured with the MOTOmed letto2 cycle ergometer can be used as a possible predictor.</p><p><strong>Methods.</strong> During the pilot study, 37 subjects were recruited. Deltoid, neck flexors and trapezius muscle strength was tested using the Oxford grading scale and respiratory muscle strength using maximum inspiratory and expiratory pressures. Endurance was determined by riding the MOTOmed letto2 cycle ergometer for 5 minutes with the upper limbs.</p><p><strong>Results.</strong> Muscle strength of the deltoid and the neck flexor muscle group tested with the Oxford grading scale was associated with successful extubation respectively, (<em>p</em>=0.022; <em>p</em>=0.019). Muscle endurance tested with the MOTOmed letto2 cycle ergometer also demonstrated an association with successful extubation (<em>p</em>=0.014).</p><p><strong>Conclusion.</strong> Future studies with larger sample sizes are recommended.</p><p><strong>Keywords.</strong> Mechanical ventilation, intensive care unit, extubation failure, respiratory muscle strength, peripheral muscle strength, muscle endurance</p> C.R. de Beer, A.J. van Rooijen, J.P. Pretorius, P.J. Becker, P Rheeder, F Paruk Copyright (c) Mon, 11 Mar 2019 00:00:00 +0000 Parental satisfaction with the quality of care in a South African paediatric intensive care unit <p><strong>Background.</strong> The quality of family-centred care in the paediatric intensive care unit (PICU) has been poorly studied in South Africa (SA).</p><p><strong>Objective.</strong> To explore parents’ satisfaction with care in a PICU in SA.</p><p><strong>Methods.</strong> A prospective descriptive survey study was conducted among a convenience sample of 100 parents of children admitted to the PICU for ≥48 hours. Participants completed the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30) questionnaire, which includes 30 closed questions rating satisfaction in different domains and four open-ended questions to qualitatively describe PICU experiences.</p><p><strong>Results.</strong> Of the 100 admissions included in the study, 35% were unplanned and 88% were mechanically ventilated. Parents were very satisfied with the quality of PICU care, with mean scores in all domains reaching ≥5.5 on a 6-point Likert scale. Parents were most satisfied with the professional attitude of PICU staff, whereas the lowest scores were seen in the ‘Information’ and ‘Parental participation’ domains. The internal consistency (Cronbach’s α) associated with the different domains ranged between 0.25 (Parental participation) and 0.59 (Care and cure). The need for communication and support during the admission period, and the importance of environmental factors, proximity to the child, the attitude of medical staff and social support during the PICU stay emerged as common themes from the responses to the open-ended questions.</p><p><strong>Conclusion.</strong> Although parents were generally well satisfied with the quality of care, improving family involvement and providing adequate information in the PICU can contribute to quality family-centred care.</p><p><strong>Keywords.</strong> Family-centered care; patient- centered care; paediatric intensive care unit; quality of care</p> C Mol, A.C. Argent, B.M. Morrow Copyright (c) Mon, 11 Mar 2019 00:00:00 +0000 Characteristics, course and outcomes of children admitted to a paediatric intensive care unit after cardiac arrest <p><strong>Background.</strong> Cardiac arrest is a potentially devastating event, associated with death or severe neurological complications in survivors. There is little evidence on paediatric cardiac arrest prevalence, characteristics and outcomes in South Africa (SA).</p><p><strong>Objective.</strong> To describe the characteristics, course and outcomes of children admitted to an SA paediatric intensive care unit (PICU) following cardiac arrest.</p><p><strong>Methods.</strong> Retrospective descriptive study of routinely collected data (January 2010 - December 2011).</p><p><strong>Results.</strong> Of 2 501 PICU admissions, 110 (4.4%) had preceding cardiac arrest. The median (interquartile range (IQR)) age of children was 7.2 (2.5 - 21.6) months. In-hospital arrests accounted for 80.6% of the events. The most common primary diagnostic categories were respiratory (29.1%), cardiovascular (21.4%) and gastrointestinal (21.4%). Twenty-four patients (23.3%) arrested during endotracheal intubation. Cardiopulmonary resuscitation (CPR) was applied for a median (IQR) of 10 (5 - 20) minutes. Duration of CPR for non-survivors and survivors was 17.5 (10 - 30) v. 10 (5 - 15) minutes (<em>p</em>=0.006). PICU mortality was 38.8%, with half of the deaths occurring within 24 hours of admission. The standardised mortality ratio was 0.7. The median (IQR) length of stay in the PICU and hospital was 3 (1 - 8) and 27 (9 -52) days, respectively. No independent predictors of mortality were identified. Thirty-nine surviving patients (76.5%) had normal neurological function or mild disability at follow-up after hospital discharge. Six (11.8%) survived with severe disability.</p><p><strong>Conclusion.</strong> Mortality was lower than predicted in children admitted to the PICU following cardiac arrest. The majority of survivors had good neurological outcomes.</p><p><strong>Keywords.</strong> Pediatric, cardiac arrest, cardiopulmonary resuscitation, pulseless electrical activity, ventricular tachycardia, pediatric intensive care unit, in-hospital cardiac arrest, out-of-hospital cardiac arrest</p> J Appiah, S Salie, A Argent, B Morrow Copyright (c) Mon, 11 Mar 2019 00:00:00 +0000