Qatar Medical Journal - 2 - Qatar Critical Care Conference Proceedings, February 2020

Pediatric intensivists are called to patient bedsides in the pediatric cardiac intensive care unit (CICU) after congenital cardiac surgery for low blood pressure (BP) and/or poor perfusion, acute change in heart rate (HR) or rhythm, surgical site bleeding or increased chest tube output, anuria or oliguria, oxygen desaturation less than expected or metabolic acidosis with rising lactic acid and base deficit. Causes of acute circulatory failure after Read More

Background: Starting a new extracorporeal membrane oxygenation (ECMO) program requires synergizing different organizational aspects and extensive training of a core team to deliver care safely.1,2 Sidra Medicine, a newly opened facility in Qatar, started accepting acute inpatients and activated its ECMO program in 2018. The aim of this quality review is to evaluate the training of ECMO Specialists through benchmarking our ECMO progr Read More

The neonatal circulation is unique due to the presence of fetal shunts. With the advances in biomedical technology, the assessment of sick newborn infants has improved significantly. It allows to collect, store and analyze the complex physiometric data and provides a foundation for advances in diagnosis and management of neonatal cardiovascular compromise. This could allow the clinician to have objective information to complime Read More

Introduction: Delirium is a well-documented problem in the adult population however, its importance in the paediatric population has evolved recently with the development and validation of reliable paediatric delirium (PD) assessment tools. Definition: The key feature of delirium is an alteration in both cognition and arousal. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)1, de Read More

Neurodevelopmental outcomes are of paramount importance for every clinician as the survival rates of term and preterm babies have continued to improve. We aim to provide a framework for developing a Neuroprotective Neonatal Intensive Care Unit (NICU) by describing five main domains below. We achieve this in our NICU by a multidisciplinary team consisting of neonatologists, respiratory therapist, occupational therapist, physiothera Read More

There is an ongoing debate about the management of the critically ill mother, notably with regards to who should manage this group of patients (the intensivist, the obstetric anaesthetist, or the obstetrician?) and where is the ideal place to manage them (labour ward, obstetric high dependency unit or the intensive care unit?). To make the most appropriate choice, an understanding of how to recognise maternal critical illness is paramount. Read More

Introduction: Delirium, the most prevalent form of acute brain dysfunction in the Intensive Care Unit (ICU) is characterized by inattention, changes in cognition and at times thought and perceptual disturbances (e.g., delusions and hallucinations). Recent estimates of delirium prevalence suggest around 70% of patients on mechanical ventilation will experience delirium during their critical illness and almost a third of days in the ICU are days sp Read More

Monitoring the health of an injured brain is essential to forewarn neurological worsening and to gain insight into the pathophysiology of a complex disorder. Clinical examination remains a cornerstone in monitoring patients with brain injury. The Glasgow coma score (GCS) is widely used but lacks information regarding brain stem functions like pupillary reaction and shows moderate inter-observer reliability. However, despite these short Read More

The use of adrenaline during a cardiac arrest is well-established and supported by international guidelines. However, recent studies1–2 have questioned the appropriateness of adrenaline administration whereas other papers indicate that any benefit from adrenaline maybe time-sensitive.3–4 Two recently published studies have both challenged the use of adrenaline during resuscitation and whilst both papers used different methodologies they d Read More

Introduction: Hypoxic-ischemic encephalopathy (HIE) is the leading cause of death in comatose patients after cardiac arrest resuscitation.1 Poor neurological outcome is defined as death from neurological cause, persistent vegetative state, or severe neurological disability which is predicted in these patients by assessing the severity of HIE. Background: The most commonly used indicators of severe HIE include a bilateral absence of Read More

The incidence of deep vein thrombosis (DVT) in the critically ill ranges from 3.6% to 37%. Despite seemingly adequate prophylaxis the risk for DVT is still between 4 and 15%. Currently the known risk factors can be divided into inherited and acquired. In addition, the underlying disease and comorbidities play a major role, e.g., history of DVT, malignancy, ongoing infectious disease, cardiovascular disease and pregnancy1. DVT prevention is ap Read More

Autoimmune rheumatological disorders are rare but important to consider in Intensive Care Unit (ICU) patients. Overall prevalence of these disorders is approximately 3% in the general population. About 25% of patients presenting with these disorders to the emergency room (ER) require hospital admission and up to one third require ICU admission.1 Mortality is variable and reported to be around 20% in recent studies.2,3 The most co Read More

Background: The World Health Organization acknowledges sepsis as a global priority. Healthcare providers and governments have a critical role to play.1 National sepsis programs have been established in Qatar and in many other countries.1,2 Here, we share our pediatric sepsis program development and success. Missing signs of early sepsis in children can result in delayed management, complications, and death. A standardized pediatric sepsi Read More

Sepsis clinically manifests as life-threatening organ dysfunction due to a dysregulated host response to infection.1 Optimal fluid resuscitation is relevant for all sepsis patients, and perhaps it is most important for those with septic shock. Septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greatest risk of mortality, and septic shock is clinically identi Read More

Sepsis, a heterogeneous syndrome, is usually associated with uncontrolled body response to a systemic infection leading to dysregulated pro- and anti-inflammatory cascades.1 This, subsequently, leads to immune suppression, tissue damage, and organ failure. With time, the natural body compensation is lost and a state of shock, characterized by profound hypotension and abnormal cellular metabolism, ensues. Sepsis and septic shock are th Read More

Catecholamines are an integral component of the host stress response and usually increase appropriately at times of need. Unfortunately, in severe and prolonged critical illness, they can contribute to significant harm with unwanted biological effects on cardiac function, inflammatory, immune, metabolic, and coagulation pathways1. A good example is Takotsubo (‘stress’) cardiomyopathy where heart failure ensues after an emotional stress res Read More

Debriefing after critical events is a well-known practice in medicine, utilized in both simulated and real-life situations. In addition to reviewing the medical aspects of the care, debriefing allows for examination of team performance and human factors involved in the event. Various methods, locations, and time intervals can be utilized to debrief to meet the team's needs. Some proven methods of debriefing include plus-delta, directive feedback, Read More

There are several questions that need answering regarding mobilization of Intensive Care Unit (ICU) patients. How do we mobilize ICU patients? Is there an internationally agreed definition? Is there an internationally agreed prescription/program for mobilizing the patients? What is considered early? Why should we mobilize our patients, and lastly, why don't we? Mobilization of ICU patients takes many different forms and views. It includes bed a Read More

ICUs in the future will comprise a larger percentage of hospital beds as care of less seriously ill patients shifts to home and other environments. ICUs will need to adapt to increased demand for services and concomitant economic pressures with efficiency and innovation. The future ICU will see changes in form, function, personnel and patients. The type of patients in ICUs and their medical conditions will be different. Prevention, early detection, Read More

Background: Improving patient safety and reducing risk is important to a Paediatric Intensive Care Unit (PICU). Simulation-based education has generally focused on the management of clinical diagnoses, whereas the Quality and Safety Team has traditionally focused on collecting and analysing data about adverse events. There is a need to bridge the gap between the two streams - lessons learnt from adverse incidents and their impartation to s Read More