Faisal A. Al-Suwaidan, J. Aljarallah, N. Alyousefi, G. Hussein
Background: With the escalation of the coronavirus disease (COVID-19) pandemic, critical care specialists have been challenged by ethical issues related to the distribution of scarce resources. Many relevant guidelines have been published worldwide. The Saudi Critical Care Society included a local framework for ethics in its first clinical guidelines for clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic for COVID-19 patients in intensive care units (ICUs). This study aimed to assess the awareness, opinions, and attitudes of ICU specialists concerning these ethical guidelines and the proposed definitions. Methods: A descriptive cross-sectional study using a self-administered questionnaire was conducted. The study population included 300 ICU physicians in Saudi Arabia who were members of the Saudi Critical Care Society. Results: A total of 70 participants (23.3%) responded to the questionnaire. Most were male, non-Saudi, and Muslim. Professionally, they were mostly intensivists with 10 or more years of experience. The most agreed-upon suggested definitions were “health crisis,” “salvageable patients” category, and the “necessity scale” (32; 45.7%, 37; 52.9%, 52; 74.3%, and 34; 48.6%, respectively). Less agreement was observed for the definitions of “de-escalation without omission” and “primary triage scale” (20; 28.6%, and 21; 3%, respectively). The most agreed-upon statements were those requiring healthcare providers to receive training on contagious diseases and calling for providing them with housing if a situation requires them to leave their homes (56; 80%), while the least agreed-upon statements concerned withholding mechanical ventilation from patients (29; 41.4%). Conclusion: During epidemics, health-care workers provide services in unusual, challenging situations. Doing so necessitates support in social, psychological, and professional areas. A decision-making framework is needed that endorses the cultural and religious contexts, as well as the lived experiences of frontline clinicians, including a clear de-escalation plan and a primary triage system during the pandemic.
背景:随着新型冠状病毒病(COVID-19)大流行的升级，重症监护专家受到了与稀缺资源分配相关的伦理问题的挑战。世界各地已经出版了许多相关的指导方针。沙特重症监护协会(Saudi Critical Care Society)在其首份临床指导方针中纳入了一项当地伦理框架，该指导方针涉及COVID-19大流行期间为重症监护病房(icu)患者分配稀缺资源的临床决策。本研究旨在评估ICU专家对这些伦理准则和拟议定义的认识、意见和态度。方法:采用自填问卷进行描述性横断面研究。研究人群包括沙特阿拉伯的300名ICU医生，他们是沙特重症监护协会的成员。结果:共70人(23.3%)参与问卷调查。大多数是男性，非沙特人和穆斯林。在专业上，他们大多是有10年以上经验的重症监护医师。最一致同意的建议定义是"健康危机"、"可抢救的病人"类别和"必要性量表" (32;37岁的45.7%;52.9%, 52个;74.3%， 34%;分别为48.6%)。对于“不遗漏的降级”和“主要分类等级”的定义，意见不太一致(20;28.6%， 21%;分别为3%)。最一致同意的声明是要求医疗保健提供者接受关于传染病的培训，并呼吁在需要他们离开家园的情况下为他们提供住房(56;80%)，而最不一致的说法是停止对患者进行机械通气(29;41.4%)。结论:在流行病期间，卫生保健工作者在不寻常的、具有挑战性的情况下提供服务。这样做需要社会、心理和专业领域的支持。需要一个支持文化和宗教背景以及一线临床医生的实际经验的决策框架，包括大流行期间明确的降级计划和初级分诊系统。
{"title":"Awareness, opinion, attitude of intensive care unit specialists about the ethical guidelines for dealing with clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic","authors":"Faisal A. Al-Suwaidan, J. Aljarallah, N. Alyousefi, G. Hussein","doi":"10.4103/sccj.sccj_17_22","DOIUrl":"https://doi.org/10.4103/sccj.sccj_17_22","url":null,"abstract":"Background: With the escalation of the coronavirus disease (COVID-19) pandemic, critical care specialists have been challenged by ethical issues related to the distribution of scarce resources. Many relevant guidelines have been published worldwide. The Saudi Critical Care Society included a local framework for ethics in its first clinical guidelines for clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic for COVID-19 patients in intensive care units (ICUs). This study aimed to assess the awareness, opinions, and attitudes of ICU specialists concerning these ethical guidelines and the proposed definitions. Methods: A descriptive cross-sectional study using a self-administered questionnaire was conducted. The study population included 300 ICU physicians in Saudi Arabia who were members of the Saudi Critical Care Society. Results: A total of 70 participants (23.3%) responded to the questionnaire. Most were male, non-Saudi, and Muslim. Professionally, they were mostly intensivists with 10 or more years of experience. The most agreed-upon suggested definitions were “health crisis,” “salvageable patients” category, and the “necessity scale” (32; 45.7%, 37; 52.9%, 52; 74.3%, and 34; 48.6%, respectively). Less agreement was observed for the definitions of “de-escalation without omission” and “primary triage scale” (20; 28.6%, and 21; 3%, respectively). The most agreed-upon statements were those requiring healthcare providers to receive training on contagious diseases and calling for providing them with housing if a situation requires them to leave their homes (56; 80%), while the least agreed-upon statements concerned withholding mechanical ventilation from patients (29; 41.4%). Conclusion: During epidemics, health-care workers provide services in unusual, challenging situations. Doing so necessitates support in social, psychological, and professional areas. A decision-making framework is needed that endorses the cultural and religious contexts, as well as the lived experiences of frontline clinicians, including a clear de-escalation plan and a primary triage system during the pandemic.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127101915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mustafa AlDhoon, Diana S. Lalithabai, Nizar AbuSahyoun
