3. Electronic Theses and Dissertations (ETDs) - All submissions

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    Patient characteristics and determinants of outcomes of children admitted with pneumonia to a Paediatric Intensive Care Unit (SLE) in a Tertiary Hospital in Johannesburg
    (2017) Keeling, Kathryn Helen
    Background. Pneumonia is the leading infectious cause of death worldwide. HIV infected and exposed children are at greater risk for developing pneumonia. HIV exposed infants have been said to have a worse outcome than their HIV unexposed counterparts. Objectives. To describe the patient characteristics and determinants of the outcome of children admitted to the paediatric intensive care unit (PICU) with pneumonia. Methods. This was a retrospective review of patients admitted to a PICU between 1 January 2013 and 31 December 2014. Results. One hundred and seven patients were analyzed, of these 65.4% had a normal weight for age. Fifty percent of patients were HIV unexposed, 21.5% HIV infected and 26.2% HIV exposed but uninfected. The HIV infected group had a significantly longer length of stay (p= .011), duration of ventilation (p= .003) and higher mortality (p= .014) when compared to the HIV uninfected group. Likewise compared to HIV exposed but uninfected children, HIV infected had a longer length of stay (p=. 006), duration of ventilation (p= .003) and a greater mortality (p= .038). When the oxygenation index is ≥16, patients had a longer duration of ventilation (p= .037) and they had an increased risk of mortality (p< .001) Multiple regression showed that oxygenation index was the only significant predictor of death. Conclusion. HIV infected children had a significantly higher mortality than both HIV uninfected and HIV exposed but uninfected children. An oxygenation index of greater than 16 is a significant predictor for longer duration of mechanical ventilation and death.
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    The opinions of a multidisciplinary team in paediatric intensive care units regarding weaning protocols for mechanical ventilation
    (2015) Njolomole, Abbie N
    Background: Despite the empirical evidence of the significance of weaning protocols in Intensive Care Units, variations still exist in the adoption of weaning protocols. Multidisciplinary teams hold the responsibility for the introduction and development of weaning protocols in PICU. Purpose: To explore and describe the opinions of multidisciplinary teams practicing in the paediatric and cardiothoracic ICU at an academic hospital in Johannesburg concerning weaning protocols from mechanical ventilation. Design: Qualitative descriptive. Method: Data was collected from multidisciplinary team comprising of registered nurses (n=8) and doctors (n=2) practicing in PICU and CTICU who were purposively selected using semi-structured interviews to obtain qualitative information on their opinions regarding weaning protocols. Data collected was analysed using a Braun and Clarke method of qualitative thematic analysis. Seven categories were identified in which three themes, which provided the fundamental structure of the findings for the discussion, emerged and included the following:  Unstructured weaning – the current practice.  Recognition of the need for weaning protocols.  Being not in favour of weaning. Results: The majority of the multidisciplinary team members recognise the need to develop weaning protocols in PICU for standardisation of practice. Currently there are no weaning protocols and a multidisciplinary approach was identified as an important strategy to develop the protocols. However, nurses practicing in PICU are not trained in Critical Care nursing which poses a challenge to the practice. Conclusion This study indicates that there is need for the development of weaning protocols in PICU. Although nurses are weaning patients in PICU, there are no standardised weaning protocols to guide the practice. The study therefore suggests the need to develop weaning protocols through multidisciplinary approach and training of nurses in critical care nursing to improve knowledge base and skills. Keywords: Mechanical ventilation, weaning, protocols, paediatric patients, opinions/perception and multidisciplinary team.
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