H. van Aswegen

The effect of penetrating trunk trauma and mechanical ventilation on the recovery of adult survivors after hospital discharge

Objectives. To establish whether survivors of penetrating trunk trauma recover adequately and spontaneously following critical illness. Material and methods. A prospective observational study was conducted. Intubated and ventilated males and females with penetrating trunk trauma (SV group (mechanical ventilation (MV) <5 days, N =13), LV group (MV ≥5 days, N =29)) were recruited from four intensive care units. Dynamometry, lung function tests, 6-minute walk distance (6MWD), oxygen uptake and quality of life (QOL), assessed with the short form-36 English UK version (SF-36) questionnaire, were recorded over a 6-month period following discharge. Results were compared with a healthy control group ( N =40). Results. In the LV group, 6MWD was reduced in comparison wit h controls at 1 ( p =0.00) and 3 months ( p =0.00) after discharge. Morbidity correlated with 6MWD at 3 ( p =0.03) and 6 months ( p =0.02), and there was a reduction in strength at 1, 3 and 6 months relative to the SV group and controls ( p =0.00 - 0.04). In addition, intensive care unit and hospital length of stay correlated with muscle strength at 1 and 3 months for these subjects. SF-36 physical health domains were significantly reduced for LV group subjects up to 6 months compared with the SV group and controls ( p =0.00 - 0.02). Conclusion. SV group subjects recovered adequately and spontaneously within 3 months of discharge. LV group subjects, however, had significant limitations in exercise capacity, muscle strength and physical components of QOL up to 6 months after discharge. Persistent impairment of function is related to duration of illness and immobility.

Effect of penetrating trunk trauma on the recovery of adult survivors: a pilot study.

Gunshot and/or stab wounds to the trunk are injuries seen in South African hospitals. Patients are managed in the intensive care unit. Prolonged mechanical ventilation with immobilization results in some degree of muscle dysfunction. Our goal was to determine if patients recover adequately spontaneously following critical illness. No formal rehabilitation programmes exist in South Africa for these patients following discharge. A prospective, observational study was conducted. Patients were recruited from three ICUs in Johannesburg. Lung function tests, dynamometry, quality of life, 6-minute-walk, and oxygen uptake tests were performed over 6 months following discharge from the hospital. The control group consisted of existing data for healthy volunteers. Distance walked during 6-minute-wallk test was significantly reduced for the study group compared to the control group (1 month [p=0.00251]; 6 months [p=0.0355]). At 1 month there was a significant reduction in quadriceps and triceps strength for the study group compared to the control group (p=0.0089; p=0.0246, respectively). Quadriceps strength remained significantly reduced for the study group (3 months [p=0.0489]). No difference in muscle strength was detected between the groups at 6 months. Actual and predicted residual volumes differed significantly for the study group (1 month [p=0.0034]; 6 months [p=0.0157]). A trend of muscle weakness (to 3 months), poor exercise capacity, and abnormal lung volumes was identified. A formal rehabilitation programme may be needed to address these disabilities.

Contamination of nebulisers and surrounding air at the bedside of mechanically ventilated patients

Background . The delivery of aerosolised medication, as performed by nurses and physiotherapists in intensive care units (ICUs), forms an important component of patient care. Objectives. To determine the presence of contamination of nebulisers used within a ventilator circuit; to describe the protocol and clinical practice regarding decontamination and storage of these devices; and to identify micro-organisms colonising contaminated nebulisers and the surrounding air at patients’ bedsides. Methods . A cross-sectional multicentre observational study was conducted, including site and equipment sampling to determine contamination. ICU managers were interviewed to determine the decontamination and storage protocols used for nebulisers in their units. Swabs were taken from nebuliser chambers and streaked onto blood agar plates (BAPs). An air sampler was used to collect air samples from the surrounding bedside environment. The BAPs were incubated for bacterial and fungal contamination. Species of colonies observed in these samples were identified. Results. Sixty-one nebulisers from seven ICUs were sampled (Micro Mist n =37; Aeroneb n =24). Half of the nebulisers (Micro Mist ( n =19, 51.4%));Aeroneb ( n =12, 50%)) and most air samples ( n =60, 98%)) presented with contamination. All participating ICUs reported decontamination and storage protocols, but visual inspection of nebulisers suggested that the protocols were not observed. Nebulisers rinsed with alcohol and left open to the environment to dry had the lowest contamination rates. Coagulase-negative Staphylococcus species (spp.) were mostly found in the surrounding air and Aeroneb samples, and Enterococcus spp. were mostly found in the Micro Mist nebulisers. Conclusion . Although decontamination and storage protocols for nebulisers were in place, nebuliser and air contamination was high, possibly due to poor staff adherence

The implementation of the Objective Structured Practical Examination (OSPE) method: Students’ and examiners’ experiences

Background. Traditionally, physiotherapy practical skills have been assessed by a method that relies on the subjective interpretation of competency by the examiner and lacks the formative benefits of assessment. Objective. To describe and compare student performance and satisfaction and examiner satisfaction with regard to the Objective Structured Practical Examination (OSPE) and traditional mark sheets during the practical skills assessment. Method. Students and examiners taking part in the second-year physiotherapy practical skills test were invited to participate by completing a series of questionnaires. Performance of techniques was marked using both the OSPE and traditional mark sheets. Results. Sixty-seven students and nine examiners participated in the study. Students scored an average of 4.6% (SD ±16.4) better when using the traditional mark sheet. Nonetheless, students and examiners expressed a preference for the OSPE mark sheet. Conclusion. The OSPE mark sheet allows for increased objectivity, as the specific micro-skills are clearly listed and appropriately weighted. This resulted in increased satisfaction, but a decrease in marks obtained. By assessing the effect of implementation of the OSPE method on performance and satisfaction, change in the current situation can be monitored.