Background: Critical care response team (CCRT) intervenes quickly in life-threatening situations to reduce adverse outcomes and improve patient safety. Nurses play an essential role in CCRT activation. Despite clearly satisfied criteria, there have been instances where nurses have failed to activate CCRT. Objective: This study examined the factors that influence nurses' CCRT activation. Methodology: The proposed study was done in an acute health-care setting using a cross-sectional survey approach. The study participants included 206 nurses working in inpatient care units. Nursing staff in intensive care units, pediatric intensive care units, operating rooms, outpatient departments, and main emergency rooms were excluded from the study. Results: Moreover, half of the majority (54.4%) of the 206 responders are knowledgeable about CCRT activation. Nearly 83 (40.3%) choose not to activate CCRT due to fear of being chastised. Nurses were more reliant on physicians to trigger CCRT. The activation score significantly correlated with the nurse participants' job title and working unit. Conclusions: Nursing staff avoided using the CCRT for fear of being blamed despite having a positive impression. They are primarily reliant on physicians to initiate CCRT. In addition to education and training that engages all health-care workers, hospitals should empower nurses to reduce barriers and improve CCRT activation.
{"title":"Factors influencing nurses' decision to activate critical care response team: The nursing perspective","authors":"Mustafa AlDhoon, Diana S. Lalithabai, Nizar AbuSahyoun","doi":"10.4103/sccj.sccj_16_22","DOIUrl":"https://doi.org/10.4103/sccj.sccj_16_22","url":null,"abstract":"Background: Critical care response team (CCRT) intervenes quickly in life-threatening situations to reduce adverse outcomes and improve patient safety. Nurses play an essential role in CCRT activation. Despite clearly satisfied criteria, there have been instances where nurses have failed to activate CCRT. Objective: This study examined the factors that influence nurses' CCRT activation. Methodology: The proposed study was done in an acute health-care setting using a cross-sectional survey approach. The study participants included 206 nurses working in inpatient care units. Nursing staff in intensive care units, pediatric intensive care units, operating rooms, outpatient departments, and main emergency rooms were excluded from the study. Results: Moreover, half of the majority (54.4%) of the 206 responders are knowledgeable about CCRT activation. Nearly 83 (40.3%) choose not to activate CCRT due to fear of being chastised. Nurses were more reliant on physicians to trigger CCRT. The activation score significantly correlated with the nurse participants' job title and working unit. Conclusions: Nursing staff avoided using the CCRT for fear of being blamed despite having a positive impression. They are primarily reliant on physicians to initiate CCRT. In addition to education and training that engages all health-care workers, hospitals should empower nurses to reduce barriers and improve CCRT activation.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"138 1 Suppl 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128764730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Alharbi, Ahmed Nadama, Reem Alsergani, Haifa M. Alwael, R. Alshathri, Amal Alshaibi, Nora Alshabib
Background: With the COVID-19 pandemic having a significant negative impact on the health-care systems globally, different models of respiratory intermediate care units were shown to play a vital role in the management of COVID-19 patients, especially those with impaired oxygenation. The present study demonstrates that respiratory intermediate care units were helpful in reducing health-care cost and acting as a backup for intensive care units (ICUs) in Saudi Arabia. Design and Setting: This is a retrospective study that was carried out in King Saud University Medical City, Riyadh, Saudi Arabia, between June 15, 2020, and August 7, 2020. The study team collected information from patients' records. The data collected comprised patient's demographic information, admission site, admission criteria, and length of hospital stay. Descriptive and comparative analyses were carried out through the SPSS version 26. Results: Eighty-one patients were eligible for inclusion: 67.9% were male, 58% were above 50 years old, and similar proportions were overweight. Chronic kidney disease was the most commonly occurring comorbidity (23.5%), whereas only three patients had hypertension, and a similar number had some form of immunosuppression. In addition, 44.4% of patients were admitted through COVID wards. The mean length of hospital stay was 11 ± 5 days, with 54.3% of patients staying for more than 10 days. About 97.5% of the patients were transferred to the general medical COVID-19 ward, whereas only 2.5% were admitted to ICU. The percentage of high-flow oxygen either high-flow nasal cannula or noninvasive ventilator was 66.2 ± 15.7%. About 27.2% of the patients required oxygenation through a simple standard interface such as a mask or nasal cannula. There was no significant difference among age groups and different body mass index categories in terms of hospitalization course and oxygenation. Females used noninvasive ventilation (P = 0.008) more than males. Conclusion: Females are more prone to higher oxygenation needs compared to males with COVID-19 infections. Respiratory care units can reduce the number of females who need ICU admissions for noninvasive ventilation.
