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GUIDELINE
The saudi critical care society clinical practice guidelines on the management of COVID-19 patients in the intensive care unit
Waleed Alhazzani, Faisal A Al-Suwaidan, Zohair A Al Aseri, Abbas Al Mutair, Ghassan Alghamdi, Ali A Rabaan, Mohmmed Algamdi, Ahmed F Alohali, Ayed Y Asiri, Mohammed S Alshahrani, Maha F Al-Subaie, Tareq Alayed, Hind A Bafaqih, Safug Alkoraisi, Saad M Alharthi, Farhan Z Alenezi, Ahmed Al Gahtani, Anas A Amr, Abbas Shamsan, Zainab Al Duhailib, Awad Al-Omari
April-June 2020, 4(2):27-44
DOI:10.4103/sccj.sccj_15_20  
Background: Although recent international guidelines have been published on the management of critically ill patients with the novel coronavirus disease 2019 (COVID-19), there is a vital need to develop clinical practice guidelines tailored to the context of Saudi Arabia. Methods: The Saudi Critical Care Society (SCCS) is the sponsor for this guideline. The expert panel consisted of 19 members. All members completed the World Health Organization Conflict of Interest Form. The expert panel formulated questions on the management of critically ill patients in the intensive care unit with COVID-19. Panel members identified relevant studies. The panel used the categories of Grading Recommendations, Assessment, Development, and Evaluation (GRADE) to assess the confidence in the evidence. Results: The SCCS expert panel issued 53 statements; of which 7 were strong recommendations, 9 were best practice statements, 32 were weak recommendations, and we were not able to issue recommendations in 5 instances. The statements covered different aspects of the critical illness in COVID-19 patients, including: infection control; therapeutic interventions; supportive care; and crisis management. Conclusion: The SCCS guidelines on the management of critically ill COVID-19 patients have been based on the best available evidence and tailored to the context of Saudi Arabia. These guidelines will be updated periodically to incorporate new evidence.
  7 11,954 641
ORIGINAL ARTICLES
Dynamics of SARS-CoV-2 outbreak in the Kingdom of Saudi Arabia: A predictive model
Waleed Tharwat Aletreby, Abdulrahman Mishaal Alharthy, Fahad Faqihi, Ahmed Fouad Mady, Omar Elsayed Ramadan, Bassim Mohammad Huwait, Mohammed Ali Alodat, Abdullah Ba Lahmar, Nasir Nasim Mahmood, Shahzad Ahmad Mumtaz, Waseem Alzayer, Dimitrios Karakitsos
April-June 2020, 4(2):79-83
DOI:10.4103/sccj.sccj_19_20  
Background: COVID-19 is a worldwide pandemic that was first reported in China, and has spread to almost all nations. Measures of containment and control practiced by governments and authorities may benefit from prediction of the extent and peaks of spread to properly prepare to face the pandemic. Aim: The aim of the study was to predict the peak numbers of mortality, intensive care unit (ICU) admission, hospitalization, and positive cases and the time of their occurrence. Settings and Design: The study design is of a mathematical prediction model of prediction of spread of infectious disease, based on data from Saudi Arabia. Materials and Methods: We utilized a SEIR predictive model that divides the population into compartments and utilizes mathematical equations to predict the dynamics of the infection and its peak. The model exploited data from reliable sources on the Internet, and is – by design – based on certain assumptions. Statistical Analysis: Predefined mathematical equations that incorporate different parameters and assumptions were used for statistical analysis. Results: We estimated an R 0 value for our model of 2.2, and the model predicted a peak incidence of the pandemic around July 26, 2020. The peak mortality was predicted at 99,749 persons, predicted peak ICU admission of 70,246 patients, and peak hospitalization of 11,997,936 patients; all these predicted values were out of a total of predicted 14,049,104.83 COVID-19-positive cases. Conclusion: The COVID-19 pandemic in Saudi Arabia is predicted to peak by the end of July 2020, and may pose a serious burden on health-care systems already in shortage. Proper crisis management and effective resource utilization is crucial to safely overcome the pandemic, in addition to continuing control measures at least till the predicted peak time is over.
