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High-Flow Nasal Cannula for Patients with COVID-19 Acute Hypoxemic Respiratory Failure 高流量鼻插管治疗COVID-19急性低氧性呼吸衰竭
Pub Date : 2020-12-01 DOI: 10.4103/sccj.sccj_42_20
Hassan M. Alshaqaq, Z. A. Al Aseri, M. Alshahrani
High-flow nasal cannula (HFNC) is a noninvasive oxygenation modality that delivers heated and humidified oxygen. It possesses several advantages due to the unique physiological effects on the lung and ventilation mechanics compared to other modes of oxygen therapy. The use of HFNC is tolerable, comfortable, and easy to set up. Current evidence indicates that the use of HFNC in critically ill patients with coronavirus disease 2019 (COVID-19)-acute hypoxemic respiratory failure (AHRF) is noninferior to noninvasive ventilation in the reduction of endotracheal intubation rate. Early identification of HFNC failure is vital to avoid delaying intubation. However, multiple knowledge gaps exist, and unpowered observational studies limit HFNC incorporation into strong recommendations. The low dispersion of particles demonstrates the feasibility of HFNC; yet, an appropriate setting and precautions should be maximized. Here, we review the recent evidence of HFNC implications in the management of patients with COVID-19-AHRF.
高流量鼻插管(HFNC)是一种无创氧合方式,提供加热和湿化氧气。与其他氧疗方式相比,它具有独特的肺生理作用和通气力学优势。HFNC的使用是可以忍受的,舒适的,并且易于设置。目前的证据表明,在冠状病毒病2019 (COVID-19)-急性低氧性呼吸衰竭(AHRF)危重患者中使用HFNC在降低气管插管率方面不亚于无创通气。早期识别HFNC失败对于避免延迟插管至关重要。然而,存在多种知识空白,无证据的观察性研究限制了HFNC纳入强有力的建议。粒子的低分散证明了HFNC的可行性;然而,适当的环境和预防措施应该最大化。在这里,我们回顾了HFNC对COVID-19-AHRF患者管理影响的最新证据。
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引用次数: 2
Understanding the Psychological Stress and Optimizing the Psychological Support for the Acute-Care Health-Care Workers during the COVID-19 Pandemic COVID-19大流行期间急症医护人员心理压力的认识与优化心理支持
Pub Date : 2020-12-01 DOI: 10.4103/sccj.sccj_62_20
M. Temsah, S. Alenezi
In this narrative review, we examined the psychological issues related to healthcare workers (HCWs) in acute-care areas during the COVID-19 pandemic. PubMed was searched on 18 Aug 2020 for published articles, with the following keywords: “COVID-19”, “mental health”, “health-care workers”, “front-lines”, “psychology”, “anxiety”, “depression”, “burnout” and “stress” in various combinations. We identified 23 studies, out of which 15 were selected. Data from several international studies indicate that HCWs are prone to developing mental health problems such as anxiety, depression, and substance abuse; thus, screening and supporting the HCWs who are at bigger risk for such psychological distress is warranted. We conclude that the healthcare system should have processes for providing support to minimize possible post-traumatic consequences among HCWs.