背景:随着COVID-19大流行对全球卫生保健系统产生重大负面影响，不同模式的呼吸中间护理单位在COVID-19患者，特别是氧合受损患者的管理中发挥了至关重要的作用。本研究表明，呼吸中间护理单位有助于降低医疗保健成本，并作为沙特阿拉伯重症监护单位(icu)的后备。设计和环境:这是一项回顾性研究，于2020年6月15日至2020年8月7日在沙特阿拉伯利雅得的沙特国王大学医学城进行。研究小组从病人的记录中收集信息。收集的数据包括患者的人口统计信息、入院地点、入院标准和住院时间。通过SPSS version 26进行描述性和比较分析。结果:81例患者符合纳入条件:67.9%为男性，58%为50岁以上，超重比例相近。慢性肾脏疾病是最常见的合并症(23.5%)，而只有3名患者有高血压，相似数量的患者有某种形式的免疫抑制。44.4%的患者是通过新冠肺炎病房入院的。平均住院时间为11±5天，其中住院时间超过10天的占54.3%。约97.5%的患者转入普通内科病房，而只有2.5%的患者转入ICU。高流量鼻插管和无创呼吸机的高流量供氧率为66.2±15.7%。约27.2%的患者需要通过简单的标准接口(如口罩或鼻插管)进行氧合。住院时间、氧合情况在不同年龄组、不同体质指数类别间无显著差异。女性使用无创通气的人数多于男性(P = 0.008)。结论:新型冠状病毒感染女性比男性更容易出现更高的氧合需求。呼吸护理单位可以减少需要ICU入院进行无创通气的女性人数。
{"title":"Respiratory intensive care unit: An initiative during pandemic COVID-19","authors":"A. Alharbi, Ahmed Nadama, Reem Alsergani, Haifa M. Alwael, R. Alshathri, Amal Alshaibi, Nora Alshabib","doi":"10.4103/sccj.sccj_6_22","DOIUrl":"https://doi.org/10.4103/sccj.sccj_6_22","url":null,"abstract":"Background: With the COVID-19 pandemic having a significant negative impact on the health-care systems globally, different models of respiratory intermediate care units were shown to play a vital role in the management of COVID-19 patients, especially those with impaired oxygenation. The present study demonstrates that respiratory intermediate care units were helpful in reducing health-care cost and acting as a backup for intensive care units (ICUs) in Saudi Arabia. Design and Setting: This is a retrospective study that was carried out in King Saud University Medical City, Riyadh, Saudi Arabia, between June 15, 2020, and August 7, 2020. The study team collected information from patients' records. The data collected comprised patient's demographic information, admission site, admission criteria, and length of hospital stay. Descriptive and comparative analyses were carried out through the SPSS version 26. Results: Eighty-one patients were eligible for inclusion: 67.9% were male, 58% were above 50 years old, and similar proportions were overweight. Chronic kidney disease was the most commonly occurring comorbidity (23.5%), whereas only three patients had hypertension, and a similar number had some form of immunosuppression. In addition, 44.4% of patients were admitted through COVID wards. The mean length of hospital stay was 11 ± 5 days, with 54.3% of patients staying for more than 10 days. About 97.5% of the patients were transferred to the general medical COVID-19 ward, whereas only 2.5% were admitted to ICU. The percentage of high-flow oxygen either high-flow nasal cannula or noninvasive ventilator was 66.2 ± 15.7%. About 27.2% of the patients required oxygenation through a simple standard interface such as a mask or nasal cannula. There was no significant difference among age groups and different body mass index categories in terms of hospitalization course and oxygenation. Females used noninvasive ventilation (P = 0.008) more than males. Conclusion: Females are more prone to higher oxygenation needs compared to males with COVID-19 infections. Respiratory care units can reduce the number of females who need ICU admissions for noninvasive ventilation.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130648080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Distinctions in the DNA sequence of the genes pertaining to α and β adrenergic receptors can result in genetic polymorphisms. These variations can potentially impact response to treatment with adrenergic agonists and antagonists that likely warrant medical intervention. Pharmacogenomics is conceptualized as “the right drug to the right patient,” which implies that pharmacogenomics is entirely personalized. Given that adrenoreceptors play a fundamental role in regards to the pharmacogenetic interaction between catecholamines with α and β adrenergic receptors, it is, therefore, pivotal to highlight and further analyze variants amongst adrenergic receptors to improve the management of diseases pertaining to catecholamine dysfunction. In this review, we highlight the pharmacogenomics of adrenergic receptors and their potential clinical implications in critical care. It is evident that there are several variants associated with the adrenergic receptor alpha 1A (ADRA1A), adrenergic receptor alpha 2A (ADRA2A), adrenergic receptor beta-1 (ADRB1), adrenergic receptor beta-2 genes for α and β adrenergic receptors that were observed among different populations and ethnic groups including the Arg347Cys and Arg389Gly in ADRA1A and ADRB1, respectively. These polymorphisms have resulted in interindividual variability in drug responses for epinephrine, dexmedetomidine, and salbutamol, which concludes that pharmacogenomics of adrenergic receptors have proven immense variability in candidate genes amongst populations that lead to different drug responses.