  4 2,822 246
Exploring acute care workplace experiences of Saudi female nurses: Creating career identity
Sharifah Alsayed, Sandra West
April-June 2019, 3(2):75-84
DOI:10.4103/sccj.sccj_11_19  
Background: Saudi registered nurses (RNs) currently comprise 30% of Saudi Arabia's nursing workforce, and turnover/attrition rates remain problematic. No studies exploring Saudi RNs' experiences of acute care work and/or the factors that influence their decision to continue working were located. Purpose: To construct an insightful understanding of the acute care workplace experiences of female Saudi RNs and factors affecting retention. Methods: Snowball sampling was used to recruit 26 female acute care Saudi RNs who were interviewed about their workplace experiences. A constructivist grounded theory approach was used to code and categorize data to construct a shared understanding reflective of the experiences of participants and the researcher as both constructing the meanings given. Results: Shared understandings of patients' culture, religion, and language were assisting Saudi RNs to feel competent in making a unique contribution to patient care. Although participants reported negative impacts from some workplace policies, they were able to create their own identity and to find their own place by creating a career identity as Saudi-Muslim nurses. Successfully creating this unique nursing identity enhanced their motivation, work commitment, and competence; however, difficulties were encountered in accommodating work conditions and working as a minority group within a workplace largely staffed by foreign nurses. Conclusion: Saudi nurses' acute care workplace experiences were found to be complex and challenging and significantly affected by the lack of supportive policies designed to help them to keep working clinically. Implications for Nursing Policy: Workplace retention of Saudi RNs is an organizational issue that needs wide discussion to enable continuing clinical work of Saudi female nurses.
  3 4,228 342
Cross-Sectional study of the overall emotional functioning of health-care providers in Saudi
Abbas Al Mutair, Fadillah Al Obaidan, Mohammed Al-Muhaini, Khulud Al Salman, Samer Al Mosajen
July-September 2017, 1(3):80-86
DOI:10.4103/sccj.sccj_2_18  
Background: Health-care professionals work long hours, handle demanding patient loads, and make important decisions under conditions of uncertainty. These uncertain conditions have been shown to be associated with negative emotional and psychological outcomes for health-care professionals. In addition, they have been shown to lead to anxiety, depression, and other psychological and interpersonal strains, ultimately compromising the quality of patient care. Purpose: The purpose of this study is to evaluate the mental health issues of health-care providers including anxiety, depression, behavioral control, positive effect, and general distress. Methods: This is a cross-sectional study using a self-administered questionnaire. The questionnaire was distributed to health-care providers working at governmental and private health sectors in Saudi Arabia from January to April 2016. The questionnaire included a demographic survey and the Mental Health Inventory. Forty-five (45%) staff members completed the questionnaire. Results: Health-care professionals scored higher within the psychological distress, anxiety, depression, and loss of behavioral emotional control domains, indicating greater psychological distress. Females scored more on the depression domain than male participants. Further, physicians scored higher on the general positive effect domain than other health-care providers. Non-Saudi health-care providers scored higher on psychological distress scale than Saudi participants. Multiple regression analysis indicated that general positive effect, emotional ties, and life satisfaction were predictors of psychological well-being; on the other hand, anxiety, depression, and loss of behavioral/emotional control were predictors of psychological distress. Conclusion: High psychological distress may result from stressors associated with high work demands, workload, staff shortage, fear of infection, licensing board, fear of losing job, fear of reaction from leadership, peer, and patients and their families. Implication for Nursing Policy: Organizational supportive programs should be developed to enhance the psychological well-being of health-care professionals. These programs may decrease staff stress, anxiety, and depression and contribute to improve psychological well-being.
  3 3,557 249
ORIGINAL ARTICLE
Assessment of knowledge, attitude, and practice of hand hygiene among medical and health profession students at King Saud Bin Abdulaziz University for Health Sciences in Saudi Arabia
Mohammed Bin Humran, Khalid Alahmary
October-December 2018, 2(4):66-72
DOI:10.4103/sccj.sccj_6_19  
Background: In recent years, patients' safety has become high priority for health-care organizations. It has been documented that poor knowledge and compliance of health-care providers toward hand hygiene have contributed to poor patient safety outcomes. College students of health sciences may not receive adequate education and training on hand hygiene best practices. Objectives: To assess the health profession students' knowledge, attitude, and practice toward hand hygiene and to investigate the factors associated with poor hand hygiene knowledge and practice. Methods: This cross-sectional, correlational, descriptive study was conducted at King Saud Bin Abdulaziz University for Health Sciences performing clinical rotations at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A proportional sampling was used to calculate the required proportions that reflect the size of student population form each of the three colleges. A total of 270 students including 140 medical, 83 nursing, and 47 respiratory therapy students who were selected using a simple random sampling method were included in the study. An adapted and validated knowledge, attitude, and practice (KAP) questionnaire was used to assess four domains: general information, knowledge, self-reported compliance to the WHO 5 Moments of Hand Hygiene, and general satisfaction on received education. Results: The overall average of knowledge score was 81.13 points out of 100. The results revealed that the knowledge score of hand hygiene was higher for nursing school (84.22 ± 12.98), followed by medical school (81.71 ± 11.31) and then respiratory therapy program (75.53 ± 11.76). The results also showed that students who took courses covering hand hygiene scored higher in knowledge score (83.28 ± 11.3) as compared to students who did not take such courses (75.16 ± 12.89). In the compliance domain, the results showed that there were no significant differences in compliance of hand hygiene between students in all categories. In terms of overall student satisfaction with hand hygiene education and training, the results showed that nursing students have higher satisfaction score (72.7%) than their counterparts in medical school (48.3%) and respiratory therapy program (49.7%). Conclusion: Hand hygiene knowledge among students was generally good, and the highest was among nursing students and the lowest among respiratory therapy students. The compliance of students toward the WHO 5 Moments of Hand Hygiene did not vary across different colleges. Improved knowledge was found to be associated with improved compliance with hand hygiene best practices. Recommendations: Increasing the academic focus on hand hygiene in both the curriculum and clinical rotations with periodic standardized educational courses and focusing on hands-on workshops could have a positive impact on the knowledge and practice of hand hygiene for current health sciences students and future health-care providers. Future studies are needed to assess the hand hygiene KAP among students in hospital settings using observation of actual practice.