在这篇叙述性综述中,我们研究了COVID-19大流行期间急症护理区医护人员(HCWs)的心理问题。2020年8月18日,在PubMed上搜索已发表的文章,关键词如下:“COVID-19”、“心理健康”、“卫生保健工作者”、“一线”、“心理学”、“焦虑”、“抑郁”、“倦怠”和“压力”,以各种组合形式出现。我们确定了23项研究,其中15项被选中。几项国际研究的数据表明,卫生保健工作者容易出现焦虑、抑郁和药物滥用等心理健康问题;因此,筛查和支持有较大心理困扰风险的医护人员是有必要的。我们的结论是,卫生保健系统应该有提供支持的程序,以尽量减少卫生保健工作者可能的创伤后后果。
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引用次数: 9
The Current Use of Anti-IL6 and Corticosteroids in COVID-19 Patients with Cytokine-Release Syndrome 抗il - 6和皮质类固醇在COVID-19细胞因子释放综合征患者中的应用现状
Pub Date : 2020-12-01 DOI: 10.4103/sccj.sccj_38_20
M. Amer, M. Bawazeer, T. Dahhan, E. Kseibi, A. Butt, M. Abujazar, R. Alghunaim, M. Rabee, S. Khurshid
Cytokine-release syndrome (CRS) includes overproduction of inflammatory cytokines, termed a “cytokine storm,” which has been observed in a large proportion of critically ill COVID-19 patients. Patients diagnosed with CRS rapidly progress to cardiovascular collapse and multi-organ failure and carry a high mortality rate. Therefore, early detection, treatment, and prevention of cytokine storms are important. Immunomodulators, such as interleukin-6 (IL-6) antagonists, have recently emerged as an alternative therapeutic option for COVID-19 patients with cytokine storms. In preparation for a clinical trial, we searched the PUBMED, EMBASE, and COCHRANE databases to obtain related publications on the use of immunotherapies in CRS and CRS with COVID-19. We also included major review articles and recent guidelines. In our proposal, we aim to evaluate the efficacy and safety of anti-IL-6 alone versus anti-IL-6 and corticosteroid combination in COVID-19 critically ill patients with CRS. Our primary outcomes are duration of mechanical ventilation and 28-day ventilator-free days.
细胞因子释放综合征(CRS)包括炎症细胞因子的过度产生,称为“细胞因子风暴”,在很大比例的COVID-19危重患者中都观察到这种情况。诊断为CRS的患者迅速发展为心血管衰竭和多器官衰竭,死亡率高。因此,早期发现、治疗和预防细胞因子风暴是很重要的。免疫调节剂,如白细胞介素-6 (IL-6)拮抗剂,最近成为COVID-19细胞因子风暴患者的替代治疗选择。在准备临床试验时,我们检索了PUBMED、EMBASE和COCHRANE数据库,以获取有关在CRS和合并COVID-19的CRS中使用免疫疗法的相关出版物。我们还包括了主要的评论文章和最近的指南。在我们的提案中,我们旨在评估抗il -6单独与抗il -6和皮质类固醇联合治疗COVID-19重症CRS患者的疗效和安全性。我们的主要结局是机械通气持续时间和28天无呼吸机天数。
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引用次数: 2
Successful Rapid Deployment of Intensive Care Services in Response to the COVID-19 Pandemic: A Case Study in Saudi Arabia 成功快速部署重症监护服务以应对COVID-19大流行:以沙特阿拉伯为例
Pub Date : 2020-12-01 DOI: 10.4103/sccj.sccj_44_20
Awad Al-omari, A. Al Mutair, A. Elhazmi, Khalid. Alobeiwi., Amin K. Khattab, A. Rabaan
The coronavirus disease-2019 (COVID-19) pandemic has triggered a significant demand to support the most affected areas of severe and acute cases inside Saudi Arabia including the application of telemedicine. During the pandemic, the intensive care unit (ICU) staff from the largest private health-care sector were deployed to support the national critical care services and overcome the shortage of ICU staff in the greatest affected regions in Saudi Arabia. This study aims to describe the administrative actions taken to manage and treat the severe cases of COVID-19 that required ICU services and the deployment of the ICU services provided by private health-care providers to the most affected areas. The ICU staff have been rapidly deployed from the largest private health-care provider in the Middle East, from Riyadh province in the Central Region of Saudi Arabia for Madinah province in the Western region. Within 10 weeks, a total of 309 patients have received ICU and tele-ICU services. Approximately, 208 ICU staff, including intensivists, nurses, respiratory therapists, clinical nutritionists, and clinical pharmacists, have been providing ICU services 24 h a day, 7 days a week. The tele-ICU command center has provided valuable support, including the expert clinical guidance and consultation from the expert ICU consultants, utilizing audio-visual telecommunication networks, and governance of quality of the ICU among other many functions. With an average of 11.82% mortality rate, no accidental re-intubation reported cases, a zero re-intubation and re-admission rate within 48 h, this approach can be successfully followed and implemented in the future for risk and crisis management at local and international levels.
