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REVIEW ARTICLES
The cuff leak test prior to extubation: A practice based on limited evidence
Kim Lewis, Waleed Alhazzani
2017, 1(6):22-24
DOI:10.4103/sccj.sccj_27_17  
Endotracheal intubation and mechanical ventilation are lifesaving interventions that are commonly performed in the intensive care unit (ICU). The trauma of endotracheal intubation itself, the prolongued pressure exerted by the endotracheal tube on the larynx, and miscellaneous factors such as fluid overload can result in laryngeal edema (LE). Extubation of a patient with undiagnosed LE can results in respiratory failure secondary to an upper airway obstruction and may require reintubation. Respiratory failure requiring reintubation is associated with morbidity and mortality. The cuff leak test (CLT) is the only method intensivists use to predict the presence of LE. Despite the CLT's first description in 1988, the correct way to interpret the results (either qualitatively or quantitatively) is unknown, and its diagnostic accuracy has been called into question. In fact, the CLT could be detrimental to patients if it has a high false positive rate (i.e. no air leak is detected indicating LE when none actually exists). Incorrectly diagnosing patients with LE may result in prolongued mechanical ventilation that predisposes patients to barotrauma, ventilator-associated infections, exposure to systemic steroids, and a prolongued stay in the ICU. Given the paucity of data, the Cuff Leak and Airway Obstruction in Mechanically Ventilated ICU Patients (COMIC) research group is conducting a survey to understand international practice surround the use of the CLT prior to extubation, as well as a randomized controlled trial that will capture the accuracy of the test and determine the bet method to measure cuff leak.
  17,763 566 -
The experience of adult patients who have tracheostomy tubes in situ: A systematic review
Mohammed Al Humaid, Rick Wiechula
January-March 2017, 1(1):24-42
DOI:10.4103/sccj.sccj_2_17  
Background: There is a wide range of conditions requiring a patient to have tracheostomy tube insertion. The use of tracheostomy tubes in hospitals has increased among patients with both stable and critical conditions. Respiratory illness may make it necessary for patients to have an alternative breathing system (apart from the mouth or nose) whether as a temporary or permanent procedure. Patients have different experiences of tracheostomy tube insertion. Aims: This study aims to perform a systematic review of qualitative research into the experiences of patients treated with a tracheostomy tube. Objective: The objective of this study is to systematically appraise qualitative evidence on the experience of adult patients having a tracheostomy tube in situ. The report seeks to answer the following question: What are the experiences faced by adult patients with a tracheostomy tube in situ? Inclusion Criteria: Types of Participants: This review included any research that used qualitative methods to investigate the experiences of adult patients with tracheostomy tube insertion. Phenomenon of Interest: The phenomenon of interest was the experience of patients with a tracheostomy tube in situ either as a temporary or permanent procedure, either in hospital or in the community. Types of Studies: This review deliberated on studies that concentrated on qualitative data. The review included all study designs; for instance, phenomenology, action research, grounded theory, feminist research, and ethnography. Search Strategy: The review included all relevant studies published in Arabic and English obtained from the following databases: CINAHL, Cochrane Library, EMBASE, MEDLINE (PubMed), and Scopus and reference lists. There was no limitation on year of publication, and reference list items were searched along with keywords in the heading, abstract, and topic descriptors. Methodological Quality: The methodological quality of each study was assessed by applying the Joanna Briggs Institute's Qualitative Assessment and Review Instrument. Data Collection: The study included adult patients treated with a tracheostomy tube. The research literature was searched using the standard methodology of qualitative research. The two reviewers then applied inclusion and exclusion criteria to the studies and evaluated the findings that met the inclusion criteria on the same subject. Data Synthesis: Synthesis of all data enabled a statement to be created that explains the experiences of adult patients with a tracheostomy tube in situ in the hospital or community. The data were then characterized according to the quality of findings and the similarity of meaning. Results: Four studies met the study selection criteria and were included in the systematic review that determined the experience of patients with a tracheostomy tube in situ. There were 18 findings extracted from the included studies. These were synthesized and then grouped into seven categories in relation to similarity of meaning. The seven categories remaining were then synthesized in a meta-synthesis that produced four outcomes linked to the experiences of participants having a tracheostomy tube in situ: (i) Communication is fundamental. (ii) The experience has both physical and psychological impacts. (iii) There are long-term consequences. (iv) Staff and patients work together to achieve positive outcomes. Conclusions: In the studies appraised by the reviewers, the importance of understanding the experiences of adult patients with tracheostomy tubes in situ was clarified. Patients have a right to experience correct practices that may help them to adapt to a new lifestyle with a tracheostomy. Implications for Practice: Patients should be given support physically, psychosocially, and emotionally after tracheostomy tube insertion. In addition, nurses' awareness about patients' educational needs regarding tracheostomy care, before discharge from hospital, needs to be increased. Implications for Further Research: Further research is required to identify the ways to reduce patients' negative experiences after having a tracheostomy tube in situ.