  2 3,523 273
ORIGINAL ARTICLES
Colistin monotherapy versus colistin-based combination therapy in the treatment of extensive drug-resistant Acinetobacter baumannii infections: A retrospective cohort study
Awad Al-Omari, Waleed Alhazzani, Maha F Al-Subaie, Ziad Memish, Hesham Abdelwahed, Jinhui Ma, Mohammed Abdullah Alamri, Saleem Saleh Alenazi, Haifa Al-Shammari, Hazem Aljomaah, Samer Salih, Suleiman Al-Obeid
July-September 2017, 1(3):87-94
DOI:10.4103/sccj.sccj_18_17  
Introduction: Acinetobacter baumannii is a Gram-negative Coccobacillus and is a frequent cause of hospital-acquired infections. Because some strains of A. baumannii are resistant to many antibiotics (i.e., extensively drug-resistant A. baumannii, or XDRAB), selecting antibiotics to treat infected patients is challenging. Clinical outcomes in critically ill patients with XDRAB infections are poor. In this study, we evaluated the clinical effectiveness of colistin as monotherapy and in combination with other antibiotics. Patients and Methods: A retrospective cohort study was performed on 94 critically ill patients (age ≥18 years) to assess the clinical effectiveness of treating XDRAB infections with colistin, either in monotherapy or combination with tigecycline, meropenem, or both. Clinical and microbiological data were obtained from patient records. We included patients suffering from XDRAB ventilation-associated pneumonia (VAP), or ventilator-associated tracheobronchitis (VAT), or VAT with bacteremia. Results: The mean age of the patients was 53.3 years (±23.7 years), and the mean Acute Physiology and Chronic Health Evaluation II score was 22.7 (standard deviation = 7.1). VAP and VAT with bacteremia were found in 84% and 16% of patients, respectively. Half (51%) of patients achieved microbiological clearance. The median Intensive Care Unit (ICU) stay was 29 days (interquartile range [IQR]: 17, 55) and the median mechanical ventilation (MV) duration was 21 days (IQR: 12, 42). MV duration and ICU length of stay were lower in the group of patients treated with colistin and meropenem than in those treated with colistin alone. Mortality was significantly lower in patients who received (colistin and tigecycline 30%) than in those who were treated with monotherapy (75%) with an odd ratio 0.03 (95% confidence interval: 0.00, 0.32; P < 0.01). Conclusions: Colistin-based combination treatment regimens mainly with tigecycline or with tigecycline and meropenem were associated with better treatment outcomes of XDRAB-induced VAP and VAT with bacteremia than colistin monotherapy.
  2 4,478 262
REVIEW ARTICLES
TAME cardiac arrest: A phase III multicenter randomized trial of targeted therapeutic mild hypercapnia after resuscitated cardiac arrest
Glenn M Eastwood, Alistair Nichol, Rinaldo Bellomo, Yaseen Arabi
2017, 1(6):10-13
DOI:10.4103/sccj.sccj_23_17  
Cardiac arrest (CA) is a catastrophic world-wide health problem with substantial human and financial costs. Ongoing cerebral vasoconstriction and cerebral hypoxia during the early post-resuscitation period may contribute to the often poor neurological outcome in CA survivors. Arterial carbon dioxide (PaCO2) is the major determinant of cerebral blood flow and an increased PaCO2 (hypercapnia) markedly increases cerebral blood flow and oxygenation. This paper reports on the background and method of The TAME Cardiac Arrest trial (Clinicaltrials.gov (NCT03114033) which is a phase III multi-center, randomized, parallel-group, controlled trial. The trial will determine if targeted therapeutic mild hypercapnia (TTMH) (PaCO250-55mmHg) during mechanical ventilation improves neurological outcome at 6 months compared to targeted normocapnia (TN) (PaCO235-45 mmHg) in resuscitated CA patients. The intervention is cost-free and will be applied over the first 24-hours of ICU care. A total of 1700 adult resuscitated CA patients from ICUs around the world will be enrolled. When completed the TAME Cardiac Arrest trial will provide unprecedented insights that will transform the care of resuscitated CA patients admitted to the intensive care unit (ICU) around the world. Moreover, this therapy is cost free and, if shown to be effective, will improve thousands of lives, transform clinical practice, and yield major financial savings.