{"title":"Pharmacogenomics of adrenergic receptors from bench to bedside: Potential clinical implications in critical care","authors":"Jude Howaidi, H. Lababidi","doi":"10.4103/sccj.sccj_19_21","DOIUrl":"https://doi.org/10.4103/sccj.sccj_19_21","url":null,"abstract":"Distinctions in the DNA sequence of the genes pertaining to α and β adrenergic receptors can result in genetic polymorphisms. These variations can potentially impact response to treatment with adrenergic agonists and antagonists that likely warrant medical intervention. Pharmacogenomics is conceptualized as “the right drug to the right patient,” which implies that pharmacogenomics is entirely personalized. Given that adrenoreceptors play a fundamental role in regards to the pharmacogenetic interaction between catecholamines with α and β adrenergic receptors, it is, therefore, pivotal to highlight and further analyze variants amongst adrenergic receptors to improve the management of diseases pertaining to catecholamine dysfunction. In this review, we highlight the pharmacogenomics of adrenergic receptors and their potential clinical implications in critical care. It is evident that there are several variants associated with the adrenergic receptor alpha 1A (ADRA1A), adrenergic receptor alpha 2A (ADRA2A), adrenergic receptor beta-1 (ADRB1), adrenergic receptor beta-2 genes for α and β adrenergic receptors that were observed among different populations and ethnic groups including the Arg347Cys and Arg389Gly in ADRA1A and ADRB1, respectively. These polymorphisms have resulted in interindividual variability in drug responses for epinephrine, dexmedetomidine, and salbutamol, which concludes that pharmacogenomics of adrenergic receptors have proven immense variability in candidate genes amongst populations that lead to different drug responses.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123382338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Meshram, Subho Sankar Banerjee, Ruchi Dave, S. Chauhan, V. Kute, H. Patel, Sudeep Desai, Priya Tambi, N. Shah, Akash Shah
Introduction: Acute kidney injury (AKI) in coronavirus disease (COVID-19) is understudied, especially after the initial pandemic wave and in South East Asian Region. Materials and Methods: This was a single-center retrospective cohort of 856 hospitalized COVID-19 cases between March 26, 2021, and June 7, 2021 in India to study the spectrum of AKI in COVID-19. The primary outcome was to analyze predictors of AKI. Other secondary outcome measured was mortality in AKI. Results: The incidence of AKI was 38.1%. The incidence of hemodialysis requirement was 3.5%. The proportion of AKI I, II, and III was 80.2%, 8.2%, and 11.6%, respectively. The mortality in AKI was statistically significantly higher than in non-AKI compared to AKI. Among the laboratory markers, the highest area under the curve (AUC) in the receiver operator curve was reached for red cell distribution width [AUC = 0.77 (0.73–0.81); P < 0.01]. The predictors for AKI calculated by multivariable logistic regression model in the cohort were obesity (hazard ratio (HR) = 3.2 (1.08–9.73); P = 0.04) and baseline European Cooperative Oncology Group (ECOG ≥ 3) (HR = 3.4 (1.77–6.69); P < 0.01). Similarly, the risk factors for developing AKI III included male sex (HR = 1.33 (1.05–1.68); P = 0.02) and ECOG ≥ 3 (HR = 1.5 [1.18–1.9]; P < 0.01). Conclusion: The incidence of AKI is high in hospitalized patients in the COVID-19 second wave. The mortality associated with AKI remains high. The comorbidity burden was not linked with AKI.