2019冠状病毒病(COVID-19)大流行引发了对支持沙特阿拉伯境内严重和急性病例受影响最严重地区的巨大需求,包括远程医疗的应用。在大流行期间,部署了来自最大私营保健部门的重症监护病房(ICU)工作人员,以支持国家重症监护服务,并克服沙特阿拉伯受影响最严重地区ICU工作人员短缺的问题。本研究旨在描述为管理和治疗需要ICU服务的COVID-19重症病例所采取的行政措施,以及私营卫生保健提供者向受影响最严重地区提供ICU服务的部署情况。重症监护室的工作人员已从中东最大的私营保健提供者迅速调派,从沙特阿拉伯中部地区的利雅得省调派到西部地区的麦地那省。10周内,共有309例患者接受了ICU和远程ICU服务。大约有208名ICU工作人员,包括重症监护医师、护士、呼吸治疗师、临床营养师和临床药剂师,每周7天,每天24小时提供ICU服务。远程ICU指挥中心提供了宝贵的支持,包括专家临床指导和专家ICU顾问的咨询,利用视听通信网络,以及ICU质量治理等诸多功能。平均死亡率为11.82%,无意外再插管病例报告,48小时内再插管和再入院率为零,这一方法可以成功地遵循和实施,未来在地方和国际层面进行风险和危机管理。
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引用次数: 0
The Use of Simulation in Health-Care Response to COVID-19 模拟在卫生保健应对COVID-19中的应用
Pub Date : 2020-12-01 DOI: 10.4103/sccj.sccj_43_20
S. Aldekhyl, David Elbling, Y. Arabi
In preparation for the COVID-19 pandemic, simulation came in handy in aiding health-care facilities around the world to establish strategies to manage its personnel, space, and processes through experiential learning. Simulation bloomed during the epidemic due to its flexibility and capacity to train large number of health-care professionals at different levels in a timely manner while maintaining high safety profile. This brief review aims at providing some examples of simulation use in the era of COVID-19 pandemic around the world. In addition, we will address some of the limitations that faced simulation-based learning and provide a glimpse to the future of simulation in addressing global pandemics.
在为COVID-19大流行做准备时,模拟在帮助世界各地的医疗机构制定通过体验式学习管理其人员、空间和流程的战略方面派上了用场。在疫情期间,模拟因其灵活性和及时培训大量不同级别的卫生保健专业人员的能力而蓬勃发展,同时保持高度的安全性。这篇简短的综述旨在提供一些在全球COVID-19大流行时代使用模拟的例子。此外,我们将讨论基于模拟的学习所面临的一些限制,并展望模拟在应对全球流行病方面的未来。
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引用次数: 2
Extracorporeal membrane oxygenation in COVID-19: The Saudi ECLS-Chapter perspective COVID-19的体外膜氧合:沙特ECLS-Chapter视角
Pub Date : 2020-10-01 DOI: 10.4103/sccj.sccj_55_20
H. Mufti, Hussam Bahudden, Z. A. Al Aseri, Mohamed H. Azzam
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引用次数: 1
Herpes zoster coinfection and the current COVID-19 pandemic 带状疱疹合并感染与当前COVID-19大流行
Pub Date : 2020-10-01 DOI: 10.4103/sccj.sccj_45_20
I. Altaf
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.
