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

Ballot, Daynia; Ramdin, Tanusha; White, Douglas B.; Dhai, Ames

doi:10.7196/sajbl.2019.v12i1.672

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…South Africa is a middle-income country with a vast disparity between public and private healthcare access, with the public sector being severely under-resourced with limited availability of PICU beds (13). Another possible reason for the extremely high prevalence in our study may relate to strict admission criteria to the publicly funded RCWMCH’s PICU.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Incidence of Pediatric Acute Respiratory Distress Syndrome in a Tertiary Academic PICU in South Africa

Ray

Argent

Lupton-Smith

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To determine the prevalence and incidence of pediatric acute respiratory distress syndrome (pARDS) among infants and children admitted to the PICU. Design: A single-center descriptive point prevalence study with twice weekly data collection over a 6 months (August 2020 to February 12, 2021). Setting: Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Patients: All infants and children admitted to the PICU on study days were included. Interventions: Data were captured electronically on a standardized case record form using a Research Electronic Data Capture electronic database. Measurements and Main Results: The Pediatric Acute Lung Injury Consensus Conference criteria were used to define pARDS cases. Prevalence was calculated as the total number of pARDS cases/1,000 PICU bed days. The study included 354 patients (median [interquartile range]) 10.1 months old (1.5–61.3 mo old), with 204 males (57.6%), who occupied 879 bed days. Of these 879 bed days, 266 (30.3%; 95% CI, 27.2–33.3%) were occupied by pARDS cases, with a calculated prevalence and incidence of 302.6 of 1,000 bed days (30.3%) and 29.7% (95% CI, 26.7–32.7%), respectively. Three cases from the cohort were defined using the oxygen saturation index calculation. In cases receiving invasive ventilation (n = 494; 56.2%), pARDS severity was classified as mild (n = 143; 16.3%), moderate (n = 44; 5.0%), and severe (n = 29, 3.3%). A further 205 beds (23.3%) were occupied by patients classified as being at risk of pARDS. Conclusions: The prevalence and incidence of pARDS in a South African PICU appears substantially higher than findings described in international reports. Further investigation of risk factors and outcomes is warranted.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Incidence of Pediatric Acute Respiratory Distress Syndrome in a Tertiary Academic PICU in South Africa

Ray

Argent

Lupton-Smith

et al. 2023

Pediatric Critical Care Medicine

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“…This seems likely in a context such as SA, where healthcare professionals are faced with resource limitations and heavy patient loads. [19] As with the concerns expressed with the informative model, the communication challenges and possible power dynamics between doctor, child and parent may create an atmosphere ripe for the doctor's influence.…”

Section: The Models Of the Doctor-patient Relationship In The Paediat...mentioning

confidence: 99%

“…However, the microethics of clinical practice, even in such a setting, would ensure that the doctor carefully balances the principles of autonomy and beneficence in the treatment of the child. Ballot et al [19] have argued that the ethics of care and the principle of ubuntu are more appropriate to a resource-stricken healthcare environment. The analysis in this article resonates with that conclusion.…”

Section: The Models Of the Doctor-patient Relationship In The Paediat...mentioning

confidence: 99%

Inserting microethics into paediatric clinical care: A consideration of the models of the doctor-patient relationship

Lutchman

2023

S Afr J Bioethics Law

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Microethics is about the ethics of everyday clinical practice. The subtle nuances in communication between doctor and patient (the doctor’s choice of words, tone, body language, gestures, etc.) can influence the exercise of the patient’s autonomy. The four models of the doctor- patient/physician-patient relationship (paternalistic, informative, interpretive, deliberative) weigh respect for autonomy and beneficence in varying proportions. Each model may be appropriate in certain circumstances. This article considers these models from the perspective of microethics and the unique dimensions created by the doctor-child-parent relationship. In particular, the article considers the nuances to the autonomy principle created by the child’s developing maturity and the parent’s role as a co-fiduciary of the child’s interests. Ultimately, the deliberative model seems most appropriate to the paediatric setting, since it accommodates the child’s developing maturity in making healthcare-related decisions. This model infuses care into the doctor’s communication with the child and parent.

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“…There are currently no national guidelines on the allocation of PICU beds; therefore, hospitals draw on international guidelines or set up their own admission guidelines [12]. There is a need for low-and middle-income countries (LMICs) to develop their own critical care guidelines based on available resources and disease spectrum while being guided by the local context [18].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Observational Study of the Impact of HIV Status on the Outcome of Paediatric Intensive Care Unit Admissions at a Tertiary Hospital in South Africa (2015–2019)

Whitehead,

Ballot

2023

Pediatric Reports

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HIV-infected and HIV-exposed but uninfected (HEU) children have unique health risks. Our study looked at how HIV exposure and infection impact presentation and outcomes in PICU in an era of improved ART. A retrospective analysis of children admitted to PICU was performed. The sample was divided into HIV negative, HEU and HIV infected, and presentation and outcomes were compared with a significance level set at α = 0.05. Our study showed that 16% (109/678) of children admitted to PICU were HEU and 5.2% (35/678) were HIV infected. HIV-infected children were admitted at a younger age (median two months) with an increased incidence of lower respiratory infections than HIV-negative children (p < 0.001); they also required longer ventilation and admission (p < 0.001). HIV-infected children had a higher mortality (40%) (p = 0.02) than HIV-negative (22.7%) children; this difference was not significant when comparing only children with a non-surgical diagnosis (p = 0.273). HEU children had no significant difference in duration of ICU stay (p = 0.163), ventilation (p = 0.443) or mortality (p = 0.292) compared to HIV-negative children. In conclusion, HIV-infected children presented with more severe disease requiring longer ventilation and admission. HEU had similar outcomes to HIV-negative children.

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

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 3 publications

References 10 publications

Prevalence and Incidence of Pediatric Acute Respiratory Distress Syndrome in a Tertiary Academic PICU in South Africa

Prevalence and Incidence of Pediatric Acute Respiratory Distress Syndrome in a Tertiary Academic PICU in South Africa

Inserting microethics into paediatric clinical care: A consideration of the models of the doctor-patient relationship

A Retrospective Observational Study of the Impact of HIV Status on the Outcome of Paediatric Intensive Care Unit Admissions at a Tertiary Hospital in South Africa (2015–2019)

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