ABSTRACT
INTRODUCTION: Chest infections are a frequently encountered problem in patients admitted to the intensive care unit (ICU), more so in tracheostomised patients. This study aimed to audit the tracheostomy care practices in patients with neurosurgical pathologies in the ICU of Wellington Clinics Abuja, a tertiary neurosurgical hospital in Nigeria. METHODS: We conducted a closed-loop audit with mixed methods involving analysis of 24 patients who had tracheostomy within the first two weeks of neurosurgical pathology at a tertiary neurosurgical hospital and semi-structured interviews to determine tracheostomy care practices among the primary caregivers - nurses, intensivists, and doctors. RESULTS: Of the 161 ICU admissions in the first cycle, 22 patients received tracheostomy, 16 met the eligibility criteria. At re-audit (second cycle), eight of 40 patients met the criteria. All the patients received open suctioning through a dual cannula-cuffed tracheostomy tube and had independent portable suction units. In the baseline audit (first cycle), suction catheters were reused for 12-24 hours in each patient and were stored in varying combinations of normal saline and Savlon antiseptic (5 mg of cetrimide (0.5% w/w) and 1 mg of chlorhexidine digluconate (0.1% w/w)). The frequency, technique, and assessment of the need for airway suctioning were inconsistent among caregivers interviewed. All 16 patients had at least one episode of pneumonia, 10 patients had a second episode, and two patients had > two episodes. One mortality was recorded directly attributable to the complications of pneumonia. While in the re-audit, with adherence to recommendations, three patients suffered one episode of pneumonia and only one had a second episode. No mortality was recorded. CONCLUSION: A standard practice guideline was necessary for tracheostomy care in our ICU. In low-resource settings, stated recommendations such as single-use suction catheters and improved hygienic practices can reduce rates of pneumonia in tracheostomised patients.
ABSTRACT
Overactive bladder syndrome (OAB) is a common, chronic, complex, often under-reported and under-treated condition with a significant impact on quality of life. It poses a high burden on healthcare systems. Clam ileocystoplasty is an invasive procedure typically reserved for the treatment of severe refractory cases. Malignant transformation in the area of anastomosis remains a rare but real, life-threatening risk in the patient group and requires active life-long surveillance and follow-up. We report the case of a 51-year-old woman who presented with recurrent urinary tract infections and non-visible haematuria 30 years after clam ileocystoplasty for urge incontinence. Imaging revealed an anterior bladder tumour with hepatic metastases. On multiple occasions, she was unfit for any invasive surgical sampling options to obtain tissue samples to allow for treatment planning, and was provided with best supportive care. The disease rapidly progressed to death within 10 weeks of presentation. This case buttresses the need for informed consent regarding the risks, including malignant transformation several years after the procedure, and the necessity for lifelong follow-up and surveillance cystoscopy, with frequency tailored to individual patient risk assessment.
ABSTRACT
Fever is often associated with infectious, traumatic, or allergenic etiologies, a known consequence of the systemic inflammatory response. Its association with a rise in intracranial pressures (ICP) is an uncommon presentation. We herein describe two patients who developed acute hydrocephalus and presented with high-grade fever. This febrile component was resistant to conventional antipyretics and was only relieved by cerebrospinal fluid (CSF) diversion.