Pediatric Intensive Care in South Africa

Argent, Andrew C.; Ahrens, Johann O; Morrow, Brenda; Reynolds, Louis; Hatherill, Mark; Salie, Shamiel; Benatar, Solomon R.

doi:10.1097/pcc.0000000000000029

Cited by 49 publications

(48 citation statements)

References 22 publications

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“…It would therefore be tempting to try to include developing and developed countries together in pediatric septic shock trials in order to improve enrolment efficiency. However, differences in access to care, availability of resources (40;41) and underlying causes of septic shock in developed versus developing countries (5;42) could seriously affect the integrity of the study design. While it is very important to conduct pediatric septic shock trials in different parts of the world, the interventions to be studied along with the relevant outcome measures may differ significantly depending on the region, making it difficult to conduct combined studies.…”

Section: Discussionmentioning

confidence: 99%

“…We excluded trials in centers that did not have access to PICU services as the patient populations, interventions and outcomes in those areas have the potential to be significantly affected by the lack of resources (40;41). In addition, this review focused on outcomes of RCTs for interventions for septic shock and therefore included trials on patients for whom the standard interventions (i.e.…”

Section: Discussionmentioning

confidence: 99%

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Primary Outcome Measures in Pediatric Septic Shock Trials: A Systematic Review*

Menon

McNally

Zimmerman

et al. 2017

Pediatric Critical Care Medicine

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Objective To evaluate all published pediatric randomized controlled trials (RCTs) of patients with septic shock from any cause to examine the outcome measures used, the strengths and limitations of these measurements and whether the trial outcomes met feasibility criteria. Data source We used a previously published database of pediatric critical care RCTs (PICUtrials.net) derived from searches of MEDLINE, EMBASE, LILACS and CENTRAL. Study selection We included RCTs of interventions to children admitted to a pediatric intensive care unit (PICU) with septic or dengue hemorrhagic shock which were published in English. Data extraction Study characteristics and outcomes were retrieved by two independent reviewers with disagreement being resolved by a third reviewer. We defined feasibility as 1) recruitment of at least 90% of the targeted sample size and agreement of the observed outcome rate in the control group with the rate used for the sample size calculation to within 10% or 2) finding of a statistically significant difference in an interim or final analysis. Data synthesis Nineteen of 321 identified articles were selected for review. Fourteen of 19 studies (74%) provided an a priori definition of their primary outcome measure in their methods section. Mortality rate was the most commonly reported primary outcome (8/14, 57%), followed by duration of shock (4/14, 29%) followed by organ failure (1/14, 7%). Only 3 of 19 included trials met feasibility criteria. Conclusions Our review found that use of mortality alone as a primary outcome in pediatric septic shock trials was associated with significant limitations and that long-term patient centered outcomes were not utilized in this setting. Composite outcomes incorporating mortality and long-term outcomes should be explored for use in future pediatric septic shock trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Primary Outcome Measures in Pediatric Septic Shock Trials: A Systematic Review*

Menon

McNally

Zimmerman

et al. 2017

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Rationing of care has been practised for a long time, but the criteria have changed over the decades. Argent et al [12] have developed admission guidelines for PICUs in SA. The exclusion criteria (for withholding ICU care) are similar to the RCPH criteria, and include futile care, underlying lethal conditions and 'conditions with a currently poor outcome' .…”

Section: Ethical Challenges: Withholding or Withdrawal Of Carementioning

confidence: 99%

“…This last includes patients who have deteriorated on appropriate treatment after more than 5 days of hospital admission. [12] Charlotte Maxeke Johannesburg Academic Hospital has a combined paediatric and neonatal ICU, and the admission criteria for neonates affect the overall availability of ICU beds. Based on justice considerations, birth weight has long been used to ration admission to NICU in SA.…”

Section: Ethical Challenges: Withholding or Withdrawal Of Carementioning

confidence: 99%

Ethical dilemmas in paediatric intensive care in the South African public healthcare sector

et al. 2019

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“…Some PICUs have developed and implemented explicit policies for the use of PICU resources, thus providing a 'reasonable' process for equitable utilisation of limited resources; however, SA does not have national or provincial guidelines for admitting patients to an ICU. [4,5] Various scoring systems have been developed to allow for assessment of the quality of care in PICUs, e.g. PRISM III, PIM2, PEMOD, PELOD, TISS and SOFA scores.…”

mentioning

confidence: 99%