  2 3,412 196
CASE REPORT
Herpes zoster coinfection and the current COVID-19 pandemic

October-December 2020, 4(4):130-133
DOI:10.4103/sccj.sccj_45_20  
Clinical presentation of COVID-19 infection can be variable in the current pandemic, even in patients presenting to the clinic with mild history of upper respiratory complaints. Various cutaneous manifestations have been noticed in COVID-19 patients with herpes zoster (HZ) being one among them. HZ is an infection that results when varicella zoster virus reactivates from its latent state in a posterior dorsal root ganglion. Here, we aim to expand our knowledge by reporting three cases of associated zoster infection in COVID-19 patients admitted to our intensive care unit in view of respiratory complaints. All the three patients admitted had revealed lymphocytopenia at the time of HZ diagnosis and were managed conservatively throughout the course. In all the cases, acyclovir/valacyclovir led to the resolution of lesions in 10 days. No postherpetic sequelae were observed. We hereby suggest that the clinical presentation of HZ at the time of current pandemic should be considered as an alarming sign for a latent subclinical SARS-CoV-2 infection and thorough follow-up of such patients should be adopted.
  1 2,603 149
CASE REPORTS
Phosphate-induced hypocalcemia may have a role to play in a patient of recurrent cardiac arrest with severe hypophosphatemia
Mohammed Rizwan Jabbar, Arijit Sardar
January-March 2018, 2(1):12-14
DOI:10.4103/sccj.sccj_12_18  
Hypophosphatemia is a common electrolyte abnormality in our day-to-day practice in Intensive Care Unit. Severe hypophosphatemia is usually multifactorial and can lead to devastating consequences such as cardiac arrest. Phosphate replacement can be considered in severe symptomatic hypophosphatemia. We describe a patient of chronic alcoholic and diabetic who presented with diabetic ketoacidosis, right-lung pneumonia, and septic shock. Subsequently, the patient developed recurrent cardiac arrest. Both hypophosphatemia and phosphate-induced hypocalcemia were attributed to be the cause of this recurrent cardiac arrest.
  1 3,290 153
EDITORIAL
Moving the critical care research agenda forward in Saudi Arabia
Yaseen M Arabi, Yasser Mandourah, Fahad M Al-Hameed, Khalid Maghrabi, Mohammed S ALshahrani, Musharaf Sadat
January-March 2019, 3(1):1-2
DOI:10.4103/2543-1854.259476  
  1 2,338 230
Extracorporeal membrane oxygenation in COVID-19: The Saudi ECLS-Chapter perspective

October-December 2020, 4(4):115-118
DOI:10.4103/sccj.sccj_55_20  
  1 3,140 211
Average length of patient stay in inpatient and the emergency room
Hiba Chagla, Abbas Al Mutair
April-June 2019, 3(2):73-74
DOI:10.4103/2543-1854.267617  
  1 2,394 204
ORIGINAL ARTICLE
Exploring factors affecting critical care response team service at a tertiary hospital in Riyadh: A retrospective cohort study

October-December 2020, 4(4):123-129
DOI:10.4103/sccj.sccj_57_20  
Background: Critical care response team (CCRT) is a proactive department of intensive care unit (ICU) that consists of an intensivist, a staff physician, a critical care nurse, and a respiratory therapist. The purpose of this team is to manage patients in their wards to avoid unnecessary ICU bed occupancies. The aim of the study is to explore factors affecting CCRT service in terms of patient disposition and mortality rate and to analyze interventions provided to the patients by the team. Materials and Methods: This is a retrospective cohort study conducted at a tertiary hospital in Riyadh. All CCRT event data collection forms from the period between February 2018 and April 2019 were reviewed. Patients meeting our criteria were included. Outcome measures were as follows: (1) patient disposition. (2) mortality rate. Factors that were tested for effect on CCRT service were patient age, activation time, and reasons for activation. All statistical analyses were done using SAS software 9.4. Results: A total of 1088 CCRT events were considered during the period of the study. Out of all deaths, the mean age was 70.90 ± 16.67 compared to the mean age of survivors 61.21 ± 20.65 (P < 0.0001). Furthermore, older patients had higher chances for ICU transfer (P = 0.0399). CCRT service was not affected by activation time as patient disposition and mortality rates were almost the same in activations during and out of work hours. The most common reason for CCRT activation was tachypnea (28.49%). Majority of patients within each reason for activation were not transferred to the ICU, except for low oxygen saturation (50.54% transferred to the ICU) (P = 0.0001), decreased level of consciousness (DLOC) (49.40% transferred to ICU) (P = 0.0001). Patients not transferred to the ICU had lower mortality rate (15.18%) than those transferred to the ICU (55.41%) (P < 0.0001). Conclusion: Given these results, increased vigilance and quick responses to CCRT calls for older patients, and those with low oxygen saturation and DLOC, must be considered. Increased vigilance is also needed for those spending more time in ICUs.