{"title":"COVID-19 associated acute kidney injury in the second wave of pandemic in India: A single-center retrospective report","authors":"H. Meshram, Subho Sankar Banerjee, Ruchi Dave, S. Chauhan, V. Kute, H. Patel, Sudeep Desai, Priya Tambi, N. Shah, Akash Shah","doi":"10.4103/sccj.sccj_32_21","DOIUrl":"https://doi.org/10.4103/sccj.sccj_32_21","url":null,"abstract":"Introduction: Acute kidney injury (AKI) in coronavirus disease (COVID-19) is understudied, especially after the initial pandemic wave and in South East Asian Region. Materials and Methods: This was a single-center retrospective cohort of 856 hospitalized COVID-19 cases between March 26, 2021, and June 7, 2021 in India to study the spectrum of AKI in COVID-19. The primary outcome was to analyze predictors of AKI. Other secondary outcome measured was mortality in AKI. Results: The incidence of AKI was 38.1%. The incidence of hemodialysis requirement was 3.5%. The proportion of AKI I, II, and III was 80.2%, 8.2%, and 11.6%, respectively. The mortality in AKI was statistically significantly higher than in non-AKI compared to AKI. Among the laboratory markers, the highest area under the curve (AUC) in the receiver operator curve was reached for red cell distribution width [AUC = 0.77 (0.73–0.81); P < 0.01]. The predictors for AKI calculated by multivariable logistic regression model in the cohort were obesity (hazard ratio (HR) = 3.2 (1.08–9.73); P = 0.04) and baseline European Cooperative Oncology Group (ECOG ≥ 3) (HR = 3.4 (1.77–6.69); P < 0.01). Similarly, the risk factors for developing AKI III included male sex (HR = 1.33 (1.05–1.68); P = 0.02) and ECOG ≥ 3 (HR = 1.5 [1.18–1.9]; P < 0.01). Conclusion: The incidence of AKI is high in hospitalized patients in the COVID-19 second wave. The mortality associated with AKI remains high. The comorbidity burden was not linked with AKI.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116455926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heena Garg, Shailendra Kumar, Yudhyavir Singh, P. Khanna, A. Trikha, R. Subramaniam
Background and Aims: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a large number of healthcare workers (HCW) getting infected, making it difficult to sustain uninterrupted and quality healthcare services. Using a mask is the minimum standard of care to prevent the spread of infection. Recently, the World Health Organization (WHO) has added airborne spread as an important mode of spread of COVID-19. The aim of this survey study was to assess the awareness about the use and reuse of masks for infection control practices among HCWs during the ongoing pandemic. Materials and Methods: A questionnaire-based survey on the awareness, knowledge, and practices related to the use of masks in COVID-19 infection in the healthcare setting was circulated through E-mail to medical and paramedical staff. A convenient sampling method was used for data collection, and the distribution of responses was presented as frequencies and percentages. Descriptive statistics were performed for all groups and subgroups based on the responses. Results: The survey sent to 1000 HCWs but only 394 responses (response rate 39.4%) were obtained. N95 was used by 282 (71.57%) personnel, surgical mask in 99 (25.12%) workers, cloth mask 11 (2.79%), and no mask in 2 (0.05%) HCW. Two hundred and eighty (71.07%) HCWs were reusing the mask. However, only 150 out of 280 subjects (53.57%) were correctly reusing the mask. Conclusion: Although universal masking was present in our study population, the awareness about the correct practice of reuse was limited. Since the pandemic is not going to settle any time soon and we might get short on existing supplies, it is vital that the HCWs need to be trained for the correct reuse and more efficient ways of reuse need to be explored.
