Off-Hours Admissions and Mortality in PICU Without 24-Hour Onsite Intensivist Coverage.

Objective: To evaluate whether the off-hours admission has any effect on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (PICU) without 24-hour in-house intensivist coverage.

Design: Prospective cohort study.

Setting: A 34-bed tertiary PICU.

Adherence to surviving sepsis guidelines among pediatric intensivists. A national survey.

To assess the compliance with the 2006 American College of Critical Care-Pediatric Advanced Life Support (ACCM-PALS) guidelines for sepsis management, and the 2012 surviving sepsis campaign (SSC), for the management of pediatric patients with sepsis and to identify the main barriers to adherence to these guidelines. Methods: In November 2015, a prospective cohort study in which a web based electronic survey using a case scenario to explore the usual management of a child with severe sepsis was designed and sent to all consultant pediatric intensivists practicing in Kingdom of Saudi Arabia (KSA). Adherences to 2012 SSC guidelines and to 4 algorithmic time-specific goals outlined in the ACCM-PALS guidelines were measured.

Pilot trial of a novel two-step therapy protocol using nebulized tranexamic acid and recombinant factor VIIa in children with intractable diffuse alveolar hemorrhage.

Background And Objectives: Diffuse alveolar hemorrhage (DAH) is a life threatening condition with very limited, often unsuccessful, therapeutic options. This study aimed at exploring the feasibility and efficacy of nebulized tranexamic acid TXA (n-TXA) and nebulized recombinant factor VIIa (n-rFVIIa) when used in a two-step therapy protocol in children with intractable DAH in a pediatric intensive care unit.

Methods: In a prospective trial, n-TXA (250 mg/dose for children < 25 kg and 500 mg/dose for children > 25 kg) was administered to 18 children (median age [interquartile range]; 24.

Incidence, Risk Factors, and Prognosis of Intra-Abdominal Hypertension in Critically Ill Children: A Prospective Epidemiological Study.

Purpose: To assess the incidence, risk factors, and outcomes of intra-abdominal hypertension (IAH) in a pediatric intensive care unit (PICU).

Methods: Prospective cohort study from January 2011 to January 2013. All children consecutively admitted to the PICU, staying more than 24 hours and requiring bladder catheterization, were included in the study.

Middle East respiratory syndrome coronavirus in children.

The Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). The disease is reported mainly in adults. Data in children are scarce.

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension in children.

Pulmonary hypertension (PH) is relatively uncommon in children. Pulmonary arterial hypertension (PAH) in pediatric comprises a wide spectrum of diseases, from a transient neonatal condition to a progressive disease associated with morbidity and mortality. Most common PAH in pediatric are idiopathic (IPAH) or PAH associated with congenital heart disease (PAH-CHD), while other associated conditions, such as connective tissue disease (CTD), are less common in pediatrics.

Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: 2014 updates.

The Saudi Association for Pulmonary Hypertension (previously called Saudi Advisory Group for Pulmonary Hypertension) has published the first Saudi Guidelines on Diagnosis and Treatment of Pulmonary Arterial Hypertension back in 2008.[1] That guideline was very detailed and extensive and reviewed most aspects of pulmonary hypertension (PH). One of the disadvantages of such detailed guidelines is the difficulty that some of the readers who just want to get a quick guidance or looking for a specific piece of information might face.

Utility of daily routine portable chest X-ray in mechanically ventilated patients in the pediatric intensive care unit.

The utility of daily routine chest X-rays (CXRs) in mechanically ventilated patients in intensive care units is still controversial. The present study compared the diagnostic, therapeutic and outcome efficacy between daily routine and non-routine (clinically indicated) CXRs in children patients in pediatric intensive care unit (PICU). A prospective randomized study conducted in tertiary center 18-bed PICU, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia.

Septic pulmonary embolism secondary to Staphylococcus aureus septic thrombophlebitis in a pediatric patient.

We present the clinical course of an 11-year-old child with septic pulmonary embolism secondary to community acquired methicillin-resistant Staphylococcus aureus (MRSA) septic deep venous thrombosis. The aim is to emphasize the non-specific symptoms of septic pulmonary embolism in pediatrics, the frequent association with septic deep venous thrombosis and osteomyelitis, and to highlight that MRSA is the most frequently isolated organism. Pediatricians should consider septic pulmonary embolism in cases of septic deep venous thrombosis even in the absence of respiratory symptoms.

Acute necrotizing encephalopathy associated with enterovirus infection.

Acute necrotizing encephalopathy is a rare, clinically distinct entity of acute encephalopathy triggered by acute febrile diseases, mostly viral infections. It is postulated to arise from uncontrolled cytokine release during a febrile illness, and is most often seen in East Asia. We describe a rare Saudi patient of acute necrotizing encephalopathy attributable to enterovirus in a 4 years and 6 months old girl.

Shock: an unusual presentation of Kawasaki disease.

Unlabelled: Kawasaki disease (KD) is a common acute systemic vasculitis of childhood. Although KD has wide spectrum of clinical features, shock is not one of its common presentation form. We describe a 5-month-old female infant with severe shock syndrome requiring fluid resuscitation, inotropic support, and PICU admission.

Overview of bronchiolitis.

Respiratory syncytial virus RSV, a nonsegmented, single stranded ribonucleic acid virus, infects one-half of all infants within the first year of life. Respiratory syncytial virus possesses pathogenetic qualities that may be attributed to the interplay of viral and host-specific factors including virus strains of different virulence, size of the inoculum, family history of asthma or airway hyper-reactivity and immunologic anomalies of the host. Inflammatory cell recruitment and activation occur in response to RSV infection of epithelial cells.

Can we reduce mortality in sepsis?

Considerable progress has been made over the last 2 decades in diagnosing and treating sepsis. Although the mortality rate is beginning to decline with the development of new therapeutic interventions, it still remains unacceptably high. Five such interventions are discussed in this review article to provide guidance for intensivists on the integration and implementation of new interventions into the intensive care unit.

Donor experience and outcome of pediatric living-related liver transplantation in Saudi Arabia.

Background/purpose: The purpose of this article is to present the first series of living donation of liver grafts in Saudi Arabia, as well as in the Arab World, and to report the morbidity and mortality of the living donors after such procedures.

Methods: A retrospective review of the medical charts of 37 living donors who were involved in the procedure of living-related liver transplantation (LRLT), that took place in Riyadh Armed Forces Hospital in the period between November 1998 and July 2002, is conducted.

Results: The age of living donors ranged between 21 and 41 years, and there were 22 women and 15 men.

Pediatric living-related liver transplantation in Saudi Arabia.

Objective: The purpose of this paper is to report our experience of the first 29 consecutive living-related liver transplants in pediatric recipients and to demonstrate the feasibility of living-related liver transplantation in the Arab World. The first living-related liver transplantation in the Kingdom of Saudi Arabia was performed in November 1998 by Bassas et al following an appropriate period of multi-disciplinary preparation.

Methods: This study was carried out at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia, during the period November 1998 through to October 2001.

Living-related liver transplantation for Crigler-Najjar syndrome in Saudi Arabia.

Objective: To analyse the outcome of six children with Crigler-Najjar syndrome type I (CNS-I) and report the first three living-related liver transplants for this syndrome in Saudi Arabia and the Middle East.

Settings: To review the medical records of six children suffering from CNS-I, three of whom underwent living-related liver transplantation (LRLT) between 22 November 1998 and January 2001.

Main Results: Living-related liver transplantation was performed in three children with a pre-transplant unconjugated bilirubin level of 362, 381 and 502 micromol/L, respectively, despite daily phototherapy of >or= 12 h.