  1 1,274 124
ORIGINAL ARTICLES
Critical care pharmacy services in the Western Region of Saudi Arabia
Ohoud A Aljuhani
April-June 2020, 4(2):66-72
DOI:10.4103/sccj.sccj_2_20  
Background: The value of critical care pharmacists (CCPs) in intensive care units (ICUs) has been well documented, and various studies have demonstrated the positive impacts of CCPs. Despite growing evidence supporting the contributions of clinical pharmacists in general and CCPs in particular in improving patient outcomes, many hospitals in the Kingdom of Saudi Arabia (KSA) still lack clinical pharmacy services. Most studies that have measured the impacts of CCPs in ICU settings have been conducted outside Saudi Arabia, with a significant gap in the literature related to CCP-related impacts, needs and obstacles in Saudi Arabia. Objective: To evaluate the current status of CCP services and the CCP services that are needed in Saudi Arabia as well as the barriers to establishing these services. Setting: Governmental and non-governmental hospitals in the western region of the KSA. Method: This was a cross-sectional survey-based study conducted in the western region of the KSA. The questionnaire included questions investigating current CCP services, which include clinical, educational, administrative and research services. Additional questions assessed the obstacles, needs and limitations related to the development of CCP services. Main Outcome Measures: The primary outcome is to describe the current status of ICU pharmacists in the KSA. Secondary outcomes of interest are the evaluation of the need for CCP services and the identification of the main barriers to establishing these services. Results: Of the 130 hospitals with ICUs to which surveys were emailed, 94 (72%) responded. Forty-three percent of responding hospitals had an ICU multidisciplinary team structure that included a pharmacist who visited the unit during medical rounds. Up to 54% of the hospitals with CCP services had one dedicated pharmacist present at bedside and during medical rounds. Approximately 78% of the ICU pharmacists performed one or more clinical activities. Training pharmacy interns was one of the major educational activities provided by ICU pharmacists. Clinical services (42%) were the most needed services, followed by educational (14%) activities. Limited job availability was the main barriers to having CCP services among hospitals. Conclusion: Critical care pharmacists in the western region of the KSA mainly provide fundamental clinical services, with limited engagement in desirable and optimal services such as research activities. The limited CCP services in the KSA are due to several barriers that warrant national efforts from the Ministry of Health (MOH) and the Saudi Commission for Health Specialists (SCFHS).
  1 2,660 196
Saudi family perceptions of family-witnessed resuscitation in the adult critical care setting
Abdulaziz Alshaer, Khalid Alfaraidy, Florence Morcom, Wasaif Alqahtani, Zahra Alsadah, Atheer Almutairi
October-December 2017, 1(4):113-117
DOI:10.4103/sccj.sccj_5_18  
Background: During cardiopulmonary resuscitation, family members are usually pushed out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Some health organizations worldwide such as American Heart Association and the Resuscitation Council in the UK supports family-witnessed resuscitation (FWR) and urge hospitals to develop policies to ease this process. The opinions on FWR vary widely among various cultures, and some hospitals are not applying such polices yet. This is the first study which explores the Saudi family members' opinion for family witness resuscitation in adult critical care setting. Objectives: To investigate whether patient's next of kin would like to have been present in the resuscitation room during attempted cardiopulmonary resuscitation (CPR) of their relative and their experience or knowledge of what is involved in CPR. Subjects and Methods: A retrospective, descriptive telephone survey of families of patients who had admitted in critical cares areas from January 2016 to June 2016. A family presence survey was developed to determine the desires, beliefs, and concerns about FWR. Results: Out of the 235 respondents, 143 (60.9%) wanted to be present in the room of their loved one just before death while CPR was going on. One hundred and eighty-two (77.4%) of the respondents believed that the family members should be with their loved one before death. More than half, i.e., 141 (60.0%) of the respondents believed that their presence might have eased the suffering of the deceased. One hundred and fifty-seven (66.8%) of the family members thought that their presence with the deceased in their last moments could have helped their sorrows and sadness. Conclusion: Most relatives of patients requiring CPR would like to be offered the possibility of being in the resuscitation room; this could have several benefits, so this study suggests that institutions should consider establishing programs of witnessed cardiopulmonary resuscitation for family members.