{"title":"Knowledge, attitude, and practices regarding the use of mask among healthcare workers during coronavirus disease 2019 pandemic: A questionnaire-based survey","authors":"Heena Garg, Shailendra Kumar, Yudhyavir Singh, P. Khanna, A. Trikha, R. Subramaniam","doi":"10.4103/sccj.sccj_23_21","DOIUrl":"https://doi.org/10.4103/sccj.sccj_23_21","url":null,"abstract":"Background and Aims: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a large number of healthcare workers (HCW) getting infected, making it difficult to sustain uninterrupted and quality healthcare services. Using a mask is the minimum standard of care to prevent the spread of infection. Recently, the World Health Organization (WHO) has added airborne spread as an important mode of spread of COVID-19. The aim of this survey study was to assess the awareness about the use and reuse of masks for infection control practices among HCWs during the ongoing pandemic. Materials and Methods: A questionnaire-based survey on the awareness, knowledge, and practices related to the use of masks in COVID-19 infection in the healthcare setting was circulated through E-mail to medical and paramedical staff. A convenient sampling method was used for data collection, and the distribution of responses was presented as frequencies and percentages. Descriptive statistics were performed for all groups and subgroups based on the responses. Results: The survey sent to 1000 HCWs but only 394 responses (response rate 39.4%) were obtained. N95 was used by 282 (71.57%) personnel, surgical mask in 99 (25.12%) workers, cloth mask 11 (2.79%), and no mask in 2 (0.05%) HCW. Two hundred and eighty (71.07%) HCWs were reusing the mask. However, only 150 out of 280 subjects (53.57%) were correctly reusing the mask. Conclusion: Although universal masking was present in our study population, the awareness about the correct practice of reuse was limited. Since the pandemic is not going to settle any time soon and we might get short on existing supplies, it is vital that the HCWs need to be trained for the correct reuse and more efficient ways of reuse need to be explored.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128369755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Learning from case – Sheet of a COVID-19 ward","authors":"Harish Gupta, Ajay Kumar, Satish Kumar, Ajay Kumar","doi":"10.4103/sccj.sccj_25_21","DOIUrl":"https://doi.org/10.4103/sccj.sccj_25_21","url":null,"abstract":"","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"184 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124750636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ibrutinib platelet dysfunction induced intracranial hemorrhage management with activated factor VII and transfusion of platelets","authors":"Tariq Janjua, L. Moscote-Salazar","doi":"10.4103/sccj.sccj_24_21","DOIUrl":"https://doi.org/10.4103/sccj.sccj_24_21","url":null,"abstract":"","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"488 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116193774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Kinawy, Abdulhakim Assalahi, Fahad Balharith, Osama Badawy
Introduction: Chest pain is a frequent cause for admission to the emergency department (ED). It can be a sign of various conditions, from a minor disorder to a life-threatening disease such as acute myocardial infarction (AMI). Despite the availability of modern-day tools for the diagnosis of AMI, about 5% of patients with AMI are missed in the ED, with subsequent associated morbidity and mortality. QT dispersion as a marker for arrhythmic potential being a marker of in-homogeneity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia. Aims: This study we hypothesized that QTD could accurately identify patients with the acute coronary syndrome (ACS) who presented with chest pain and nondiagnostic initial electrocardiograms (ECGs). Subjects and Methods: The study population included (50) patients (37 males, 13 females) and (10) chronic stable ischemic patients as a control group, they were all in sinus rhythm on admission. All the studied patients were subjected to: History taking; complete physical examination was performed to rule out any other medical problems, standard 12-lead ECG, cardiac markers, echocardiographic examination. QT interval was calculated. The difference between the maximum and minimum QT intervals, occurring in any of the 12 leads, was measured as QTD. A corrected QT interval (QTc) of >440 ms is defined as abnormal, and the difference between QTc max and QTc min was calculated as QTcD. QT dispersion ≤40 ms was considered normal. Results: In the present study, we found that 26 patients (52%) have prolonged QTD (mean 78.800 ms, standard deviation [SD] ±49.555) and 44 patients (88%) have prolonged cQTD (mean 83.322 ms, SD ± 48.491) For patients who were admitted to the ED with chest pain and nondiagnostic initial ECG but later diagnosed as having ACS. Furthermore, we found that only 6 (12%) of patients have a significant prolongation QTD than normal in initial nondiagnostic ECG with elevated cardiac biomarkers (creatine kinase myocardial band at 0 h 48, mean creatine kinase myocardial band (CK MP) at 12 h was 145.833 ± SD 52.660, creatine phosphokinase (CPK) at 0 h: 635.33, mean CPK at 12 h 2448.66 ± SD 538.744). It has been suggested that the initial QTD level has a low predictive power for new cardiac events but that QTD can be more helpful for low-risk patients. Conclusion: Hence, in this study, we found that QTD and QTcD values are higher for ACS patients than for patients without ACS with nondiagnostic initial ECG.
