Pub Date : 2024-01-12DOI: 10.4103/2543-1854.393564
{"title":"Erratum: Antibiotic Treatment Duration for Bloodstream Infections in Critically Ill Patients: A National Survey of Kuwaiti Infectious Diseases and Critical Care Specialists","authors":"","doi":"10.4103/2543-1854.393564","DOIUrl":"https://doi.org/10.4103/2543-1854.393564","url":null,"abstract":"","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"31 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139532308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Up to one-third of intensive care unit (ICU) patients worldwide undergo mechanical ventilation. These patients frequently require analgesics and sedatives-potent medications with clear benefits and significant side effects. Objective: The current study intended to assess the effects of application of different regimens of sedation on mechanically ventilated patients regarding the length of ventilator days, length of hospital stay, multiple organ dysfunctions, ventilator-associated pneumonia (VAP), and mortality. Methods: One hundred adult patients who are intubated for any cause and attached to mechanical ventilation for more than 24 h will be included in this study. Drugs used for sedation were propofol and midazolam. Patients underwent history taking, clinical examination, laboratory investigations, chest X-ray, and electrocardiogram on admission. Results: At the end of this study, it was found that there was a significant increase in the sedation holiday group (Group II) over the no sedation group (Group I) regarding multiple organ dysfunction score, VAP, ventilator days, ICU stay, and hospital stay but there was no significant difference between both groups regarding mortality, spontaneous breathing trials, Glasgow Coma Scale, and complete blood count. Conclusions: Our results demonstrate that the use of sedatives can cause prolongation in the duration of mechanical ventilation, length of stay in the ICU, and total length of hospital stay. In addition, there is an increased risk of morbidity and mortality. It is possible to use a strategy of no sedation for critically ill patients undergoing mechanical ventilation without fears of failure.
{"title":"Effects of different regimens of sedation on mechanically ventilated patients","authors":"Usama Badr, Hossam Fouad Rida, Amr A Elmorsy","doi":"10.4103/sccj.sccj_31_22","DOIUrl":"https://doi.org/10.4103/sccj.sccj_31_22","url":null,"abstract":"Background: Up to one-third of intensive care unit (ICU) patients worldwide undergo mechanical ventilation. These patients frequently require analgesics and sedatives-potent medications with clear benefits and significant side effects. Objective: The current study intended to assess the effects of application of different regimens of sedation on mechanically ventilated patients regarding the length of ventilator days, length of hospital stay, multiple organ dysfunctions, ventilator-associated pneumonia (VAP), and mortality. Methods: One hundred adult patients who are intubated for any cause and attached to mechanical ventilation for more than 24 h will be included in this study. Drugs used for sedation were propofol and midazolam. Patients underwent history taking, clinical examination, laboratory investigations, chest X-ray, and electrocardiogram on admission. Results: At the end of this study, it was found that there was a significant increase in the sedation holiday group (Group II) over the no sedation group (Group I) regarding multiple organ dysfunction score, VAP, ventilator days, ICU stay, and hospital stay but there was no significant difference between both groups regarding mortality, spontaneous breathing trials, Glasgow Coma Scale, and complete blood count. Conclusions: Our results demonstrate that the use of sedatives can cause prolongation in the duration of mechanical ventilation, length of stay in the ICU, and total length of hospital stay. In addition, there is an increased risk of morbidity and mortality. It is possible to use a strategy of no sedation for critically ill patients undergoing mechanical ventilation without fears of failure.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127177572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical deterioration of hospitalized medical patients negatively affects patient outcomes and hospital capacity. Failure to recognize and respond promptly to an individual's worsening health status can lead to complications with far-reaching impacts on the patient and family. The ability to identify patient cues that can predict clinical deterioration is an essential role for frontline health-care providers to avert an avoidable health crisis. This protocol is designed to describe an integrative literature review plan that aims to identify, analyze, and synthesize the predictors and associated factors underlying the clinical deterioration of hospitalized medical ward patients. This planned review will follow the methodology of Whittemore and Knafl (2005), which comprises five stages: problem identification, literature search, data evaluation, data analysis, and presentation. CINAHL Plus, Embase, and PubMed databases will be used in the literature search. Primary research studies focusing on the predictors or the associated factors of clinical deterioration among medical ward patients will be eligible for the review. The quality of selected articles will be critically appraised using the Joanna Briggs Institute tools. The process of findings synthesis will be conducted according to Miles and Huberman (1994), which consists of data reduction, data display, data comparison, conclusion drawing, and verification. The findings will be presented as major themes that are supported by the appropriate primary studies.