  1 5,166 238
A pre-post study evaluating the effectiveness of a new initiative, the “PRESSURE Bundle,” Compared with standard care in reducing the incidence and prevalence of sacral pressure ulcers in Critically Ill Patients in an intensive care unit in Riyadh, Saudi Arabia
Anas Ahmad Amr, Amin M Yousef, Mohammad F Amirah, Mahmoud H Alkurdi
July-September 2017, 1(3):75-79
DOI:10.4103/sccj.sccj_29_17  
Objective: Pressure ulcers present a major health challenge worldwide, and critically ill patients are considered to be at the greatest risk for pressure ulcer development. A study was undertaken to evaluate the effectiveness of pressure ulcer prevention measures (“PRESSURE bundle”) compared with standard care in reducing the incidence and prevalence of sacral pressure ulcers in critically ill patients in an Intensive Care Unit (ICU) in Riyadh, Saudi Arabia. Methods: Patients were assigned to the standard care group (n = 330) or the “PRESSURE bundle” group (n = 360). The follow-up period for both treatment groups was 2 months. A pre-post study design was used where data were collected in two samples. Patients were aged 16 years or over and included all new patients admitted to the ICU who did not have but were considered at risk of developing, sacral pressure ulcers (Braden scale score <18). Results: In the PRESSURE care bundle group, there was a significant reduction (P < 0.001) in the incidence of newly developed sacral pressure ulcers in the 2 months treatment period (n = 1, 0.3%) compared with the standard care group (n = 16, 4.6%). There was also a significant reduction (P < 0.001) in the prevalence of sacral pressure ulcers in the PRESSURE care bundle group (4.75%) compared with the standard care group (22.7%) when prevalence figures were compared at the end of the treatment periods. Conclusion: The application of a group of pressure ulcer prevention measures (“PRESSURE bundle”) coincided with a reduction in incidence and prevalence of sacral pressure ulcers in critically ill patients who are at risk for developing pressure ulcers.
  1 7,252 358
REVIEW ARTICLE
Building capacity in critical care research coordination in Saudi Arabia: The role of the Saudi critical care trials group
Ahmad M Deeb, Eman Al Qasim, Lara Afesh, Sheryl Ann Abdukahil, Musharaf Sadat, Yaseen M Arabi
July-September 2018, 2(3):35-41
DOI:10.4103/sccj.sccj_30_18  
Critical care research is growing around the world including Saudi Arabia. The objective of this review is to discuss the building capacity in critical care research coordination in Saudi Arabia as a part of the research strategy of the Saudi Critical Care Trials Group (SCCTG). The SCCTG was developed to promote high impact critical care research in Saudi Arabia and to facilitate collaboration in national and international clinical research. Well-organized coordination between all parties is necessary by the presence of qualified clinical research coordinator (CRC). Critical care has unique features that make clinical research conduct more complex and demanding. It is a high-risk area with increased potentiality of error or adverse events occurrence. Critical care providers such as critical care nurses, critical care pharmacists, respiratory therapists, critical care physiotherapists, or intensive care unit physicians with added skills may be appropriate candidates to handle CRC roles in critical care setting. These skills include but not limited to data collection, obtaining consent, patient assessment, patient screening for the study eligibility, data entry, ethics submissions, providing teaching regarding the study protocol and research topics to clinical staff, attending to regulatory requirements, and designing data collection tools. The SCCTG shall focus on training the clinical research coordination skills through providing specialized courses and workshops that enable different hospitals to conduct and participate in clinical research. It will also help developing network group to connect critical care CRCs in Saudi Arabia and worldwide.
  1 3,101 178
COVID-19: What we all intensivists should know
Srikant Behera, Simant Kumar Jha, Nitesh Kumar Singh, Gopi Chand Khilnani, Anurag Mahajan, Shiv Kumar, Alok Kumar, Sudhanshu Sant
April-June 2020, 4(2):45-57
DOI:10.4103/sccj.sccj_16_20  
Coronaviruses were identified as a viral family in the 1960s and are known to infect both humans and animals. Novel strain of coronavirus was identified when some cases of pneumonia began to arise in Wuhan province of China without any apparent cause. Later, this novel strain was called as coronavirus disease 2019 (COVID-19). Since 2002, coronavirus has been known to cause two widespread outbreaks in humans: severe acute respiratory syndrome coronavirus in 2003 and Middle East respiratory syndrome-CoV in 2012. The present crisis began to arise in late November of 2019 and then rapidly grew to become a pandemic. The present medical crisis resulted because high virulence of this virus simultaneously infected large number of patients. Although only a small proportion of COVID-19-infected patients require hospitalization, mortality is significantly higher in elderly and in patients with preexisting diseases. Patients with COVID-19 can present with an array of symptoms such as fever, dry cough, myalgia, vomiting, and loose motions. In later stages, it can progress to breathing difficulty. High virulence of COVID-19 puts the health-care workers (HCWs) at extreme risks of contacting this infection. COVID-19 is mainly diagnosed on the basis of clinical symptoms along with reverse-transcription polymerase chain reaction (RT-PCR). However, sensitivity of RT-PCR is 67% in the first 7 days and subsequently it falls to below 50% from the 2nd week onward. Total antibody has also been used to diagnose COVID-19. They have a lower sensitivity in initial days, but their sensitivity increases to 90% above from the 2nd week onward. Currently, management of COVID-19 is focused on supportive treatment as no drug till date has proven efficacy against novel coronavirus. Current trials have shown some promise with remdesivir. Although hydroxychloroquine rose to fame with earlier studies, its role in the management of COVID-19 was not established in further research. Current focus of the world to control this pandemic is on prevention through social distancing, use of face mask, regular hand washing, cough etiquette, and isolation of suspicious and confirmed cases. This article deals with nature, progression, and possible outcomes of this infection along with necessary steps that must be taken by a HCW to preventing himself from catching COVID-19.
