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Herrera-Escobar JP, Lamarre T, Rosen J, Ilkhani S, Haynes AN, Hau K, Jenkins K, Ruske J, Wang JY, Serventi-Gleeson J, Sanchez SE, Kaafarani HM, Velmahos G, Salim A, Levy-Carrick NC, Anderson GA. Determinants of long-term physical and mental health outcomes after intensive care admission for trauma survivors. Am J Surg 2024:S0002-9610(24)00100-4. [PMID: 38413351 DOI: 10.1016/j.amjsurg.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Collectively, studies from medical and surgical intensive care units (ICU) suggest that long-term outcomes are poor for patients who have spent significant time in an ICU. We sought to identify determinants of post-intensive care physical and mental health outcomes 6-12 months after injury. METHODS Adult trauma patients [ISS ≥9] admitted to one of three Level-1 trauma centers were interviewed 6-12 months post-injury to evaluate patient-reported outcomes. Patients requiring ICU admission ≥ 3 days ("ICU patients") were compared with those who did not require ICU admission ("non-ICU patients"). Multivariable regression models were built to identify factors associated with poor outcomes among ICU survivors. RESULTS 2407 patients were followed [598 (25%) ICU and 1809 (75%) non-ICU patients]. Among ICU patients, 506 (85%) reported physical or mental health symptoms. Of them, 265 (52%) had physical symptoms only, 15 (3%) had mental symptoms only, and 226 (45%) had both physical and mental symptoms. In adjusted analyses, compared to non-ICU patients, ICU patients were more likely to have new limitations for ADLs (OR = 1.57; 95% CI = 1.21, 2.03), and worse SF-12 mental (mean Δ = -1.43; 95% CI = -2.79, -0.09) and physical scores (mean Δ = -2.61; 95% CI = -3.93, -1.28). Age, female sex, Black race, lower education level, polytrauma, ventilator use, history of psychiatric illness, and delirium during ICU stay were associated with poor outcomes in the ICU-admitted group. CONCLUSIONS Physical impairment and mental health symptoms following ICU stay are highly prevalent among injury survivors. Modifiable ICU-specific factors such as early liberation from ventilator support and prevention of delirium are potential targets for intervention.
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Affiliation(s)
- Juan P Herrera-Escobar
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Taylor Lamarre
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jordan Rosen
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Saba Ilkhani
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ashley N Haynes
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Kaman Hau
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Kendall Jenkins
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | - Jack Ruske
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | - Joyce Y Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jessica Serventi-Gleeson
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sabrina E Sanchez
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | - Haytham Ma Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ali Salim
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Nomi C Levy-Carrick
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Geoffrey A Anderson
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Almuqbil M, Almoteer AI, Suwayyid AM, Bakarman AH, Alrashed RF, Alrobish M, Alasalb F, Alhusaynan AA, Alnefaie MH, Altayar AS, Alobid SE, Almadani ME, Alshehri A, Alghamdi A, Asdaq SMB. Characteristics of COVID-19 Patients Admitted to Intensive Care Unit in Multispecialty Hospital of Riyadh, Saudi Arabia: A Retrospective Study. Healthcare (Basel) 2023; 11:2500. [PMID: 37761697 PMCID: PMC10530388 DOI: 10.3390/healthcare11182500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
During the early stages of the COVID-19 pandemic, infection rates were high and symptoms were severe. Medical resources, including healthcare experts and hospital facilities, were put to the test to ensure their readiness to deal with this unique event. An intensive care unit (ICU) is expected to be required by many hospitalized patients. Many hospitals worldwide lacked resources during the pandemic's peak stages, particularly in critical care treatment. Because of this, there were issues with capacity, as well as an excessive influx of patients. Additionally, even though the research location provides medical care to a sizable population, there is a paucity of scientific data detailing the situation as it pertains to COVID-19 patients during the height of the outbreak. Therefore, this study aimed to identify and describe the features of COVID-19 patients hospitalized in the ICU of one of the multispecialty hospitals in Riyadh, Saudi Arabia. An observational retrospective study was conducted using a chart review of COVID-19 patients admitted to the ICU between March 2020 and December 2020. To characterize the patients, descriptive statistics were utilized. An exploratory multivariate regression analysis was carried out on the study cohort to investigate the factors that were shown to be predictors of death and intubation. Only 333 (29.33%) of the 1135 samples from the hospital's medical records were used for the final analysis and interpretation. More than 76% of the patients in the study were male, with a mean BMI of 22.07 and an average age of around 49 years. The most frequent chronic condition found among the patients who participated in the study was diabetes (39.34%), followed by hypertension (31.53%). At the time of admission, 63 of the total 333 patients needed to have intubation performed. In total, 22 of the 333 patients died while undergoing therapy. People with both diabetes and hypertension had a 7.85-fold higher risk of death, whereas those with only diabetes or hypertension had a 5.43-fold and 4.21-fold higher risk of death, respectively. At admission, intubation was necessary for many male patients (49 out of 63). Most intubated patients had hypertension, diabetes, or both conditions. Only 13 of the 63 patients who had been intubated died, with the vast majority being extubated. Diabetes and hypertension were significant contributors to the severity of illness experienced by COVID-19 participants. The presence of multiple comorbidities had the highest risk for intubation and mortality among ICU-admitted patients. Although more intubated patients died, the fatality rate was lower than in other countries due to enhanced healthcare management at the ICU of the study center. However, large-scale trials are needed to determine how effective various strategies were in preventing ICU admission, intubation, and death rates.