{"title":"Predictors of clinical deterioration of hospitalized adult medical patients: An integrative literature review protocol","authors":"A. Deeb, Joy Maddigan","doi":"10.4103/sccj.sccj_30_22","DOIUrl":"https://doi.org/10.4103/sccj.sccj_30_22","url":null,"abstract":"Clinical deterioration of hospitalized medical patients negatively affects patient outcomes and hospital capacity. Failure to recognize and respond promptly to an individual's worsening health status can lead to complications with far-reaching impacts on the patient and family. The ability to identify patient cues that can predict clinical deterioration is an essential role for frontline health-care providers to avert an avoidable health crisis. This protocol is designed to describe an integrative literature review plan that aims to identify, analyze, and synthesize the predictors and associated factors underlying the clinical deterioration of hospitalized medical ward patients. This planned review will follow the methodology of Whittemore and Knafl (2005), which comprises five stages: problem identification, literature search, data evaluation, data analysis, and presentation. CINAHL Plus, Embase, and PubMed databases will be used in the literature search. Primary research studies focusing on the predictors or the associated factors of clinical deterioration among medical ward patients will be eligible for the review. The quality of selected articles will be critically appraised using the Joanna Briggs Institute tools. The process of findings synthesis will be conducted according to Miles and Huberman (1994), which consists of data reduction, data display, data comparison, conclusion drawing, and verification. The findings will be presented as major themes that are supported by the appropriate primary studies.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130024497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Al-Dorzi, Amirah Yaqoub, Fisal T Aldokhel, Khalid Alshuwaier, Sarah F Almujarri, Fatimah A Alkhaldi
Background: Critically ill adolescents are not a well-studied patient population. The optimal setting (pediatric or adult intensive care unit [ICU]) for caring for them is not clear. This study assessed adolescents admitted to the adult ICU and compared the characteristics and outcomes of younger versus older patients. Methods: This was a retrospective study of adolescent patients aged 14–19 years who were admitted to an adult tertiary care ICU between January 1, 2015, and December 31, 2020. Patients were divided into two groups, younger (14–16 years old) and older adolescents (17–19 years old). Results: The study included 276 patients; 105 patients were aged 14–16 years and 171 patients 17–19 years. Most patients were males (69.9%); only nine patients had body weights < 30 kg. Trauma was the most common reason for admission (36.2% of the younger group and 49.7% of the older group, P = 0.03) with sepsis being also common (19% of the younger group and 20.5% of the older group). Vasopressor therapy was required for 39.1% of patients and invasive mechanical ventilation for 58% (no between-group difference). The hospital mortality was 16.7% (odds ratio in younger versus older group adjusted for illness severity, 0.804; 95% confidence interval, 0.358–1.802). Mechanical ventilation duration and stay in the ICU and hospital were similar in both groups. Conclusions: Trauma was the most common reason for admission of adolescents aged 14–19 years to the adult ICU. The hospital mortality of younger and older adolescents was similar, suggesting that the management of younger adolescents in the adult ICU is safe.
