RESUMEN
INTRODUCTION: Organophosphate poisoning occurs frequently, and despite treatment, increased severity and intensive care unit (ICU) admissions have been observed. We hypothesized that early hemoperfusion/hemadsorption (HA) therapy would change the clinical course of the disease. METHODS: We performed a prospective, open, randomized controlled study at an academic ICU. Adult patients referred for an acute cholinergic toxidrome were screened. Patients meeting inclusion and exclusion criteria were randomized to standard of care (SoC) or HA therapy plus SoC, which included 2 6-h cycles of HA 12 h apart beginning within the first 24 h of ICU admission. The primary outcome was a comparison of ICU length of stay (LOS). RESULTS: There were no significant baseline differences between the groups. The median ICU LOS was 6.5 days (IQR 4.5-10) in the HA group compared to 8 days (IQR 3.5-17) for the control group, p = 0.58. Among patients with an excess ICU LOS ≥7 days, the median ICU LOS was significantly shorter for the HA group, 10 days (IQR 8-12) compared to 17 days (IQR 14-22) for the control group, p = 0.001, resulting in a cost saving of EUR 7308 per patient. Duration (8 days vs. 13.5 days) and cumulative dosage (316 mg vs. 887 mg) of atropine among patients with excess ICU LOS were significantly lower in the HA group compared to the SoC group, respectively. A similar reduction in the duration of mechanical ventilation (HA = 6 days vs. SoC = 15 days, p = 0.001) was found. The combination of day 28 mortality and severe complications was lower in the HA group (10%, n = 2/20) compared to the SoC group (42%, 14/33) p = 0.01. CONCLUSION: HA therapy resulted in significant cost savings driven by a reduced LOS among patients with excess ICU LOS ≥7 days. This therapy was also associated with a significant reduction in the combination of day 28 mortality and severe complications including cardiac arrest, organ dysfunction, reintubation, and tracheostomy.
Asunto(s)
Hemoperfusión , Adulto , Humanos , Estudios Prospectivos , Enfermedad Crítica/terapia , Organofosfatos , Unidades de Cuidados Intensivos , CarbamatosRESUMEN
INTRODUCTION: Life-threatening emergencies are not limited to the emergency department. Any delay in intervention during an emergency often culminates into a poor outcome. Early electrical defibrillation is one of the most important interventions in patients with cardiac arrest. This study aimed to conduct a clinical audit of defibrillator devices at an urban public sector hospital in Johannesburg. METHODS: All defibrillator devices within various areas of the hospital were assessed. Device characteristics were recorded into a data collection sheet and subjected to further analysis. RESULTS: This study assessed 112 out of 123 areas in the hospital with a total of 143 defibrillators comprising 139(97.2%) manual external defibrillators (MED) and four(2.8%) automated external defibrillators (AED). MEDs were located in the general wards (n=52, 37.4%), theatre complex (n=25, 17.9%), high dependency areas (n=27, 19.4%) and non-sleepover areas (n=35, 25.2%). Daily checklist books were available for 101 (72.7%) MEDs, 26 (18.7%) had at least once daily documented checks over a 5-day period while 57 (41.0%) had been serviced in the last 12 months. Seven MEDs (4.9%) and one AED (0.7%) had critical problems. CONCLUSION: Compliance with regard to the availability of defibrillator checklist books, conducting and recording of daily defibrillator checks, timely service maintenance of defibrillators and identification of critical device problems was suboptimal in this study. There is a need for ongoing training of hospital staff as well as the establishment of systems to prevent potential adverse consequences due to device failure.