  10,494 424 -
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.
  9,407 516 3
REVIEW ARTICLES
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.
  7,184 463 -
ORIGINAL ARTICLES
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.
  6,350 301 -
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.
  5,329 380 1
REVIEW ARTICLES
Pressure ulcers in critically III patients in Saudi Arabia: An opportunity for collaborative research on an ugly disease
Hasan M Al-Dorzi
2017, 1(6):14-16
DOI:10.4103/sccj.sccj_24_17  
Pressure ulcers are common in critically ill patients and are associated with increased morbidity, mortality and cost. Studies on pressure ulcer prevention and management indicate the need for multifaceted care and multidisciplinary involvement. However, there are obvious deficits in pressure ulcer prevention efforts and care worldwide. Studies on pressure ulcers acquired in the intensive care unit (ICU) in Saudi Arabia are scarce. We propose a study to determine in Saudi ICUs pressure ulcer prevalence, risk factors, management and outcomes to improve the related care processes.
  5,239 298 -
ORIGINAL ARTICLES
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.
  4,609 207 1
REVIEW ARTICLES
King Saud Medical City Intensive Care Unit: A critical and cost-focused appraisal
Abdulrahman Alharthy, Dimitrios Karakitsos
January-March 2019, 3(1):19-23
DOI:10.4103/2543-1854.259473  
Intensive care unit (ICU) cost analysis has not been extensively addressed in the Kingdom of Saudi Arabia. We have implemented cost analysis (2015–2016) at the largest polyvalent ICU of the Kingdom (King Saud Medical City). Our block model analysis assimilated both modified Therapeutic Intervention Scoring System (TISS) and Omega scoring points to evaluate the overall cost; while, specific utilization elements were included in such as medication, procedural, laboratory, radiology, physiotherapy, nursing/physician, and overhead/other costs. The overall cost (Saudi Riyals [SAR]/ICU patient/day) averaged for TISS/Omega scores and adjusted for 2015–2016 inflation rates was approximately 23.269 (TISS: 167 points; Omega: 173 points generating predictive costs scores which were approximating the aforementioned score [R2 validated 0.91 and 0.90, respectively, all P < 0.005). Thereafter, we have applied effective antibiotic stewardship program and control of procedural supplies, novel administration policies, diversification of the ergonomy and clinical orientation, early mobilization of patients, increase of by-the-bed critical care ultrasound applications and decrease in the length of stay. The cost was reduced to 19.800 SAR (15%) in 2017–2018 that is comparable to international standards. Preliminary follow-up cost analysis (2019) is confirming projections of stabilizing the ICU cost <18.000 SAR (4790 USD)/patient/day. Our budget-cut policy has provided the department with a vital investment space to integrate new therapeutic technologies.
  4,136 291 -
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.