{"title":"Characteristics and outcomes of adolescents requiring admission to the intensive care unit: A retrospective cohort study","authors":"H. Al-Dorzi, Amirah Yaqoub, Fisal T Aldokhel, Khalid Alshuwaier, Sarah F Almujarri, Fatimah A Alkhaldi","doi":"10.4103/sccj.sccj_9_23","DOIUrl":"https://doi.org/10.4103/sccj.sccj_9_23","url":null,"abstract":"Background: Critically ill adolescents are not a well-studied patient population. The optimal setting (pediatric or adult intensive care unit [ICU]) for caring for them is not clear. This study assessed adolescents admitted to the adult ICU and compared the characteristics and outcomes of younger versus older patients. Methods: This was a retrospective study of adolescent patients aged 14–19 years who were admitted to an adult tertiary care ICU between January 1, 2015, and December 31, 2020. Patients were divided into two groups, younger (14–16 years old) and older adolescents (17–19 years old). Results: The study included 276 patients; 105 patients were aged 14–16 years and 171 patients 17–19 years. Most patients were males (69.9%); only nine patients had body weights < 30 kg. Trauma was the most common reason for admission (36.2% of the younger group and 49.7% of the older group, P = 0.03) with sepsis being also common (19% of the younger group and 20.5% of the older group). Vasopressor therapy was required for 39.1% of patients and invasive mechanical ventilation for 58% (no between-group difference). The hospital mortality was 16.7% (odds ratio in younger versus older group adjusted for illness severity, 0.804; 95% confidence interval, 0.358–1.802). Mechanical ventilation duration and stay in the ICU and hospital were similar in both groups. Conclusions: Trauma was the most common reason for admission of adolescents aged 14–19 years to the adult ICU. The hospital mortality of younger and older adolescents was similar, suggesting that the management of younger adolescents in the adult ICU is safe.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"20 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120862919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Buskandar Fahad, Alalayet Abdulrahman, D. Nick, Fowler Robert
Context: Antibiotic treatment duration for bloodstream infections (BSIs) is an area of controversy and uncertainty. Aims: Our objective was to assess antibiotic treatment duration practices for critically ill patients with BSIs in Kuwait. Subjects and Methods: A survey consisting of clinical scenarios followed by questions about recommended antibiotic treatment duration for each scenario was sent to Kuwaiti infectious diseases, critical care specialists, and anesthetists with critical care experience. Statistical Analysis Used: Descriptive analysis (medians and interquartile ranges) and Kruskal–Wallis test were used for statistical analysis. Results: The survey response rate was 68% (112/164). The median (interquartile range [IQR]) ranges for antibiotic duration recommendations were similar for each bacteremic syndrome: central line-associated BSIs, 10 days (7–14); pneumonia, 10 days (7–14); urinary tract infection, 10 days (7–14); intra-abdominal infection, 10 days (7–14); and skin and soft-tissue infection, 10 days (7–14). The median (IQR) antibiotic durations for the following bacteria were as follows: Staphylococcus aureus, 14 days (10–14); extended-spectrum beta-lactamase Escherichia coli, 10 days (7–14); multidrug-resistant (MDR) Pseudomonas aeruginosa, 14 days (10–14); MDR Acinetobacter baumannii, 14 days (10–14); vancomycin-resistant Enterococcus faecalis, 14 days (10–14); carbapenem-resistant Klebsiella pneumoniae, 14 days (10–14); and coagulase-negative Staphylococcus, 7 days (7–10). For all infectious syndromes and individual organisms, duration responses often followed discrete choices of 5, 7, 10, and 14 days. Prolonging antibiotic therapy for immunocompromised patients was favored among 70% of respondents. Conclusions: This survey demonstrates practice variation in treating BSIs and supports the need for adequately powered randomized controlled trials assessing optimal antibiotic duration for various bacteremic syndromes, pathogens, and resistance patterns.
