Pakistan Journal of Intensive Care Medicine

SUCCESSFUL CONSERVATIVE SURGICAL MANAGEMENT OF SUSPECTED PLACENTA INCRETA IN A PRIMIGRAVIDA: A CASE REPORT

2026-03-07T10:36:40+00:00

Placenta accreta spectrum (PAS) disorders complicate approximately 0.19% (1 in 533) of pregnancies and are associated with significant maternal morbidity and mortality. More than 90% of cases occur in women with prior cesarean delivery, placenta previa, or previous uterine surgery. Occurrence of placenta increta in a primigravida without identifiable risk factors is therefore exceptionally rare and largely limited to isolated case reports. We report a case of a primigravida at 40+1 weeks of gestation with breech presentation and posterior placenta who underwent elective cesarean section. Intraoperatively, the placenta was found to be abnormally adherent to the posterior uterine wall, and a clinical diagnosis of placenta increta was made. The patient developed massive postpartum hemorrhage requiring multidisciplinary intervention. Conservative surgical measures, including bilateral uterine artery ligation, intrauterine packing, and B-Lynch compression suturing, successfully achieved hemostasis and preserved the uterus. The patient recovered well and resumed normal menstrual cycles on follow-up.

THE PREVENTIVE STRATEGIES USED BY CRITICAL CARE NURSES REGARDING VENTILATOR ASSOCIATED PNEUMONIA AMONG PATIENTS WITH TRACHEOSTOMY TUBE

2026-03-02T12:38:09+00:00

Background: Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in intensive care units and is linked to prolonged mechanical ventilation, increased morbidity, and higher mortality. Patients with tracheostomy tubes remain at continued risk despite potential airway management benefits. Critical care nurses are central to implementing VAP prevention bundles; however, adherence to evidence-based practices varies across clinical settings. Objective: To evaluate the preventive strategies used by critical care nurses for ventilator-associated pneumonia among patients with tracheostomy tubes in a tertiary care hospital. Study Design: Descriptive cross-sectional study. Setting: Intensive care units of a tertiary care hospital in Lahore, Pakistan. Duration of Study: January 2025 to June 2025. Methods: A total of 153 registered nurses were recruited using purposive sampling from a population of 250 nurses, with sample size calculated using Slovin’s formula. Data were collected using a structured questionnaire adopted to assess demographic characteristics and evidence-based VAP preventive practices, including humidifier care, ventilator circuit management, suctioning technique, head-of-bed elevation, cuff pressure monitoring, oral hygiene practices, sedation interruption, and spontaneous breathing trials. Data were analyzed using SPSS version 23. Descriptive statistics were presented as frequencies and percentages. Preventive practice levels were categorized as poor, moderate, or good based on composite practice scores. Results: Most participants were aged 21–25 years (47.7%), held BSN/Post-RN qualifications (63.4%), and had 1–5 years of professional experience (74.5%). High compliance was observed in infection control practices, including use of sterile water in humidifiers (98.0%), non-sharing of respiratory equipment (96.1%), aseptic tracheostomy care (96.1%), and ventilator tubing changes when indicated (96.1%). Head-of-bed elevation (89.5%), oral care every 4–8 hours (85.0%), chlorhexidine use (82.4%), and daily spontaneous breathing trials (86.9%) were also frequently reported. However, knowledge gaps were identified regarding correct suction duration (66.0%) and optimal cuff pressure range (68.0%). Overall, 42.5% of nurses demonstrated poor adherence to preventive strategies, 38.6% moderate adherence, and only 19.0% good adherence. Conclusion: While general infection control compliance was satisfactory, significant deficiencies were identified in specific technical aspects of VAP prevention among tracheostomized patients. Structured educational interventions, standardized clinical protocols, and regular competency-based evaluations are recommended to strengthen adherence to evidence-based practices and reduce VAP risk in critical care settings.