  1 2,440 229
REVIEW ARTICLES
Adjunctive continuous ketamine infusion to conventional sedation in mechanically ventilated patients: It is time for a randomized trial
Mohammed Bawazeer, Marwa Amer, Khalid Maghrabi, Kamel Al-Sheikh, Rashid Amin, Muhammad Rizwan, Mohammad Shaban, Malak Altewerki, Fawziah Alkhaldi, Sanaa Alenazi, Mehreen Bao, Edward De Vol, Mohammed Hijazi
January-March 2020, 4(1):5-8
DOI:10.4103/sccj.sccj_9_20  
Managing sedative and analgesic medications is an essential part of critical care medicine. There is a shift toward favoring the use of nonbenzodiazepine agents because of their side effects. There is an increasing interest in using ketamine as an analgo-sedative in the intensive care unit because of its unique pharmacologic properties. A comprehensive literature search was performed to capture all the studies involving ketamine use in critical care. We searched PubMed, EMBASE, and Cochrane databases. We also extracted the references from major review articles and recent guidelines. In this review, we present the most up-to-date studies done on this topic. We also present the proposal for a future multicenter randomized trial through the Saudi Critical Care Trials Group.
  1 1,688 192
Prevention of pressure injury in the intensive care unit
Hasan M Al-Dorzi
January-March 2019, 3(1):24-28
DOI:10.4103/2543-1854.259474  
Pressure injury (PI) is common in critically ill patients and is largely preventable. Prevention of PI in the intensive care unit (ICU) depends on routine risk assessment and implementation of preventive measures, such as adequate nutritional support, proper positioning and repositioning, mobilization, proper skin care, use of appropriate pressure-redistributing surfaces, and application of skin protective dressings. The available evidence suggests that a multifaceted approach is usually required. In addition, there is a need for high-quality studies to guide PI prevention in ICU patients.
  1 9,306 599
Central line-associated bloodstream infections in the Kingdom of Saudi Arabia
Raymond M Khan, Jawad Subhani, Yaseen M Arabi
January-March 2019, 3(1):43-48
DOI:10.4103/2543-1854.259482  
Healthcare-associated infections (HAI) are a preventable cause of morbidity and mortality in the Kingdom of Saudi Arabia and internationally. They are associated with increased length of stay, mortality, antibiotics cost, and overall hospital cost. About 250,000 central line-associated bloodstream infections (CLABSI) occur in the US yearly, with a rate of 0.8 per CL-days and attributed mortality of 12%–25%. CLABSI constitutes 14.2%–38.5% of HAIs in the Kingdom, with rates varying from 2.2 to 29.7/1000 CL-days and crude device-associated mortality of 16.8%–41.9%. This article highlights the scope of the problem and outlines preventive strategies.
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Society of critical care medicine discovery: Collaborative critical care research network
Jonathan E Sevransky, Ognjen Gajic
2017, 1(6):17-18
DOI:10.4103/sccj.sccj_25_17  
Large-scale clinical trials networks are best suited for understanding how care is delivered, generating evidence to minimize unnecessary heterogeneity of patient care, and testing different care patterns and medications to improve clinical outcomes. Discovery, the Critical Care Research Network, was launched in 2017 as a combined effort of the United States Critical Illness and Injury Trials (USCIIT), the Critical Care Pharmacotherapy Trials Network (CCPTN), and the Society of Critical Care Medicine (SCCM). In collaboration with our colleagues we hope to contribute evidence to help improve the care of the critically ill and injured
  1 2,642 137
Prevalence and outcomes of colistin-resistant Acinetobacter infection in Saudi critical care units
Ayman Kharaba
2017, 1(6):25-27
DOI:10.4103/sccj.sccj_28_17  
Acinetobacter baumannii is a common healthcare associated problem. It can cause a wide variety of nosocomial infections because of its tremendous ability of acquiring antibiotic resistance and to survive in hospital environments. It's associated with high morbidity and mortality. So it has been considered as one of the dangerous organisms by the Infectious Diseases Society of America. In Saudi Arabia, many studies highlighted the magnitude of Acinetobacter baumannii infections but most of the studies were small. We plan to conduct a large multicenter prospective study in major ICUs in Saudi Arabia to determine the prevalence and prognosis of Acinetobacter baumannii infection, resistant pattern, risk factors associated with resistant and outcomes.