{"title":"Antibiotic treatment duration for bloodstream infections in critically ill patients: A national survey of Kuwaiti infectious diseases and critical care specialists","authors":"Buskandar Fahad, Alalayet Abdulrahman, D. Nick, Fowler Robert","doi":"10.4103/sccj.sccj_10_23","DOIUrl":"https://doi.org/10.4103/sccj.sccj_10_23","url":null,"abstract":"Context: Antibiotic treatment duration for bloodstream infections (BSIs) is an area of controversy and uncertainty. Aims: Our objective was to assess antibiotic treatment duration practices for critically ill patients with BSIs in Kuwait. Subjects and Methods: A survey consisting of clinical scenarios followed by questions about recommended antibiotic treatment duration for each scenario was sent to Kuwaiti infectious diseases, critical care specialists, and anesthetists with critical care experience. Statistical Analysis Used: Descriptive analysis (medians and interquartile ranges) and Kruskal–Wallis test were used for statistical analysis. Results: The survey response rate was 68% (112/164). The median (interquartile range [IQR]) ranges for antibiotic duration recommendations were similar for each bacteremic syndrome: central line-associated BSIs, 10 days (7–14); pneumonia, 10 days (7–14); urinary tract infection, 10 days (7–14); intra-abdominal infection, 10 days (7–14); and skin and soft-tissue infection, 10 days (7–14). The median (IQR) antibiotic durations for the following bacteria were as follows: Staphylococcus aureus, 14 days (10–14); extended-spectrum beta-lactamase Escherichia coli, 10 days (7–14); multidrug-resistant (MDR) Pseudomonas aeruginosa, 14 days (10–14); MDR Acinetobacter baumannii, 14 days (10–14); vancomycin-resistant Enterococcus faecalis, 14 days (10–14); carbapenem-resistant Klebsiella pneumoniae, 14 days (10–14); and coagulase-negative Staphylococcus, 7 days (7–10). For all infectious syndromes and individual organisms, duration responses often followed discrete choices of 5, 7, 10, and 14 days. Prolonging antibiotic therapy for immunocompromised patients was favored among 70% of respondents. Conclusions: This survey demonstrates practice variation in treating BSIs and supports the need for adequately powered randomized controlled trials assessing optimal antibiotic duration for various bacteremic syndromes, pathogens, and resistance patterns.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125074710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eslam E. Abdelshafey, Nashwa Abdalkreem, Ashraf S. Altayar
Basic skills and knowledge of critical care ultrasonography (CCUS) are considered mandatory in intensive care unit (ICU) practice. A link for the survey questionnaire [Appendix 1] was distributed to attendees of critical care meetings from different regions in Saudi Arabia about the topics of CCUS availability, use for diagnosis, and intervention. Responses were recorded for 48 h from launching on 1st day. We received 172 full responses, 95% of responders claimed that they have their own ultrasound machines in their units. In the opinion of 85.5% of the responders, the need for CCUS in ICU is mandatory and 14% of responders see it as optional. A significant positive association was found between responders' years of experience and obstacles to use CCUS (P < 0.001), while there was no significant association regarding responders' specialties, work region in Saudi Arabia and type of hospital they are working in (P = 0.509, 0.081, and 0.122, respectively).
{"title":"Use of critical care ultrasound in Saudi Arabia: Questionnaire analysis","authors":"Eslam E. Abdelshafey, Nashwa Abdalkreem, Ashraf S. Altayar","doi":"10.4103/sccj.sccj_7_23","DOIUrl":"https://doi.org/10.4103/sccj.sccj_7_23","url":null,"abstract":"Basic skills and knowledge of critical care ultrasonography (CCUS) are considered mandatory in intensive care unit (ICU) practice. A link for the survey questionnaire [Appendix 1] was distributed to attendees of critical care meetings from different regions in Saudi Arabia about the topics of CCUS availability, use for diagnosis, and intervention. Responses were recorded for 48 h from launching on 1st day. We received 172 full responses, 95% of responders claimed that they have their own ultrasound machines in their units. In the opinion of 85.5% of the responders, the need for CCUS in ICU is mandatory and 14% of responders see it as optional. A significant positive association was found between responders' years of experience and obstacles to use CCUS (P < 0.001), while there was no significant association regarding responders' specialties, work region in Saudi Arabia and type of hospital they are working in (P = 0.509, 0.081, and 0.122, respectively).","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126064684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer de Beer, Dalia Sunari, Seema Nasser, Zahra Alnasser, H. Rawas, H. Alnajjar
Background: Moral distress (MD) was first defined as a situation in which one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. This can be even more challenging within the critical care context as critical the care context imposes physical, emotional, and cognitive stressors on critical care nurses. Methodology: A descriptive quantitative approach was followed, and the critical care units of two tertiary hospitals in two provinces in Saudi Arabia were included in the study, yielding a cluster sample size of 361 critical care nurses. Data were collected using the MD Scale-Revised, for which reliability and validity have been established. Results: The mean total MD experienced by respondents was 77.15 ± 58.32, representing a low level of MD. The statement that nurses indicated as causing the most distress was “follow the family's wishes to continue life support even though I believe it is not in the best interest of the patient” with 5.98 ± 5.04. Furthermore, 17.5% (n = 63) of nurses had considered leaving their positions because of MD. MD was the highest in the Emergency department with 102.12 ± 70.59; as experience increased by 1 year, the MD score increased by 11.56. Conclusion: When dealing with issues related to futile care, critical care nurses experience MD. Therefore, future research is required to develop appropriate interventions with which to address critical care-related MD.