ASSESSMENT OF NURSES' KNOWLEDGE REGARDING MALNUTRITION IN CHILDREN UNDER 5 YEARS

2026-03-08T11:10:17+00:00

Background: Childhood malnutrition remains a major public health challenge and contributes substantially to morbidity and mortality among children under five years of age. Nurses play a critical role in the early identification, assessment, and management of severe acute malnutrition in pediatric care settings. Adequate knowledge of evidence-based management protocols is therefore essential to ensure timely treatment and improved clinical outcomes. However, deficiencies in knowledge among healthcare providers may limit effective care for malnourished children. Objective: To assess nurses’ knowledge regarding the management of malnutrition in children under five years of age in pediatric care settings. Study Design: Descriptive cross-sectional study. Settings: Pediatric wards, nutrition stabilization centers, and child health units of tertiary care healthcare facilities. Duration of Study: January to June 2025. Methods: A total of 153 nurses and healthcare providers involved in the care of severely malnourished children were recruited using non-probability convenience sampling. Data were collected through a structured self-administered questionnaire that included demographic characteristics and knowledge-based items related to the management of severe acute malnutrition. Key domains included identification of complications, treatment of hypoglycemia, feeding practices, monitoring of hypothermia, dehydration management, and electrolyte imbalance. Data were analyzed using SPSS version 25. Descriptive statistics were applied, and results were presented as frequencies and percentages. Results: Among the 153 participants, most were aged 21–30 years (54.9%), female (91.5%), and held a nursing diploma (55.6%). Regarding initial management priorities, 27.5% identified treatment or prevention of dehydration as the first step, and 27.5% identified treatment of hypoglycemia as the first step, while 24.8% selected correction of electrolyte imbalance. Hypothermia with dehydration and dehydration with hypoglycemia were the most frequently recognized coexisting conditions (28.1% each). Only 28.1% correctly identified the recommended feeding frequency for hypoglycemia management. Correct identification of hypothermia thresholds was reported by 38.6% of participants, and 28.8% reported appropriate temperature monitoring during treatment. In dehydration management, 37.3% selected replacement of stool losses with oral rehydration solution. A majority (81.7%) correctly recognized sodium imbalance as the electrolyte disturbance associated with edema in severely malnourished children. Conclusion: The findings suggest important knowledge gaps among nurses in several critical aspects of severe acute malnutrition management, particularly treatment prioritization, feeding practices, hypothermia monitoring, and dehydration management. Targeted training and continuing professional education may strengthen nurses’ competencies and support improved management of malnourished children in pediatric healthcare settings.

THE ASSESSMENT OF MOTHERS’ KNOWLEDGE REGARDING NEONATAL JAUNDICE AND ITS TREATMENT

2026-03-05T12:27:56+00:00

Background: Neonatal jaundice is common in newborns, affecting about 60% of term and 80% of preterm infants in the first week of life. While most cases are benign, severe hyperbilirubinemia can lead to serious conditions like acute bilirubin encephalopathy or kernicterus, resulting in neurological damage or death. Early identification and management rely on maternal awareness, as mothers are key in recognising warning signs. In low- and middle-income countries, such as Pakistan, limited maternal knowledge can delay healthcare-seeking and increase risks. Objective: To assess mothers’ knowledge regarding neonatal jaundice and its treatment among mothers attending a tertiary care hospital in Lahore, Pakistan. Study Design: Descriptive cross-sectional study. Settings: Sir Ganga Ram Hospital, Lahore, Pakistan. Duration of Study: January 2025 to June 2025. Methods: A total of 187 mothers of neonates were recruited using convenience sampling. Data were collected using an adopted and translated structured questionnaire comprising demographic variables and 14 knowledge-based items on the definition, causes, complications, and treatment of neonatal jaundice. Each correct response was worth 1 point, for a maximum score of 14. Knowledge levels were categorised as good (>66.6%), moderate (33.3–66.6%), and poor (<33.3%). Data analysis was performed using SPSS version 25. Descriptive statistics, including frequencies and percentages, were used to summarise the findings. Reliability of the questionnaire was assessed using Cronbach’s alpha, while construct validity was examined using the Kaiser–Meyer–Olkin measure and Bartlett’s test of sphericity. Results: Among the 187 participants, the majority were aged 26–35 years (57.8%), had matric or intermediate education (59.4%), and resided in urban areas (79.7%). Most mothers correctly identified neonatal jaundice as a yellow discolouration of the skin (84.0%) and recognised that it commonly occurs in newborns (75.4%). However, misconceptions were frequently observed. Nearly half of the participants believed that maternal dietary intake could cause jaundice (49.2%), while 36.9% attributed the condition to improper breastfeeding. Regarding complications, 62.0% believed jaundice could lead to neonatal death, and 60.4% recognized its potential to cause brain damage. Despite this awareness, 45.5% reported that they might delay seeking hospital care if jaundice developed in their newborn. Overall knowledge assessment showed that 39.0% of mothers had poor knowledge, 38.0% had moderate knowledge, and only 23.0% demonstrated good knowledge regarding neonatal jaundice and its treatment. Conclusion: Maternal knowledge regarding neonatal jaundice in this population was generally limited, with persistent misconceptions about its causes and management. Strengthening maternal education through antenatal counselling, postnatal guidance, and community health awareness programs may improve early recognition and timely healthcare utilisation, thereby reducing the risk of preventable complications associated with neonatal jaundice.