  1 2,579 162
SYSTEMATIC REVIEW AND META-ANALYSIS
Postpyloric feeding in critically ill patients: Updated systematic review, meta-analysis and trial sequential analysis of randomized trials
Fayez Alshamsi, Rucha Utgikar, Saleh Almenawer, Mustafa Alquraini, Bandar Baw, Waleed Alhazzani
January-March 2017, 1(1):6-23
DOI:10.4103/2543-1854.208928  
Background: Current guidelines recommend early enteral nutrition in the critically ill. Nutritional deficiencies in this population may result in unfavorable outcomes. However, enteral nutrition may be complicated with feeding intolerance, aspiration, pneumonia, and interruption of feeding. Objectives: We updated our systematic review and meta-analysis that compared the effect of postpyloric and gastric feeding on risk of pneumonia, duration of mechanical ventilation (MV), Intensive Care Unit (ICU) length of stay (LOS), gastrointestinal (GI) bleeding, aspiration, vomiting, and mortality. Methods: We searched MEDLINE, EMBASE, and clinical registries for data through April 2017 without language or date of publication restrictions. We included randomized controlled trials (RCTS) comparing postpyloric feeding to gastric feeding. Two reviewers independently screened titles and abstracts for eligibility and extracted data in duplicate. Reviewers used the Cochrane Collaboration tool to assess the risk of bias, and the Grading of Recommendations, Assessment, Development, and Evaluation methodology to assess the quality of the evidence. We used trial sequential analysis (TSA) as a sensitivity analysis to adjust for sequential testing. Results: We included 21 RCTs (1573 patients). Postpyloric feeding reduced the risk of nosocomial pneumonia (relative risk [RR] 0.73; 95% confidence interval [CI] 0.57, 0.95; P = 0.02; I2 = 11%; moderate quality), ventilator-associated pneumonia (RR 0.74, 95% CI 0.57, 0.96; P = 0.02; I2 = 10%, moderate quality), and duration of MV (mean difference [MD] - 2.10 days, 95% CI −3.93, −0.28; P = 0.02; I2 = 67%, low quality), compared to gastric feeding. There was no difference in mortality (RR 1.07, 95% CI 0.90, 1.27; P = 0.44; I2 = 0%, moderate quality), ICU LOS (MD - 1.01 days, 95% CI −3.32, 1.3; P = 0.39; I2 = 84%, very low quality), aspiration (RR 0.81, 95% CI 0.4, 1.60, P = 0.54; I2 = 21%, very low quality), vomiting (RR 0.97, 95% CI 0.70, 1.36, P = 0.87; I2 = 33%, very low quality), and GI bleeding (RR 0.88, 95% CI 0.56, 1.38; P = 0.56; I2 = 0%, very low quality). Sensitivity analysis using TSA mirrored those of conventional analyses. Conclusions: Moderate quality evidence showed that postpyloric feeding may reduce the risk of pneumonia. Low-quality evidence yielded that duration of MV is shorter with pyloric compared to gastric feeding, with no significant impact on other outcomes. Although the results are promising further assessment in large clinical trials is warranted.
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SYSTEMATIZED REVIEW
A systematized review aimed to identify the impact of basic electrocardiogram training courses on qualified nurses
Fahad Zeed Alanezi
October-December 2018, 2(4):51-65
DOI:10.4103/sccj.sccj_2_19  
Aims: A systematized review aimed to identify the impact of basic electrocardiogram (ECG) training courses on qualified nurses. Background: ECG plays a crucial role in helping to diagnose, follow-up, and detect any abnormalities in patients' conditions. Nurses often work on the frontline in hospitals and are the ones who initially assess patients' conditions. According to the British Heart Foundation (n. d), 26% of all mortality in the UK is attributable to heart and circulatory diseases. Methodology: A comprehensive, systematized review was undertaken using the AMED, EMBASE, CINAHL, and MEDLINE databases. Thematic analysis was then used to synthesis the findings from the studies selected. Ten papers were selected following the application of inclusion and exclusion criteria. Conclusion: Basic ECG training courses were found to improve nurses' knowledge, compared to those who did not possess ECG training, the quality of care was seen better among nurses who had received ECG courses, and even patient outcomes were improved in the total number of myocardial infarction events in hospital which was decreased compared to before the intervention. Cardiac care nurses had better ECG interpretation skills than other nurses regardless if they took ECG courses or not.
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* Source: CrossRef