{"title":"The presence of moral distress among critical care nurses in Saudi Arabia","authors":"Jennifer de Beer, Dalia Sunari, Seema Nasser, Zahra Alnasser, H. Rawas, H. Alnajjar","doi":"10.4103/sccj.sccj_29_22","DOIUrl":"https://doi.org/10.4103/sccj.sccj_29_22","url":null,"abstract":"Background: Moral distress (MD) was first defined as a situation in which one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. This can be even more challenging within the critical care context as critical the care context imposes physical, emotional, and cognitive stressors on critical care nurses. Methodology: A descriptive quantitative approach was followed, and the critical care units of two tertiary hospitals in two provinces in Saudi Arabia were included in the study, yielding a cluster sample size of 361 critical care nurses. Data were collected using the MD Scale-Revised, for which reliability and validity have been established. Results: The mean total MD experienced by respondents was 77.15 ± 58.32, representing a low level of MD. The statement that nurses indicated as causing the most distress was “follow the family's wishes to continue life support even though I believe it is not in the best interest of the patient” with 5.98 ± 5.04. Furthermore, 17.5% (n = 63) of nurses had considered leaving their positions because of MD. MD was the highest in the Emergency department with 102.12 ± 70.59; as experience increased by 1 year, the MD score increased by 11.56. Conclusion: When dealing with issues related to futile care, critical care nurses experience MD. Therefore, future research is required to develop appropriate interventions with which to address critical care-related MD.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127213576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Bakhsh, Mohamed M. Humoodi, Abdullah A. Alzahrani, S. Osman, R. Babakr, Nada Townsi, Maha Azzam
Background: Sedation practices in pediatric intensive care units (PICUs) vary significantly worldwide. This study aimed to explore the current sedation and analgesia practices among paediatric intensivists in Saudi Arabia. Methods: This web-based survey was conducted among pediatric intensive care physicians in Saudi Arabia. The survey investigated the participating PICUs, physicians' demographic data, and sedation/analgesia practices. Results: Of the 160 physicians included, the response rate was 67% (n = 108). Of the 100 participants who provided location information, 51% (n = 51) were from the central region of Saudi Arabia. Approximately two-thirds of the participants were consultants, and 48.1% had >10 years of experience. Most respondents practised in general PICUs and routinely assessed sedation and analgesia levels. The COMFORT-Behavior and Face, Legs, Activity, Cry, and Consolability scales were popular (42.6%). More than half of the respondents (52/98) did not practice daily sedation interruption. Furthermore, 78.3% of the respondents assessed patients for withdrawal, whereas only 25% used delirium screening scores. Infusions were preferred over interrupted doses to provide comfort for mechanically ventilated patients. The first-choice infusions were midazolam for sedation and fentanyl for analgesia. Dexmedetomidine was preferred when a third agent was required. Sedation protocols were used by 41.2% of the respondents and were mainly physician-led (75.2%). Various nonpharmacological measures were used to provide patient comfort, and parents often participated in their application. Conclusions: The practice of sedation varies significantly between pediatric intensivists, and formal assessment for delirium is infrequently done in PICUs in Saudi Arabia.