{"title":"The diagnostic value of QT dispersion for acute coronary syndrome in patients with nondiagnostic initial electrocardiograms","authors":"S. Kinawy, Abdulhakim Assalahi, Fahad Balharith, Osama Badawy","doi":"10.4103/sccj.sccj_6_21","DOIUrl":"https://doi.org/10.4103/sccj.sccj_6_21","url":null,"abstract":"Introduction: Chest pain is a frequent cause for admission to the emergency department (ED). It can be a sign of various conditions, from a minor disorder to a life-threatening disease such as acute myocardial infarction (AMI). Despite the availability of modern-day tools for the diagnosis of AMI, about 5% of patients with AMI are missed in the ED, with subsequent associated morbidity and mortality. QT dispersion as a marker for arrhythmic potential being a marker of in-homogeneity of ventricular repolarization. The QT dispersion is increased in myocardial ischemia. Aims: This study we hypothesized that QTD could accurately identify patients with the acute coronary syndrome (ACS) who presented with chest pain and nondiagnostic initial electrocardiograms (ECGs). Subjects and Methods: The study population included (50) patients (37 males, 13 females) and (10) chronic stable ischemic patients as a control group, they were all in sinus rhythm on admission. All the studied patients were subjected to: History taking; complete physical examination was performed to rule out any other medical problems, standard 12-lead ECG, cardiac markers, echocardiographic examination. QT interval was calculated. The difference between the maximum and minimum QT intervals, occurring in any of the 12 leads, was measured as QTD. A corrected QT interval (QTc) of >440 ms is defined as abnormal, and the difference between QTc max and QTc min was calculated as QTcD. QT dispersion ≤40 ms was considered normal. Results: In the present study, we found that 26 patients (52%) have prolonged QTD (mean 78.800 ms, standard deviation [SD] ±49.555) and 44 patients (88%) have prolonged cQTD (mean 83.322 ms, SD ± 48.491) For patients who were admitted to the ED with chest pain and nondiagnostic initial ECG but later diagnosed as having ACS. Furthermore, we found that only 6 (12%) of patients have a significant prolongation QTD than normal in initial nondiagnostic ECG with elevated cardiac biomarkers (creatine kinase myocardial band at 0 h 48, mean creatine kinase myocardial band (CK MP) at 12 h was 145.833 ± SD 52.660, creatine phosphokinase (CPK) at 0 h: 635.33, mean CPK at 12 h 2448.66 ± SD 538.744). It has been suggested that the initial QTD level has a low predictive power for new cardiac events but that QTD can be more helpful for low-risk patients. Conclusion: Hence, in this study, we found that QTD and QTcD values are higher for ACS patients than for patients without ACS with nondiagnostic initial ECG.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129240741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-27DOI: 10.21203/rs.3.rs-726484/v1
M. Almutairi, K. Sulaiman, S. Alenazi, R. Vishwakarma, Ohoud Aljuhani
Background: Inappropriate antibiotics dosing in critically ill patients with augmented renal clearance (ARC) may be associated with pathogens resistance and worse outcomes. Unfortunately, studies regarding the relationship between ARC and clinical outcomes in patients treated with antibiotics medication are rare. The study aims to evaluate the efficacy and clinical outcomes of selected broad spectrum hydrophilic antibiotics (Meropenem, Imipinem, Piperacillin/Tazobactam) in augmented renal function critically ill patients with confirmed infections.Methods: A retrospective cohort study in critically ill patients who were admitted to intensive care units (ICUs) at King Abdulaziz Medical City (KAMC)-Riyadh and received broad-spectrum Hydrophilic antibiotics (Meropenem, Imipenem, or Piperacillin/Tazobactam) with confirmed infection. All the patients who met our inclusion criteria during the study period (01/01/2018 – 31/12/2019) were included. Eligible patients have been divided into two groups (augmented renal clearance (ARC) Vs. Non-ARC) according to the estimated creatinine clearance (CrCl) to assess pathogen eradication at 10-14 days. Results: A total of 2682 patients were screened; 133 patients were included in the study. The eradication of pathogen at 10-14 days in ARC group was non-inferior to non-ARC group (OR 1.08; 95% CI, 0.41–2.78 p = 0.88). The Resistance (OR 0.78; 95% CI, 0.25–2.40 p = 0.66), and Persistence after 3 days (OR 0.88; 95% CI, 0.35–2.18 p = 0.78) were not significantly different between the groups. In other words, patients with ARC have the same rate of resistance and persistence of pathogen after three days. There was no difference in the 30-day mortality between the two groups (OR 0.22; 95% CI, 0.04–1.40 p = 0.11). Also, there was no difference in the ICU length of stay (LOS) nor in hospital LOS between the two groups (22.0 days vs. 17.5 days, p = 0.37), and (51.0 days vs. 30.0 days, p = 0.07) respectively. Conclusion: Using standard dosing of hydrophilic broad-spectrum antibiotics in ARC patients was not inferior to non-ARC patients in terms of the pathogen eradication, resistance, and persistence. Further randomized clinical and interventional studies are required to confirm our findings.
