A retrospective chart review was conducted to estimate the prevalence and severity level of hyponatremia on admission at the pediatric intensive care unit (PICU) in a Saudi tertiary hospital. Hyponatremia was highly prevalent (67.2%) and severe hyponatremia was frequent among patients with Pediatric Risk of Mortality score > 10%. Severe hyponatremia was also associated with increased length of stay (p = 0.04) and a trend of increased mortality (p = 0.054). However, disease severity was not an independent risk factor of mortality in PICU, but might confound other risk factors that render the children requiring prolonged hospital stay, mechanical ventilation, and increased health costs.

Status epilepticus (SE), a subset of epilepsy, represents a debilitating neurological disorder often associated with alarming mortality and morbidity numbers. Even though SE is one of the extensively researched topics with conspicuous data available in the literature, a scientific gap exists in understanding the heterogeneous facets of the disorder like occurrence, definition, classification, causes, molecular mechanisms, etc., thereby providing a defined management program. Cognizance of this heterogeneity and scientific limitation with its subsequent correlation to the recent advancements in medical and scientific domains would serve not only in bridging the gap but also in developing holistic and prompt management programs. Keeping this as an objective, an extensive literature survey was performed during this study, and key findings have been shared. The present study provides a semantic and perspective synopsis toward acknowledging the diversified nature of SE and its variants with respect to their definition, classification, etiology, diagnosis, and management.

This study was aimed at determining the extubation failure (EF) rate in a pediatric intensive care unit (PICU), and assessing the etiology, associated risk factors, and outcomes. We conducted a retrospective study on 335 pediatric patients admitted to King Abdulaziz University Hospital between 2018 and 2020, ranging in age from 1 month to 14 years, who required invasive mechanical ventilation (MV) for >24 h. Extubation readiness was determined by the attending pediatric intensive care physician, according to the patients’ clinical status and extubation readiness criteria. In the cohort of 335 patients, 42 experienced issues during extubation (failure rate, 12.5%). Cardiovascular disease (42.9%) was the main primary admission condition in patients with EF. Younger age (median, interquartile range [IQR]: 4, 1.38–36 months) was strongly associated with EF compared with successful extubation (median, IQR: 12, 2–48; p = 0.036), and with a high predicted mortality rate (10.9%; p < 0.001) and Pediatric Risk of Mortality III (PRISM) score (13; p < 0.001). Furthermore, prolonged ICU stay (25.5 days; p < 0.001) and longer MV requirements (4 days; p < 0.001) before extubation in patients with EF were associated with a high mortality rate (∼12%; p < 0.001). Interestingly, dexamethasone administration before extubation significantly alleviated EF risk (28.3%; p < 0.001). A higher EF rate in younger patients may potentially be associated with longer ICU stays, prolonged MV requirements before extubation, and the primary diagnostic condition. Dexamethasone effectively alleviated EF incidence. Further research with a rigorous evidence-based study design is necessary to substantiate the factors identified as predictors of EF and to develop strategies to avoid EF.

Background: Artificial Intelligence (AI) has the potential to revolutionize Pediatric Intensive Care Units (PICUs) by enhancing diagnostic accuracy, improving patient outcomes, and streamlining routine tasks. However, integrating AI into PICU environments poses significant ethical and data privacy challenges, necessitating effective governance and robust regulatory frameworks to ensure safe and ethical implementation. This study aimed to explore valuable insights into healthcare professionals' current perceptions and readiness to adopt AI in pediatric critical care, highlighting the opportunities and challenges ahead.Methods: A cross-sectional study conducted an online survey among healthcare practitioners at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. The survey included questions about professional roles, experience, and familiarity with AI, their opinions on AI's role, trust in AI-driven decisions, and ethical and privacy concerns. Statistical analyses were performed using IBM SPSS.Results: Results found varying familiarity with AI among healthcare professionals, with many expressing limited knowledge of AI applications in PICU settings. Despite this, there was growing recognition of AI's current applications. Trust in AI-driven decisions for PICU management was mixed, with most expressing partial trust. Opinions on AI's role in enhancing diagnostic accuracy and improving patient outcomes varied. Ethical considerations, data privacy, and effective governance to address regulatory and ethical challenges were highlighted as critical concerns.Conclusion: Healthcare practitioners in the PICU preferred using AI for routine patient monitoring but had concerns about its use in diagnoses and advanced healthcare. Concerns were held regarding data privacy, security breaches, and patient confidentiality.

