The organisational response of a hospital critical care service to the COVID-19 pandemic: The Groote Schuur Hospital experience

Background. There are limited data about the coronavirus disease-19 (COVID-19)-related organisational responses and the challenges of expanding a critical care service in a resource-limited setting.Objectives. To describe the ICU organisational response to the pandemic and the main outcomes of the intensive care service of a large state teaching hospital in South Africa.Methods. Data were extracted from administrative records and a prospective patient database with ethical approval. An ICU expansion plan was developed, and resource constraints identified. A triage tool was distributed to referring wards and hospitals. Intensive care was reserved for patients who required invasive mechanical ventilation (IMV). The total number of ICU beds was increased from 25 to 54 at peak periods, with additional non-COVID ICU capacity required during the second wave. The availability of nursing staff was the main factor limiting expansion. A ward-based high flow nasal oxygen (HFNO) service reduced the need for ICU admission of patients who failed conventional oxygen therapy. A team was established to intubate and transfer patients requiring ICU admission but was only available for the first wave. Results. We admitted 461 COVID-19 patients to the ICU over a 13-month period from 5 April 2020 to 5 May 2021 spanning two waves of admissions. The median age was 50 years and duration of ICU stay was 9 days. More than a third of the patients (35%; n=161) survived to hospital discharge. Conclusions. Pre-planning, leadership, teamwork, flexibility and good communication were essential elements for an effective response. A shortage of nurses was the main constraint on ICU expansion. HFNO may have reduced the requirement for ICU admission, but patients intubated after failing HFNO had a poor prognosis.

Can Facebook® be used to administer a distance-learning module of evidence-based medicine? An observational study

Introduction: There is a small volume of published literature describing the use of social networking sites, such as Facebook®, in medical education. However where this literature is available, only poor outcome measures such as learner satisfaction have been measured.Objectives: The primary aim of this study was to create and measure the use of a novel distance-learning module on the practice of evidence based medicine (EBM). This programme was to be delivered using an established and free web-based social-networking site, Facebook®.Methods: A prospective observational study was performed. 31 postgraduate residents enrolled to participate in a module that was delivered by Facebook® over five simultaneous weeks. A standardised tool, the Columbia EBM Instrument, was used to measure outcome measures such as "comfort-level", "self-reported practice", and "knowledge" before and after the module. Results: 12 residents (40%) engaged with the Facebook® activities. The residents' knowledge of EBM did increase, though a quasiexperimental analysis revealed that this increase of knowledge could not be attributed to the Facebook® group.were aged 3 years and younger. Scalds were by far the commonest type of burn occurring in 93% of the patients. Partial thickness burns accounted for 91.7% of cases. The average length of hospital stay was 20.9 days and the mortality rate 16.7%. Total Body Surface Area (TBSA) burned greater than 25% and full thickness burns were associated with mortality.Conclusion: Residents did not engage with the Facebook® groups despite the feasibility of doing so being high. The results of this study should guide educators to use Facebook® with caution as students may not engage with the activities

Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome

The phenomenon of intra-abdominal hypertension (IAH) and its progression to abdominal compartment syndrome (ACS) is a common and frequently under-recognised condition in critically ill patients. IAH is defined as an intra-abdominal pressure (IAP) greater than 12 mmHg. The ACS occurs once IAH is associated with organ dysfunction. Early detection is the cornerstone of management in the critically ill patient and the regular measurement of IAP in patients at risk for developing raised IAP is encouraged. The intravesical technique of measurement is relatively non-invasive and provides excellent correlation with direct measurement of IAP. The consequences of ACS are multi-systemic; resulting in organ dysfunction. The respiratory; cardiovascular; renal and gastrointestinal systems are particularly affected. The vicious cycle of organ dysfunction may be perpetuated by excessive fluid resuscitation. Early intervention is essential to prevent complications; which carry significant morbidity and; if untreated; possible mortality. Definitive management of this condition is the prompt surgical decompression of the abdomen followed by temporary abdominal closure