背景:在肾清除率增强(ARC)的危重患者中，不适当的抗生素剂量可能与病原体耐药性和更糟糕的结局有关。不幸的是，关于ARC与抗生素治疗患者临床结果之间关系的研究很少。本研究旨在评估选定的广谱亲水性抗生素(美罗培南、亚胺平、哌拉西林/他唑巴坦)对确诊感染的肾功能增强危重患者的疗效和临床结果。方法:对在利雅得阿卜杜勒阿齐兹国王医疗城(KAMC)重症监护病房(icu)接受广谱亲水抗生素(美罗培南、亚胺培南或哌拉西林/他唑巴坦)确诊感染的危重患者进行回顾性队列研究。所有在研究期间(2018年1月1日至2019年12月31日)符合我们纳入标准的患者都被纳入。根据估计的肌酐清除率(CrCl)将符合条件的患者分为两组(增强肾清除率(ARC)和非ARC)，以评估10-14天的病原体根除情况。结果:共筛选2682例患者;133名患者参与了这项研究。ARC组10-14 d病原菌根除率不低于非ARC组(OR 1.08;95% CI, 0.41-2.78 p = 0.88)。阻力(OR 0.78;95% CI, 0.25-2.40 p = 0.66)和3天后的持久性(OR 0.88;95% CI (0.35 ~ 2.18 p = 0.78)组间差异无统计学意义。换句话说，ARC患者在3天后的耐药率和病原体持久性相同。两组患者的30天死亡率无差异(OR 0.22;95% CI, 0.04-1.40 p = 0.11)。两组患者的ICU住院时间(LOS)和住院时间(LOS)均无差异(分别为22.0天对17.5天，p = 0.37)和51.0天对30.0天，p = 0.07)。结论:在ARC患者中使用标准剂量的亲水广谱抗生素在病原体根除、耐药和持久性方面不低于非ARC患者。需要进一步的随机临床和介入性研究来证实我们的发现。
{"title":"Evaluation of Standard Dosing for Selected Broad Spectrum Hydrophilic Antibiotics in Critically Ill Patients with Augmented Renal Clearance: An Observational Study","authors":"M. Almutairi, K. Sulaiman, S. Alenazi, R. Vishwakarma, Ohoud Aljuhani","doi":"10.21203/rs.3.rs-726484/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-726484/v1","url":null,"abstract":"\u0000 Background: Inappropriate antibiotics dosing in critically ill patients with augmented renal clearance (ARC) may be associated with pathogens resistance and worse outcomes. Unfortunately, studies regarding the relationship between ARC and clinical outcomes in patients treated with antibiotics medication are rare. The study aims to evaluate the efficacy and clinical outcomes of selected broad spectrum hydrophilic antibiotics (Meropenem, Imipinem, Piperacillin/Tazobactam) in augmented renal function critically ill patients with confirmed infections.Methods: A retrospective cohort study in critically ill patients who were admitted to intensive care units (ICUs) at King Abdulaziz Medical City (KAMC)-Riyadh and received broad-spectrum Hydrophilic antibiotics (Meropenem, Imipenem, or Piperacillin/Tazobactam) with confirmed infection. All the patients who met our inclusion criteria during the study period (01/01/2018 – 31/12/2019) were included. Eligible patients have been divided into two groups (augmented renal clearance (ARC) Vs. Non-ARC) according to the estimated creatinine clearance (CrCl) to assess pathogen eradication at 10-14 days. Results: A total of 2682 patients were screened; 133 patients were included in the study. The eradication of pathogen at 10-14 days in ARC group was non-inferior to non-ARC group (OR 1.08; 95% CI, 0.41–2.78 p = 0.88). The Resistance (OR 0.78; 95% CI, 0.25–2.40 p = 0.66), and Persistence after 3 days (OR 0.88; 95% CI, 0.35–2.18 p = 0.78) were not significantly different between the groups. In other words, patients with ARC have the same rate of resistance and persistence of pathogen after three days. There was no difference in the 30-day mortality between the two groups (OR 0.22; 95% CI, 0.04–1.40 p = 0.11). Also, there was no difference in the ICU length of stay (LOS) nor in hospital LOS between the two groups (22.0 days vs. 17.5 days, p = 0.37), and (51.0 days vs. 30.0 days, p = 0.07) respectively. Conclusion: Using standard dosing of hydrophilic broad-spectrum antibiotics in ARC patients was not inferior to non-ARC patients in terms of the pathogen eradication, resistance, and persistence. Further randomized clinical and interventional studies are required to confirm our findings.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128701357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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