Background: In children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is preferable to femoral access in adults. Study reports support both perspectives. There is no consensus in meta-analyses. Children have yet to be examined in depth. Based on compliance with the central line bundle check lists, we aim to determine CRBSI risk in pediatric intensive care units for patients with non-tunneled femoral and internal jugular venous access. Methods: A retrospective cohort study was conducted on patients with central venous catheters in the pediatric ICU of King Abdulaziz University Hospital between January 1st, 2017 and January 30th, 2018. For the post-match balance, we use a standardized mean difference of less than 0.1 after inverse probability treatment weighting for all baseline covariates, and then we draw causal conclusions. As a final step, the Rosenbaum sensitivity test was applied to see if any bias influenced the results. Results: We recorded 145 central lines and 1463 central line days with 49 femoral accesses (33.79%) and 96 internal jugular accesses (66.21%). CRBSI per 1000 central line days are 4.10, along with standardized infections of 3.16. CRBSI risk differed between non-tunneled femoral vein access and internal jugular vein access by 0.074 (− 0.021, 0.167), P-value 0.06, and relative risk was 4.67 (0.87–25.05). Using our model, the actual probability was 4.14% (0.01–0.074) and the counterfactual probability was 2.79% (− 0.006, 0.062). An unobserved confounding factor was not identified in the sensitivity analysis. Conclusions: So long as the central line bundle is maintained, a femoral line does not increase the risk of CRBSI. Causation can be determined through propensity score weighting, as this is a trustworthy method of estimating causality. There is no better way to gain further insight in this regard than through the use of randomized, double-blinded, multicenter studies.

Background. Children undergoing cardiac surgery with cardiopulmonary bypass (CPB) are exposed to the risk of hormonal imbalances resulting from acute stress, which may eventually result in high postoperative mortality and morbidity. Objective. We assessed adrenal and thyroid hormonal changes and their determinants following cardiac surgery in children and explored their prognostic value in predicting cardiac outcomes. Study Design and Methods. A prospective cohort study was conducted at King Abdulaziz University Hospital (KAUH), between 2017 and 2018. The study involved 46 children aged 14 years or younger who underwent elective cardiac surgery with cardiopulmonary bypass. Serum levels of cortisol, TSH, fT3, and fT4 were measured preoperatively and 24, 48, and 72 hours after surgery. The cardiac risk was assessed using the risk adjustment for congenital heart surgery (RACHS) scale. A composite cardiovascular outcome was analyzed as a numerical variable and calculated as the number of cardiovascular events. Results. Overall, the changes in thyroid function parameters resulted in a U-shaped curve, while cortisol levels yielded a bell-shaped curve. The most significant changes occurred at 24 hours postop, including a decrease in mean TSH by 2.08 μIU/L ( ), fT3 by 2.39 pmol/L ( ), and fT4 by 2.45 pmol/L ( ) and an increase in cortisol levels by 406.48 nmol/L ( ) with respect to the baseline. Cortisol concentration peaked higher and recovered slower among patients with high cardiac risk than their counterparts. Cardiovascular outcomes were independently predicted by the extent of the decline in fT4 and TSH at 48 and 72 hours postop, with reference to the baseline, and by the cortisol level at 24 h postop, independent of the baseline, besides the RACHS category. Conclusion. Cardiac surgery among children yields a high adrenocortical response and a high incidence of nonthyroidal illness syndrome, increasing cardiovascular risk. A preventive management strategy involves improving surgical techniques to minimize trauma-related stress.