Saudi Critical Care Journal

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Objective: Pressure ulcers present a major health challenge worldwide, and critically ill patients are considered to be at the greatest risk for pressure ulcer development. A study was undertaken to evaluate the effectiveness of pressure ulcer prevention measures (“PRESSURE bundle”) compared with standard care in reducing the incidence and prevalence of sacral pressure ulcers in critically ill patients in an Intensive Care Unit (ICU) in Riyadh, Saudi Arabia. Methods: Patients were assigned to the standard care group (n = 330) or the “PRESSURE bundle” group (n = 360). The follow-up period for both treatment groups was 2 months. A pre-post study design was used where data were collected in two samples. Patients were aged 16 years or over and included all new patients admitted to the ICU who did not have but were considered at risk of developing, sacral pressure ulcers (Braden scale score <18). Results: In the PRESSURE care bundle group, there was a significant reduction (P < 0.001) in the incidence of newly developed sacral pressure ulcers in the 2 months treatment period (n = 1, 0.3%) compared with the standard care group (n = 16, 4.6%). There was also a significant reduction (P < 0.001) in the prevalence of sacral pressure ulcers in the PRESSURE care bundle group (4.75%) compared with the standard care group (22.7%) when prevalence figures were compared at the end of the treatment periods. Conclusion: The application of a group of pressure ulcer prevention measures (“PRESSURE bundle”) coincided with a reduction in incidence and prevalence of sacral pressure ulcers in critically ill patients who are at risk for developing pressure ulcers.

Introduction: Acinetobacter baumannii is a Gram-negative Coccobacillus and is a frequent cause of hospital-acquired infections. Because some strains of A. baumannii are resistant to many antibiotics (i.e., extensively drug-resistant A. baumannii, or XDRAB), selecting antibiotics to treat infected patients is challenging. Clinical outcomes in critically ill patients with XDRAB infections are poor. In this study, we evaluated the clinical effectiveness of colistin as monotherapy and in combination with other antibiotics. Patients and Methods: A retrospective cohort study was performed on 94 critically ill patients (age ≥18 years) to assess the clinical effectiveness of treating XDRAB infections with colistin, either in monotherapy or combination with tigecycline, meropenem, or both. Clinical and microbiological data were obtained from patient records. We included patients suffering from XDRAB ventilation-associated pneumonia (VAP), or ventilator-associated tracheobronchitis (VAT), or VAT with bacteremia. Results: The mean age of the patients was 53.3 years (±23.7 years), and the mean Acute Physiology and Chronic Health Evaluation II score was 22.7 (standard deviation = 7.1). VAP and VAT with bacteremia were found in 84% and 16% of patients, respectively. Half (51%) of patients achieved microbiological clearance. The median Intensive Care Unit (ICU) stay was 29 days (interquartile range [IQR]: 17, 55) and the median mechanical ventilation (MV) duration was 21 days (IQR: 12, 42). MV duration and ICU length of stay were lower in the group of patients treated with colistin and meropenem than in those treated with colistin alone. Mortality was significantly lower in patients who received (colistin and tigecycline 30%) than in those who were treated with monotherapy (75%) with an odd ratio 0.03 (95% confidence interval: 0.00, 0.32; P < 0.01). Conclusions: Colistin-based combination treatment regimens mainly with tigecycline or with tigecycline and meropenem were associated with better treatment outcomes of XDRAB-induced VAP and VAT with bacteremia than colistin monotherapy.

Background: Health-care professionals work long hours, handle demanding patient loads, and make important decisions under conditions of uncertainty. These uncertain conditions have been shown to be associated with negative emotional and psychological outcomes for health-care professionals. In addition, they have been shown to lead to anxiety, depression, and other psychological and interpersonal strains, ultimately compromising the quality of patient care. Purpose: The purpose of this study is to evaluate the mental health issues of health-care providers including anxiety, depression, behavioral control, positive effect, and general distress. Methods: This is a cross-sectional study using a self-administered questionnaire. The questionnaire was distributed to health-care providers working at governmental and private health sectors in Saudi Arabia from January to April 2016. The questionnaire included a demographic survey and the Mental Health Inventory. Forty-five (45%) staff members completed the questionnaire. Results: Health-care professionals scored higher within the psychological distress, anxiety, depression, and loss of behavioral emotional control domains, indicating greater psychological distress. Females scored more on the depression domain than male participants. Further, physicians scored higher on the general positive effect domain than other health-care providers. Non-Saudi health-care providers scored higher on psychological distress scale than Saudi participants. Multiple regression analysis indicated that general positive effect, emotional ties, and life satisfaction were predictors of psychological well-being; on the other hand, anxiety, depression, and loss of behavioral/emotional control were predictors of psychological distress. Conclusion: High psychological distress may result from stressors associated with high work demands, workload, staff shortage, fear of infection, licensing board, fear of losing job, fear of reaction from leadership, peer, and patients and their families. Implication for Nursing Policy: Organizational supportive programs should be developed to enhance the psychological well-being of health-care professionals. These programs may decrease staff stress, anxiety, and depression and contribute to improve psychological well-being.

We report a 29-year-old female patient known to have lupus nephritis on immunosuppression and peritoneal dialysis who developed large bilateral spontaneous pneumothorax and mediastinal emphysema. The patient showed signs of tension pneumothorax and pneumomediastinum; however, she adamantly refused chest tubes insertion. Recovery was noted within 18 h of high-flow oxygen with normalization of chest image.

Online since 15^th Dec, 2016