  4,012 228 2
Saudi novice undergraduate nursing students' perception of satisfaction and self-confidence with high-fidelity simulation: A quantitative descriptive study
Maram Abdullah Alammary
October-December 2017, 1(4):99-104
DOI:10.4103/sccj.sccj_7_18  
Introduction: High-fidelity simulation (HFS) has recently been used for undergraduate nursing students to simplify their learning. The aim of the current study was to explore Saudi novice nursing students perceptions of satisfaction and self-confidence with HFS and to determine if there is any correlation between participants' demographic characteristics and satisfaction and self-confidence learning scale. Methods: A descriptive quantitative study was performed to recruit Saudi participants through Saudi Arabian Cultural Mission (SACM). Data were collected over a 3-month period from February, 2017 to May, 2017 through online survey was posted on SACM's official Facebook page. The survey used the Student Satisfaction and Self-Confidence in Learning tool. A total of (n = 76) Saudi undergraduate nursing students were participated. Data were analyzed using SPSS. Results: The findings revealed that satisfaction and self-confidence had a high mean score which indicates that the majority of the students were satisfied and self-confidence with the HFS experience. No significant correlations were found between the demographic characteristics and student satisfaction and self-confidence except that those who are in the prelicensure program had a significantly higher satisfaction score (P = 0.03) than students who had a bachelor or other degrees. Furthermore, a strong correlation between students' satisfaction and self-confidence in learning was found (P < 0.0001) indicating that these factors were correlated. Conclusions: This study has further confirmed that satisfaction and self-confidence are associated with the HFS experience. HFS prepare novice nursing students for real-life experience and promote the transition to a professional career. Nurse educators should be trained in the use of simulation as a teaching strategy. In addition, nursing faculty needs to consider students perception about the simulation when designing, performing, and evaluating.
  3,978 220 -
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.
  3,776 195 1
REVIEW ARTICLES
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.
  3,657 303 1
High-flow oxygen therapy in hypoxemic respiratory failure: Review
Saumy Johnson
January-March 2017, 1(1):43-46
DOI:10.4103/sccj.sccj_8_17  
High-flow oxygen therapy is a novel technology in the treatment of hypoxemic respiratory failure (HRF). The effect in neonatal and pediatric population is well known, but its efficiency in the adult patient group is not well proven. This review tried to discuss various aspects of high-flow nasal cannula (HFNC) in terms of its components, effects, and the evidence available. High-flow nasal cannula is being used as the first choice of intervention in patients with acute HRF, especially in patients who does not have critical hypercapnia. Clinicians should be very selective while choosing the adult patients for HFNC.
  3,744 191 -
ORIGINAL ARTICLES
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.
  3,543 299 2
EDITORIAL
Saudi critical care society. A decade; but it is just the beginning!
Yasser Mandourah, Muhammad Kashif Malik
January-March 2017, 1(1):1-5
DOI:10.4103/2543-1854.208927  
  3,497 190 -
REVIEW ARTICLES
Knowledge gaps in the global practice of management of severe traumatic brain injury
Sami Alsolamy, Farah Alotaibi, Yaseen Arabi
2017, 1(6):19-21
DOI:10.4103/sccj.sccj_26_17  
Traumatic brain injury (TBI) was referred to as silent epidemic, neglected epidemic, and public health crisis by the World Health Organization due to its growing incidence and global public health, social, and economic burden. Despite the massive technological progress, no definitive treatment was found to cure TBI medically.The available evidence-based protocols are primarily directed toward stabilizing the patient and preventing secondary brain injuries, and their effectiveness has been validated in in high-income countries, but they may not be applicable to low and middle-income countries due to the lack of the appropriate infrastructure and limited human resources. Therefore, discrepancies are predicted between centers in high, low and middle-income countries and further studies are needed to asses the global managment of TBI.
  3,178 186 -
ORIGINAL ARTICLES
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.
