Thesis (MScFisio)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Objective: To describe the baseline data of a surgical ICU in South Africa before the
implementation of an evidence-based physiotherapy practice protocol. Design:
Prospective cohort observational study Setting: Ten-bed closed surgical unit in a
university affiliated tertiary hospital. Patients: All adult ICU admissions from 16 June -
30 September 2003. Measurements: The patient’s clinical data including demographic
information, admission diagnosis, surgery classification and co-morbidities were
recorded on admission to the unit. APACHE II score was calculated. The physiotherapy
techniques, positions and functional activities used, the frequency and duration of
physiotherapy treatment sessions, the provision of after-hours service and the diagnosis
of pulmonary complications were also recorded daily. The time of mechanical ventilation
was calculated and the number of re-intubations documented. The ICU length of stay or
mortality was recorded. Results: 160 patients were admitted. Patients were 49 +/-
19.95 years of age. The mean APACHE II score was 12.3 +/ 7.19 and a 12.3% mortality
was observed. Thirty seven percent of patients were admitted to the unit following
elective surgery. Patients stayed in the unit for 5.94 +/- 6.55 days. Hypertension was the
most frequent co-morbidity found in this cohort (42%), and 21% of patients tested,
tested positive for HIV. Co-morbidities had no significant association with ICU LOS or
mortality. Nine hundred and twenty seven physiotherapy records were obtained.
Students were responsible for 39% (n=366) of treatment sessions, the unit therapist for
34% (n=311) and the on-call therapists for 27% (n=250). Despite routine daily
physiotherapy for all patients in the unit, 39% (n=62) developed excessive secretions,
30% (n=48) of patients developed pneumonia and 27% (n=43) of patients were
diagnosed with basal atelectasis. Nineteen patients (12%) died in the ICU. Patients
spent a mean of 5.94 (SD 6.55) days in the unit. One hundred patients (63%) were
ventilated. Almost a third of ventilated patients (31%) were intubated more than once.
The patients spent a mean time of 3.8 days (SD 6.30) on the ventilator every time they
were re-intubated. The development of pulmonary complications significantly increased
the time on the ventilator and the LOS. Conclusions: This baseline study of a surgical
ICU presents a picture of a unit providing care comparable to first world environments.
The picture of the physiotherapy service provided in this unit is of a “traditional” service
based neither on the available evidence regarding the prevention or management of
pulmonary complications, nor on the incorporation of early rehabilitation into the
management of mechanically ventilated adult patients in ICU. / AFRIKAANSE OPSOMMING: Doel: Om die basis lyn van ‘n chirurgiese intensiewe sorg eenheid in Suid Afrika te
beskryf voor die implementering van ‘n bewysgesteunde fisioterapie protokol in die
eenheid. Studie struktuur: Prospektiewe kohort observerende studie. Eenheid: Tien
bed geslote eenheid in ‘n tertiêre opleidingshospitaal. Pasiënte: Alle volwasse pasiënte
opgeneem in die eenheid tussen 16 Junie en 30 September 2003. Meetings:
Demografiese data, diagnose met opname, chirurgie klassifikasie en ko-morbiditeite is
aangeteken by opname. APACHE II is bereken. Die fisioterapie tegnieke, pasiënt
posisies en funksionele aktiwiteite gebruik in behandelingssessies, die frekwensie en
duur van behandelingssessies, die verskaffing van na-ure diens aan die eenheid asook
die komplikasies gediagnoseer is daagliks aangeteken. Die tyd wat pasiënte geventileer
is asook die aantal kere geher-intubeer is bereken. Die tydsduur van eenheid verblyf
asook mortaliteit is aangeteken. Results: 160 pasiënte is opgeneem, met ‘n
gemiddelde ouderdom van 49 +/- 19.95. Die gemiddelde APACHE II telling was 12.3 +/
7.19 en die mortaliteit was 12.3%. Sewe en dertig persent van pasiënte is opgeneem na
elektiewe chirurgie. Pasiënte bly in die eenheid gemiddeld vir 5.94 +/- 6.55 dae.
Hipertensie was die mees algemene ko-morbiditeit (42%), en 21% van die pasiënte wat
getoets is, het positief getoets vir HIV. Ko-morbiditeite het geen beduidende verband
getoon met die tyd in die eenheid of mortaliteit nie. 927 Fisioterapie rekords is
aangeteken. Studente was verantwoordelik vir 39% (n=366) van die
behandelingssessies, die eenheid terapeut vir 34% (n=311) en die op-roep
fisioterapeute vir 27% (n=250). Ten spyte van daaglikse roetine fisioterapie behandeling
van alle pasiënte in die eenheid het 39% (n=62) oormatige sekresies ontwikkel, 30%
(n=48) is met pneumonie gediagnoseer en 27% (n=43) met basale atelektase.
Negentien pasiënte (12%) is dood in die eenheid. Die tydsduur van eenheid verblyf was
5.94 (SD 6.55) dae. Een honderd pasiënte (63%) is geventileer. Byna een derde (31%)
van pasiënte is geher-intubeer. Met elke her-intubasie het die pasiënte gemiddeld 3.8
(SD 6.30) dae langer op die ventilator gebly. Pulmonale komplikasies het beide die
tydsduur in die eenheid as op die ventilator betekenisvol verleng. Gevolgtrekkings:
Hierdie basislyn studie beskryf ‘n eenheid waar pasiënte mediese sorg ontvang
soortgelyk aan eerste wêreld lande. Die fisioterapeutiese diens wat gelewer word is
egter nie gebasseer op die nuutste bewyse in die literatuur nie. Nog, in die voorkoming
of in die behandeling van pulmonale komplikasies, nog in die vroëere inkorporasie van
rehabilitasie in die hantering van volwasse pasiënte in ‘n intensiewe sorg eenheid.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/16335 |
| Date | 12 1900 |
| Creators | Hanekom, Susan |
| Contributors | Faure, M., Coetzee, A.R., University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | Various foliations : ill. |
| Rights | University of Stellenbosch |
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