Delirium is a brain dysfunction that is characterized by attention and cognition disturbances in a fluctuating pattern. International guidelines recommend daily screening of delirium. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) were the most commonly used for delirium assessment. The reasons why this study was developed were to identify the barriers and gaps in knowledge and practice. Multi-center Hospital-based Cross-Sectional study was developed. Multistage sampling technique was used. 72 ICU doctors were randomly selected. Statistical analysis was performed through chi-square test to determine association among variables. It was considered significant when p ≤ 0.05. More than 70% of doctors were ≤ 30 years and females. 69.4% had < 1year experience. 94.4% worked in medical ICUs. Less than 20% of the doctors used delirium assessment tools with a statistically significant difference based on experience (p=0.012). 13.9% had not assessed delirium regularly. Non-pharmacological management was applied by 76.4% of the doctors, communication with patients was the most frequent (75%). Haloperidol was the most used agent (83.3%). 40.3% of doctors had not stopped delirium medications on ICU discharge. Regular assessment of delirium was applied. Yet, the use of validated assessment tools was not common. Non-pharmacological management of delirium is important which is mostly done. Our doctors prescribed anti-psychotics for treatment of both forms of delirium and almost half of them did not stop medications on ICU discharge. Medication reconciliation and contact with the next in-charge of patients is important.

Hyperglycaemia is a major risk factor in critically ill patients as it leads to adverse outcomes and mortality in diabetic and non-diabetic patients. The target blood glucose remained controversial; this study aimed to contribute in assessing the practice of hyperglycaemia control in intensive care units of Khartoum Military Hospital. Furthermore, it proposed a protocol for hyperglycaemia control based on findings. A hospital-based cross-sectional study assessed the awareness and practice towards hyperglycaemia management in a sample of 83 healthcare staff selected through stratified random sampling technique. In addition, 55 patients were enrolled, through quota sampling, after excluding those with diabetic ketoacidosis, hyperosmolar-hyperglycaemic state and patients < 18 years. A self-administrated questionnaire enabled to collect data from healthcare staff, patients data were extracted from medical records. SPSS 23 was used to analyse the collected data. Chi-square and ANOVA tests assessed the association among variables. All statistical tests were considered statistically significant when p < 0.05. The training on hyperglycaemia control differed statistically (p= 0.017) among healthcare staff. The target glycaemic level (140-180 mg/dl) was knew by 11.1% of the study participants. Neither the knowledge nor the practice of hyperglycaemia control methods differed among staff (p> 0.05). The use of sliding scale was 79.3% across the ICUs with a statistically significant difference (p= 0.002). 31.5% of patients had received glycaemic control based on different methods and 11.8% were in the targeted blood glucose level. Sliding scale was the prevalent method used by doctors (71.4%) and nurses (81.6%). A patient benefited from insulin infusion method, which achieved the NICE-SUGAR target. The poor knowledge and lack of awareness towards hyperglycaemia monitoring led to inappropriate implementation of glycaemia control methods across the Military Hospital ICUs. Sustained training programs on hyperglycaemia control to ICU staff and the availability of a protocol on glycaemia control are highly required.

Total parenteral nutrition is one of the important types of nutrition among patients with intestinal failure. This research was intended to assess total parenteral nutrition administration of the intensive care unit patients at the Military hospital, Sudan. A cross-sectional hospital-based study assessed the patients records in the period between April 2014- November 2015, data were analyzed through chi- square test, it was considered significant when p≤ 0.05. Twenty patients who received total parenteral nutrition were assessed, 60% were males, while 40% were females. The most frequent indication for total parenteral nutrition was laparotomy (35% of patients). The duration of total parenteral nutrition was assessed, 70% of patients had duration between 1-20 days. Regarding total parenteral nutrition complications, the most frequent complication was hypokalemia (45% of patients), refeeding syndrome occurred in 10 % of patients. A statistically significant association was found between total parenteral nutrition duration when assessed with age and indication (p= 0.005 and 0.000 respectively). Patients suffering from electrolytes imbalance need more care to avoid the development of refeeding syndrome, as well as high level of hygiene is strictly required to overcome septic complications. There is a need to consider specialized care team composed of nurses, clinical pharmacists and nutritionists.

Background: Delirium is a brain dysfunction that is characterized by attention and cognition disturbances in a fluctuating pattern. International guidelines recommend daily screening of delirium. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) were the most commonly used for delirium assessment. The reasons why this study was developed were to identify the barriers and gaps in knowledge and practice.Methods: Multi-center Hospital-based Cross-Sectional study was developed. Multistage sampling technique was used. 72 ICU doctors were randomly selected. Statistical analysis was performed through chi-square test to determine association among variables. It was considered significant when p ≤ 0.05.Results: More than 70% of doctors were ≤ 30 years and females. 69.4% had < 1year experience. 94.4% worked in medical ICUs. Less than 20% of the doctors used delirium assessment tools with a statistically significant difference based on experience (p=0.012). 13.9% had not assessed delirium regularly. Non-pharmacological management was applied by 76.4% of the doctors, communication with patients was the most frequent (75%). Haloperidol was the most used agent (83.3%). 40.3% of doctors had not stopped delirium medications on ICU discharge.Conclusions: Regular assessment of delirium was applied. Yet, the use of validated assessment tools was not common. Non-pharmacological management of delirium is important which is mostly done. Our doctors prescribed anti-psychotics for treatment of both forms of delirium and almost half of them did not stop medications on ICU discharge. Medication reconciliation and contact with the next in-charge of patients is important.

Hyperglycaemia is a major risk factor in critically ill patients leading to adverse outcomes and mortality in diabetic and non-diabetic patients. The target blood glucose remained controversial; this study aimed to contribute in assessing the practice of hyperglycaemia control in intensive care units of the Military Hospital. Furthermore, the study proposed a protocol for hyperglycaemia control based on findings. A hospital-based cross-sectional study assessed the awareness and practice towards hyperglycaemia management in a sample 83 healthcare staff selected through stratified random sampling technique. In addition, 55 patients were enrolled, through quota sampling, after excluding those with diabetic ketoacidosis, hyperosmolar-hyperglycaemic state and patients < 18 years. A self-administrated questionnaire enabled to collect data from health staff and patient data were extracted from the medical records. SPSS-23 was used to analyze the collected data. Chi-square and ANOVA tests assessed the association among variables, these tests were considered statistically significant when p ≤ 0.05. The training on hyperglycaemia control differed (p = 0.017) between doctors and nurses. The target glycaemic level (140–180 mg/dl) was known by 11.1% of the study participants. Neither the knowledge nor the practice of hyperglycaemia control methods differed among staff (p> 0.05). The use of sliding scale was prevalent (79.3%) across the ICUs (p = 0.002). 31.5% of the patients had received different glycaemic control methods, 11.8% were in the targeted blood glucose level. Sliding scale was the method used by doctors and nurses (71.4% and 81.6% respectively). Lack of awareness about hyperglycaemia management methods was prevalent among ICU healthcare staff. Use of obsolete methods was the common practice in the ICUS of the Military Hospital. Target blood glucose for patients were unmet. Development of a local protocol for glycaemic control in all ICUs is needed along with sustained training programs on hyperglycaemia control for ICU healthcare staff.