在当前的大流行中,COVID-19感染的临床表现可能各不相同,即使在就诊时上呼吸道症状轻微的患者中也是如此。新冠肺炎患者有多种皮肤表现,带状疱疹(HZ)是其中之一。HZ是当水痘带状疱疹病毒从潜伏状态在后背根神经节重新激活时引起的一种感染。在这里,我们的目标是扩大我们的知识,报告三例相关的带状疱疹感染病例,这些病例是在我们重症监护室收治的COVID-19患者中出现的呼吸道疾病。所有入院的3例患者在HZ诊断时均表现出淋巴细胞减少症,并在整个过程中进行了保守治疗。在所有病例中,阿昔洛韦/伐昔洛韦在10天内导致病变消退。未见带状疱疹后后遗症。在此,我们建议,在当前大流行期间,HZ的临床表现应被视为潜伏的亚临床SARS-CoV-2感染的警报信号,并对此类患者进行彻底的随访。
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引用次数: 1
Development of critical care nursing research in Saudi Arabia: 10 years' perspective 沙特阿拉伯重症护理研究的发展:10年展望
Pub Date : 2020-10-01 DOI: 10.4103/sccj.sccj_56_20
A. Deeb, M. Aljuaid
Nursing research is a scientific method that provides evidence to support nursing practices. Investigation of the critical care nursing research in Saudi Arabia has not been well established. This review aims to examine the numbers, and the characteristics of PubMed-cited critical care nursing articles contributed from Saudi Arabia over the past decade. We conducted a PubMed search to analyze nursing publications in the field of critical care published or contributed in Saudi Arabia for over 10 years (2010–2019). We investigated the number of publications per year, specialty, study design, journal impact factor, and international collaboration. A total of 94 critical care nursing publications were included in this review. International collaborations were noted in 49 (52.1%) articles. The majority 53 (56.4%) of the critical care nursing publications were related to the nursing field and 66 (70.2%) of these articles were classified as clinical practice topics. Observation cohort study was the most used study design 64 (68.1%). The median impact factor for the journals of these publications was 1.76 (1.48, 2.52). Despite the lower rate of published researches, critical care nursing research in Saudi Arabia is increasing over the years. International collaborations had contributed dramatically in the published articles. Developing local strategy for critical care nursing research and promoting local and international collaboration to conduct and use research according to the critical care nursing priority are also warranted. More interventional nursing researches are needed in critical care settings in Saudi Arabia.
护理研究是一种为护理实践提供证据的科学方法。对沙特阿拉伯重症护理研究的调查尚未很好地建立。本综述旨在研究在过去十年中沙特阿拉伯贡献的被pubmed引用的重症护理文章的数量和特征。我们进行了PubMed检索,分析了10多年来(2010-2019年)在沙特阿拉伯发表或贡献的重症护理领域的护理出版物。我们调查了每年的出版物数量、专业、研究设计、期刊影响因子和国际合作。本综述共纳入94篇重症护理出版物。49篇(52.1%)文章提到国际合作。其中53篇(56.4%)为重症护理相关文献,66篇(70.2%)为临床实践类文献。观察队列研究是最常用的研究设计64(68.1%)。这些出版物的期刊影响因子中位数为1.76(1.48,2.52)。尽管发表的研究率较低,但沙特阿拉伯的重症护理研究多年来一直在增加。国际合作对发表的文章作出了巨大贡献。制定当地的重症护理研究战略,促进当地和国际合作,根据重症护理优先级开展和使用研究也是必要的。在沙特阿拉伯的重症监护环境中,需要更多的介入性护理研究。
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引用次数: 1
Exploring factors affecting critical care response team service at a tertiary hospital in Riyadh: A retrospective cohort study 探索影响利雅得一家三级医院重症监护反应小组服务的因素:一项回顾性队列研究
Pub Date : 2020-10-01 DOI: 10.4103/sccj.sccj_57_20
A. Alhaidari, Maram Busuhail, S. Alsultan, S. Alshammari, Abdullah Alshimemeri
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.
