Managing sedative and analgesic medications is an essential part of critical care medicine. There is a shift toward favoring the use of nonbenzodiazepine agents because of their side effects. There is an increasing interest in using ketamine as an analgo-sedative in the intensive care unit because of its unique pharmacologic properties. A comprehensive literature search was performed to capture all the studies involving ketamine use in critical care. We searched PubMed, EMBASE, and Cochrane databases. We also extracted the references from major review articles and recent guidelines. In this review, we present the most up-to-date studies done on this topic. We also present the proposal for a future multicenter randomized trial through the Saudi Critical Care Trials Group.

Delirium is commonly recognized among critically ill patients; previous work suggests that delirium prevalence is up to 80% in intensive care unit (ICU) patients and is associated with a variety of adverse outcomes. While several tools have been validated for the detection of ICU delirium, the confusion assessment method -ICU and the intensive care delirium screening checklist are the most widely studied and used. Several risk factors are known to influence delirium occurrence such as benzodiazepines use, drug-induced coma, sleep alterations, metabolic disturbances, and sepsis. In Saudi Arabia, few studies have discussed delirium burden and associated risk factors among critically ill patients. Therefore, the aim of this study is to determine the prevalence of ICU delirium and to study the risk factors associated with the development of delirium in patients in the intensive care setting in Saudi Arabia. This is a 1-day cross-sectional study performed on January 28, 2020, in the medical-surgical ICUs at 14 hospitals in Saudi Arabia. Patients are excluded from the study if they have traumatic brain injury, documented dementia in patient's medical chart, and the inability to conduct valid delirium assessment.

Pharmacological venous thromboembolism prophylaxis in the trauma population is considered a real challenge. Issues like the ideal time to start therapy, type and dose of the medication, and how to monitor these patients are controversial. We searched PUBMED, EMBASE, and COCHRANE Databases. We also extracted the references from major review articles and recent guidelines. The timing to start thromboembolic prophylaxis in patients with traumatic brain injuries, Spinal Cord Injuries (SCI), and solid organ injuries is not very well defined in the literature. This is because of the associated bleeding risk. At the same time, the type of chemical prophylaxis and dose are not well defined as well. In this review, we present the most up to date studies done on this topic. We discuss the areas of controversy and the challenges behind starting chemical prophylaxis. We also discuss areas of future research potentials to do multicenter studies through the Saudi Critical Care Trials Group.

Weaning from mechanical ventilator support is the optimal goal after the resolution of indications prompting need for this intervention. Failure of patient to pass weaning indicators will lead to prolonged mechanical ventilation duration and potentially more complications. The primary aim of this literature review was to determine if multidisciplinary huddle will effectively decreased time to extubation after passing a spontaneous breathing trial and length of mechanical ventilation. For this literature review, ProQuest, Medline, and PubMed were used to find articles about the influence of multidisciplinary approach on time to extubation. Search was narrowed to article between 2013 and 2018. A total of 20 articles were included, which were found to match inclusion criteria. This literature review searched a total of 20 articles between 2015 and 2018 to determine the influence of multidisciplinary approach on time to extubation. Inclusion criteria for this literature review included studies conducted on patients aged 18 years and above, admitted to intensive care units, and on mechanical ventilation for at least 48 h. Studies on re-intubated patients and patients with a tracheostomy were excluded from this review. Findings indicated that implementation of the multidisciplinary huddle along with ABCDEF bundle was associated with reduction in duration of intubation and time to extubation, but it did not affect the patient's length of hospital stay. The prevention of prolonged duration of mechanical ventilation should be the desired goal for all endotracheally intubated patients. Achievement of this requires a multidisciplinary team huddle to minimize the weaning delay and optimize the patient's outcome.

Falls are caused by many factors. For an individual, the cause may be a complex interaction between these factors. For this case, fall assessment is mandatory because the patient has hypovitaminosis D, stroke, arthritis, urinary incontinence, cognitive impairment, “dementia,” and osteoporosis. This patient in the past 12 months, he experienced tow falls. The fall assessment was done; it showed gait instability. As the patient complained of back pain, lumbar X-ray was positive for L4 compression fracture; however, his DEXA-scan showed osteoporosis. Osteoporosis magnetic resonance imaging was done to the patient: The result showed normal pressure hydrocephalus and vascular component. lumbar puncture (LP) was done, after the LP, his motor function improved, so the final diagnosis of normal-pressure hydrocephalus was reached. As a clinical guideline, when we face a case of fall, we should perform “a multifactorial falls risk assessment by taking the history, doing the physical examination, some test, and review the medications.”

Cerebrospinal fluid (CSF) leakage is a common complication after spinal tumor resection that resolves naturally in many cases. Hydrocephalus with CSF leakage as a complication after spinal surgery is rare. Here, we report a rare case of delayed hydrocephalus due to CSF leakage after cervical cord tumor surgery.