  3,077 215 1
REVIEW ARTICLES
Fluid administration strategies in traumatic brain injury
Abdulrahman Alharthy, Waleed Tharwat Aletreby, Ibrahim Soliman, Fahad AlFaqihi, Waseem Alzayer, Nassir Nasim Mahmoud, Lawrence Marshall Gillman, Dimitrios Karakitsos
January-March 2019, 3(1):15-18
DOI:10.4103/2543-1854.259472  
Fluid restriction strategies may reduce morbidity and mortality in critical care patients and are currently trending as preliminary data showed encouraging results. A positive fluid balance was related to increase morbidity and mortality in a variety of disorders (i.e., sepsis, acute respiratory distress syndrome, and postsurgical cases) as well as resulted in an increased rate of complications observed in the intensive care unit setting. Traumatic brain injury (TBI) has been managed thus far in terms of fluid resuscitation under the concept of general trauma resuscitation recommendations that favored euvolemia above all fluid balance states. Notwithstanding, scarce data exist to clarify details about fluid management strategies in TBI such as the desirable fluid balance per se and/or its impact on patients' outcomes. We, therefore, reviewed previously published data and concluded in an observational manner (by creating a visual display model) that a highly positive and/or a negative fluid balance may have a detrimental impact on the prognosis of TBI patients. Accordingly, well-designed randomized controlled trials are clearly required to investigate further and in detail the most efficacious fluid administration strategies in TBI contributing thus in the rapidly expanding field of neurocritical care.
  2,926 341 -
1999–2019: Twenty years of watershed moments for patient safety
M Sofia Macedo, Yasser Mandourah, Anita Moore, Abdulelah AlHawsawi
January-March 2019, 3(1):3-11
DOI:10.4103/2543-1854.259479  
The case for patient safety is obvious; no one would argue in favor of harming patients. Since the launch of the paper To Err is Human, patient safety has been on the forefront of public health policymakers' priorities. Yet, 20 years later, while progress has been made, harm to patients is still a reality, daily, in health systems over the world. As countries reform their health systems, the national health programs must ensure not only the integration of universal health coverage (UHC) but also that the health coverage provided is safe. To this point, new models of care must be designed and implemented, and organizations should aim to achieve high-reliability care, similar to other industries that keep a solid safety record. This can be achieved by aiming for high-reliability organization principles, ensuring empowerment of patients as codesigners of health care, workforce safety to ensure safety of patients, and UHC without harm and proper regulation of digital health to avoid unintended adverse consequences. Since the past 20 years, the knowledge gap on patient safety has been shortened and therefore the health-care community holds a firm foundation for starting to implement evidence-based strategies that ensure safe care. The Jeddah Declaration on Patient Safety, 2019, is an actionable document that provides guidance to policy- and decision-makers globally that aim to achieve UHC free of harm. Nevertheless, given the high-level of complexity of health-care systems and its vulnerability to error, the question is what is the way forward toward a safer provision of care? How can the year 2019 be the watershed moment for the health-care industry?
  2,904 301 -
Management of carbon monoxide poisoning-induced cardiac failure and multiorgan dysfunction with combined respiratory and circulatory extracorporeal membrane oxygenation
AA Rabie, A Asiri, M Alsherbiny, W Alqassem, M Rajab, S Mohamed, W Hazem I Alenazi, L Ariplackal
January-March 2019, 3(1):12-14
DOI:10.4103/2543-1854.259471  
Carbon monoxide (CO) is an odorless, colorless, and nonirritant gas; it is the most common cause of poisoning and poisoning-related death. The main mechanism of CO toxicity is ischemic hypoxia secondary to hypoxemia. The heart is the major target organ of acute CO poisoning. Cardiac failure is the most common cardiac presentation; however, other cardiovascular manifestations include arrhythmia, pulmonary edema, and myocardial infarction. Recovery time from CO-induced cardiomyopathy varies from 4 days to 6 weeks. To our knowledge, there are a limited number of reported cases that demonstrated successful extracorporeal membrane oxygenation (ECMO) in adult and pediatric patients with CO poisoning and multiple organ failure. We present our experience with a case we think that it is the first case to be published for a patient with acute CO poisoning received both circulatory and respiratory support (hybrid venoarterial-venous ECMO).