背景:重症监护反应小组(Critical care response team, CCRT)是重症监护病房(ICU)的一个主动科室,由一名重症监护医师、一名主治医师、一名重症监护护士和一名呼吸治疗师组成。该小组的目的是管理病房内的患者,以避免不必要的ICU床位占用。本研究的目的是探讨影响CCRT服务的因素,包括病人的处置和死亡率,并分析团队为病人提供的干预措施。材料和方法:这是一项在利雅得一家三级医院进行的回顾性队列研究。审查了2018年2月至2019年4月期间所有CCRT事件数据收集表。符合我们标准的患者被纳入。结果测量如下:(1)患者情绪。(2)死亡率。影响CCRT服务的因素包括患者年龄、激活时间和激活原因。所有统计分析均采用SAS软件9.4进行。结果:在研究期间共考虑了1088例CCRT事件。在所有死亡病例中,平均年龄为70.90±16.67岁,而幸存者的平均年龄为61.21±20.65岁(P < 0.0001)。高龄患者转ICU的机率较高(P = 0.0399)。CCRT服务不受激活时间的影响,因为在工作时间和非工作时间激活时,患者的处置和死亡率几乎相同。CCRT激活最常见的原因是呼吸急促(28.49%)。除血氧饱和度低(50.54%转至ICU) (P = 0.0001)、意识水平下降(49.40%转至ICU) (P = 0.0001)外,各激活原因的大多数患者均未转至ICU。未转入ICU的患者死亡率(15.18%)低于转入ICU的患者(55.41%)(P < 0.0001)。结论:鉴于这些结果,必须考虑老年患者,低氧饱和度和DLOC患者对CCRT呼叫提高警惕性和快速反应。对于那些在重症监护室花费更多时间的人也需要提高警惕。
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引用次数: 1
Antibiotic use and resistance: Awareness among students of Prince Mohammad Bin Fahd University in Saudi Arabia 抗生素使用和耐药性:沙特阿拉伯穆罕默德·本·法赫德王子大学学生的意识
Pub Date : 2020-07-01 DOI: 10.4103/sccj.sccj_22_20
Lina Alzayer, Zainab Ambani, Lucia-Marie Ganendran
Background and purpose: Antibiotic misuse in Saudi Arabia is becoming an increasing concern. It leads to the development and acceleration of antibiotic resistance. One of the established approaches to tackle the problem is through improving public awareness of appropriate antibiotic use. This study examined the level of awareness of university students about the correct use of antibiotics and the issue of antibiotic resistance. Methods: A cross-sectional study was designed, using a self-administered online questionnaire that was sent to all students of Prince Mohammad Bin Fahd University in the Eastern Province of Saudi Arabia. Results: The total number of participants was 320 students, of whom 210 were female (65.6%) and 110 were male (34.4%). About a third (34.7%) of the students had poor knowledge regarding the fact that antibiotics should only be used for bacterial infections. In addition, just over half (50.0%–57.5%) of the students could not classify the common viral infections as antibiotic untreatable infections. On the other hand, the majority (84.1%) of the respondents were highly aware of the correct source and the correct use of antibiotic prescriptions. Similarly, 73.4% of students revealed a high awareness level of how to address the issue of antibiotic resistance. However, around one-third (35.3%) of them incorrectly thought that antibiotic-resistant bacteria cannot spread from one person to another. Conclusion: Establishing an educational intervention program is needed in Saudi universities to improve students' awareness of the specific conditions that can be treated with antibiotics. In addition, it is essential for students to know that antibiotic resistance can affect anyone, of any age, in any country, and that it can be accelerated by the improper use of antibiotics.
背景与目的:沙特阿拉伯的抗生素滥用问题日益受到关注。它导致抗生素耐药性的发展和加速。解决这一问题的既定方法之一是提高公众对适当使用抗生素的认识。本研究调查了大学生对正确使用抗生素和抗生素耐药性问题的认识水平。方法:设计了一项横断面研究,使用一份自我管理的在线问卷,发给沙特阿拉伯东部省穆罕默德·本·法赫德王子大学的所有学生。结果:共320人,其中女生210人(占65.6%),男生110人(占34.4%)。约三分之一(34.7%)的学生不了解抗生素仅用于细菌感染。此外,超过一半(50.0% ~ 57.5%)的学生不能将常见的病毒感染归类为抗生素无法治疗的感染。另一方面,大多数受访者(84.1%)对抗生素处方的正确来源和正确使用有高度的认识。同样,73.4%的学生对如何解决抗生素耐药性问题有很高的认识。然而,其中约三分之一(35.3%)的人错误地认为耐抗生素细菌不会从一个人传播到另一个人。结论:沙特大学需要建立教育干预计划,以提高学生对抗生素治疗的具体情况的认识。此外,学生们必须知道,抗生素耐药性可能影响任何年龄、任何国家的任何人,而且不当使用抗生素可能会加速耐药性的产生。
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引用次数: 0
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Saudi Critical Care Journal
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