{"title":"Sedation and analgesia practices of pediatric intensivists in Saudi Arabia","authors":"M. Bakhsh, Mohamed M. Humoodi, Abdullah A. Alzahrani, S. Osman, R. Babakr, Nada Townsi, Maha Azzam","doi":"10.4103/sccj.sccj_25_22","DOIUrl":"https://doi.org/10.4103/sccj.sccj_25_22","url":null,"abstract":"Background: Sedation practices in pediatric intensive care units (PICUs) vary significantly worldwide. This study aimed to explore the current sedation and analgesia practices among paediatric intensivists in Saudi Arabia. Methods: This web-based survey was conducted among pediatric intensive care physicians in Saudi Arabia. The survey investigated the participating PICUs, physicians' demographic data, and sedation/analgesia practices. Results: Of the 160 physicians included, the response rate was 67% (n = 108). Of the 100 participants who provided location information, 51% (n = 51) were from the central region of Saudi Arabia. Approximately two-thirds of the participants were consultants, and 48.1% had >10 years of experience. Most respondents practised in general PICUs and routinely assessed sedation and analgesia levels. The COMFORT-Behavior and Face, Legs, Activity, Cry, and Consolability scales were popular (42.6%). More than half of the respondents (52/98) did not practice daily sedation interruption. Furthermore, 78.3% of the respondents assessed patients for withdrawal, whereas only 25% used delirium screening scores. Infusions were preferred over interrupted doses to provide comfort for mechanically ventilated patients. The first-choice infusions were midazolam for sedation and fentanyl for analgesia. Dexmedetomidine was preferred when a third agent was required. Sedation protocols were used by 41.2% of the respondents and were mainly physician-led (75.2%). Various nonpharmacological measures were used to provide patient comfort, and parents often participated in their application. Conclusions: The practice of sedation varies significantly between pediatric intensivists, and formal assessment for delirium is infrequently done in PICUs in Saudi Arabia.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125278833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed Aboughanima, Abdelhameed Elsayed, Amr A. Arafat
Intra-aortic balloon pump (IABP) is commonly used for circulatory support in patients with cardiogenic shock. IABP is associated with several complications; however, IABP rupture was rarely reported. We present a female patient with acute myocardial infarction and ventricular septal rupture. The patient underwent transcatheter device closure of the ventricular septum and IABP insertion. After 4 days of insertion, we encountered a failure to cycle alarm. The IABP was removed with difficulty, and a leak coming from the shaft near the bifurcation was found. This case highlighted the importance of early detection of IABP rupture to avoid entrapment and further complications.
{"title":"A rare complication of intra-aortic balloon pump","authors":"Mohamed Aboughanima, Abdelhameed Elsayed, Amr A. Arafat","doi":"10.4103/sccj.sccj_28_22","DOIUrl":"https://doi.org/10.4103/sccj.sccj_28_22","url":null,"abstract":"Intra-aortic balloon pump (IABP) is commonly used for circulatory support in patients with cardiogenic shock. IABP is associated with several complications; however, IABP rupture was rarely reported. We present a female patient with acute myocardial infarction and ventricular septal rupture. The patient underwent transcatheter device closure of the ventricular septum and IABP insertion. After 4 days of insertion, we encountered a failure to cycle alarm. The IABP was removed with difficulty, and a leak coming from the shaft near the bifurcation was found. This case highlighted the importance of early detection of IABP rupture to avoid entrapment and further complications.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"384 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123509290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Qutob, Alanoud A. Alkhannani, A. Hussain, O. Shammeri, A. Elhazmi
The utilization of mechanical circulatory support devices in high-risk percutaneous coronary interventions (PCI) has recently evolved. In Saudi Arabia, the use of such devices is under-reported. Here, we present a 36-year-old patient who was admitted to the hospital with a non-ST-elevation myocardial infarction with biventricular dysfunction. A high-risk PCI consist of unprotected left main stenting was performed with the assistance of venoarterial extracorporeal membrane oxygenation that allowed smooth and successful intervention. Two days later, Impella was used to augment the recovery of the myocardium. The implementation of this approach helped our patient hemodynamically and allowed the recovery of the myocardium.
{"title":"ECPella: High-risk percutaneous coronary intervention in cardiogenic shock “case report”","authors":"R. Qutob, Alanoud A. Alkhannani, A. Hussain, O. Shammeri, A. Elhazmi","doi":"10.4103/sccj.sccj_18_22","DOIUrl":"https://doi.org/10.4103/sccj.sccj_18_22","url":null,"abstract":"The utilization of mechanical circulatory support devices in high-risk percutaneous coronary interventions (PCI) has recently evolved. In Saudi Arabia, the use of such devices is under-reported. Here, we present a 36-year-old patient who was admitted to the hospital with a non-ST-elevation myocardial infarction with biventricular dysfunction. A high-risk PCI consist of unprotected left main stenting was performed with the assistance of venoarterial extracorporeal membrane oxygenation that allowed smooth and successful intervention. Two days later, Impella was used to augment the recovery of the myocardium. The implementation of this approach helped our patient hemodynamically and allowed the recovery of the myocardium.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117033237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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