Arabic intensive care delirium screening checklist's validity and reliability: A multicenter study.

PURPOSE: To develop an Arabic version of Intensive Care Delirium Screening Checklist (ICDSC) and assess its validity and reliability among critically ill patients. MATERIALS AND METHODS: Multicentered study of convenience sample of adult ICU patients. Arabic translation was performed with rigorous back-to-back translation methods. Concurrent validity was established by calculating the sensitivity and specificity of two examiner assessments compared to a psychiatric evaluation. Kappa coefficients describe interrater reliability, whereas Cronbach α and composite reliability depict internal consistency. RESULTS: Three hundred critically ill patients were enrolled. Of these, validity testing was assessed in 180 patients. ICDSC screening was positive for delirium in 11% of enrolled patients. The area under the receiver operator characteristic (ROC) curve is 0.9413, with predicted sensitivity 70% (95% confidence interval [CI]: 60-81%) and specificity 99% (95% CI: 98-100%). The Arabic ICDSC showed acceptable internal consistency (Cronbach α = 0.63 and composite reliability = 0.64). Interrater agreement was excellent (Kappa coefficient [Ò¡] = 0.85). CONCLUSIONS: Arabic ICDSC is a valid and reliable delirium-screening tool among Arabic-speaking ICU population. Future studies could address whether these findings are generalizable to a higher proportion of mechanically ventilated patients, and address acceptability and reliability in other Arabic language critical care settings.

Effect of nebulized colistin on the ventilator circuit: a prospective pilot case- control study from a single cancer center.

Nebulized colistin (NC) is used for the treatment of pneumonia due to multidrug- resistant Gram-negative bacteria. In this one-year case-control study, our objective was to evaluate the effect of NC on the ventilator circuit (VC) components. The case group consisted of 25 mechanically-ventilated patients who received NC for the treatment of nosocomial pneumonia while the control group was 25 mechanically-ventilated patients who did not receive NC. Respiratory therapists inspected the VC every 4 hrs and whenever a ventilator alarm was reported. The VC component was changed if the alarm did not subside after necessary measures were performed. Patients from both groups were treated at the adult medical/surgical intensive care unit at King Hussein Cancer Center. In the case group, 22 (88%) patients required changing at least one of the circuit components (flow sensor, exhalation membrane, or nebulizer kit). The median number of changes (range) per patient of the flow sensor, exhalation membrane, and nebulizer kit were: 2 (1-3), 2 (1-6), and 1 (1-2), respectively. Large amounts of white crystals, which resembled the colistin powder, were reported on the replaced VC components. The flow sensor was changed in 2 control patients, but white crystals were absent. Crystals obtained from one case subject were confirmed to be colistin by chromatographic mass spectroscopy. Further studies are needed to evaluate the effect of crystal formation on the efficacy of NC and clinical outcomes.

The use of high frequency oscillatory ventilation in a pediatric oncology intensive care unit.

BACKGROUND: High frequency oscillatory ventilation (HFOV) has been successfully used in the management of acute respiratory distress syndrome (ARDS) in children. The aim of our study is to determine its effectiveness in pediatric patients with cancer or post hematopoietic stem cell transplantation (HSCT) diagnosed with ARDS. PROCEDURE: A retrospective case review, in a pediatric intensive care unit (PICU) in a tertiary-care oncology center in Amman, Jordan. Patients included were children with cancer and/or receiving allogeneic HSCT who were diagnosed with ARDS and placed on HFOV from January 2007 to February 2009. RESULTS: Data from 12 pediatric oncology patients on HFOV were analyzed for demographics, oncological diagnosis, PRISM III scores, ventilator settings before switching to HFOV and 24 hours after switching, complications, and outcomes. Alveolar-arterial oxygen (A-a) gradient and oxygen index (OI) were calculated, and pressure of arterial CO(2) (PaCO(2) ) was measured before and 24 hours after switching. Endpoints were successful extubation and discharge, or death while intubated. After 24 hours on HFOV, the A-a gradient decreased significantly in all patients (from a median of 564-267 torr; P=0.001). OI decreased in all but two patients who died (median 17); PaCO(2) decrease was not significant. Five patients died (two of them post-HSCT) and the 7 (58%) survivors were weaned from HFOV (median, 9 days) and discharged. CONCLUSIONS: HFOV improves gas exchange and is useful in managing critically ill children with cancer and post-HSCT patients who develop ARDS.