  2,903 239 -
ORIGINAL ARTICLES
Serological characterization of occult hepatitis B Virus infection in Riyadh regional laboratory
Fadel Hassan Al-Hababi, Eisa Eid Al-Enazi, Raed Hassan Al-Hababi, Abdulwahab Bin Jomaa, Salah Saleh Al-Sager, Ali Eidah Al-Ahmari
October-December 2017, 1(4):105-112
DOI:10.4103/sccj.sccj_3_18  
Introduction: Hepatitis B virus (HBV) infection is a major global health problem, causing chronic hepatitis, cirrhosis, hepatocellular carcinoma (HCC) and other chronic liver diseases. HBV infection is endemic in many parts of Kingdom of Saudi Arabia. Occult HBV infection (OBI) is a challenging clinical problem characterized by the absence of Hepatitis B surface Antigen (HBsAg) and low viral DNA load. Aims: This study aim is to investigate an epidemiological survey for the prevalence of OBI among Saudi healthy general population and two of most common HBV infection risks, hemodialysis and HIV patients in Riyadh Regional Laboratory. Methods: Three groups of samples were tested. 5025 blood samples healthy group were collected from Saudi citizens for pre-marriage screening testing. Second group is comprised of 658 adult patients with end-stage renal disease undergoing regular hemodialysis. Third group is comprised from 479 patients who had been previously confirmed for HIV infection. Results: Of 5025 healthy people enrolled into the study, 212 (4.2%) seropositive for HBsAg and/or anti HBc. Of them, 114/212 (53.8%) resolved infection with detectable anti-HBs (>10 mIU/mL), and 58/212 (27.36 %) had active HBV infection with detectable HBsAg. While, 40/212 (18.9%) were defined as OBI and HBV DNA was detected in two OBI patients. In 658 hemodialysis (HD) patients, 196 (27.96%) seropositive for HBsAg and/or anti-HBc. Of them 122/196 (66.3%) resolved infection with detectable anti-HBs (>10 mIU/mL), and 17/196 (9.24%) with active HBV infection with detectable HBsAg. OBI only detected in 32/196 (17.4%), HBV DNA was detected in 3 patients. Lastly, in 479 HIV patients, 152 seropositive for HBsAg and/or anti HBc. Of them 11/152 (7.23%) had active HBV infection with detectable HBsAg and 78 (51.3%) resolved infection with detectable anti-HBs (>10 mIU/mL). OBI detected in 63/152 (41.4%) and only 6 patients showed HBV DNA was detected. There were no statistically significant differences in the OBI prevalence between healthy population and HD prevalence while showed significance difference in HIV OBI prevalence compared to healthy group. Conclusions: this study proof that OBI is frequently encountered among healthy and high risk group individuals in Saudi Arabia and more support should be provided for the vaccination especially of high-risk groups, such as HIV and HD patients.
  2,968 172 -
REVIEW ARTICLES
Commitment to collaborate: The value of establishing multicenter quality improvement collaboratives in Saudi Arabia
Hanan H Edrees, Zohair Al Aseri, Yasser Mandourah, Amin Yousef, Ismael Qushmaq, Khalid A Maghrabi, Fahad Al-Hameed, Yaseen M Arabi
2017, 1(6):7-9
DOI:10.4103/sccj.sccj_22_17  
Healthcare organizations around the globe are increasingly turning to multicenter quality improvement collaboratives (QICs) to improve patient care and outcomes. Despite the increase in demand and popularity of establishing multi-organizational QICs, there is limited evidence of these collaboratives in Saudi Arabia and in the Middle Eastern region. This article highlights the main components of successful QICs, recommendations to ensure successful QICs, and implications for establishing future collaboratives in Saudi Arabia.
  2,864 165 -
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.
  2,826 168 2
CASE REPORTS
Acquired central hypoventilation: A relatively rare complication following coronary artery bypass grafting
Sonali Vadi, Bhawan Paunipagar
April-June 2017, 1(2):60-62
DOI:10.4103/sccj.sccj_10_17  
A posterior circulation stroke acquired Ondine's curse occurs following medullary infarction. Central alveolar hypoventilation, a sine qua non of this stroke, is characterized by unpredictable episodes of sleep apnea that is associated with a high mortality rate. Postcoronary artery bypass grafting, a 64-year-old male developed embolic medullary infarct leading to recurrent episodes of apnea. This was managed with tracheostomy and mechanical ventilation. Intensive respiratory monitoring is of the essence during the acute and subacute stages in these patients.
  2,810 172 -