Saudi Critical Care Journal

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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.

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.

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.

Online since 15^th Dec, 2016