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Affiliation(s)
- Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ali Ibrahim Almoteer
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Alwaleed Mohammed Suwayyid
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Abdulaziz Hussain Bakarman
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Raed Fawaz Alrashed
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Majed Alrobish
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Fahad Alasalb
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Abdulaziz Abdulrahman Alhusaynan
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Mohammed Hadi Alnefaie
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Abdullah Saud Altayar
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
| | - Saad Ebrahim Alobid
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Moneer E. Almadani
- Department of Clinical Medicine, College of Medicine, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia;
| | - Ahmed Alshehri
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, King Faisal Road, Dammam 31441, Saudi Arabia;
| | - Adel Alghamdi
- Department of Pharmaceutical Chemistry, Faculty of Clinical Pharmacy, Al Baha University, P.O. Box 1988, Al Baha 65779, Saudi Arabia;
| | - Syed Mohammed Basheeruddin Asdaq
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia; (A.I.A.); (A.M.S.); (A.H.B.); (R.F.A.); (M.A.); (F.A.); (A.A.A.); (M.H.A.); (A.S.A.)
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Arabi YM, Al Aseri Z, Alsaawi A, Al Khathaami AM, Al Qasim E, Alzahrani AA, Al Qarni M, Abdukahil SAI, Al-Dorzi HM, Alattasi A, Mandourah Y, Alaama TY, Alabdulaali MK, Alqahtani A, Shuaibi A, Al Qarni A, Alkatheri M, Al Hazme RH, Vishwakarma RK, Aldibasi O, Alshahrani MS, Attia A, Alharthy A, Mady A, Abdelrahman BA, Mhawish HA, Abdallah HA, Al-Hameed F, Alghamdi K, Alghamdi A, Almekhlafi GA, Qasim SAH, Al Haji HA, Al Mutairi M, Tashkandi N, Alabbasi SO, Al Shehri T, Moftah E, Kalantan B, Matroud A, Naidu B, Al Zayer S, Burrows V, Said Z, Soomro NA, Yousef MH, Fattouh AA, Tahoon MA, Muhammad M, Alruwili AM, Al Hanafi HA, Dandekar PB, Ibrahim K, AlHomsi M, Al Harbi AR, Saleem A, Masih E, Al Rashidi NM, Amanatullah AK, Al Mubarak J, Al Radwan AAA, Al Hassan A, Al Muoalad S, Alzahrani AA, Chalabi J, Qureshi A, Al Ansari M, Sallam H, Elhazmi A, Alkhaldi F, Malibary A, Ababtain A, Latif A, Berenholtz SM. Impact of a national collaborative project to improve the care of mechanically ventilated patients. PLoS One 2023; 18:e0280744. [PMID: 36716310 PMCID: PMC9886257 DOI: 10.1371/journal.pone.0280744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023] Open
Abstract
This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).
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Affiliation(s)
- Yaseen M. Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- * E-mail:
| | - Zohair Al Aseri
- Department of Emergency, Department of Intensive Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmohsen Alsaawi
- Department of Medical Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali M. Al Khathaami
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eman Al Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah A. Alzahrani
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Al Qarni
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sheryl Ann I. Abdukahil
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hasan M. Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaleem Alattasi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Yasser Mandourah
- Department of Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Tareef Y. Alaama
- Deputyship of Curative Services, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Abdulrahman Alqahtani
- Executive Director of Medical Affairs Department, Ministry of Health, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmad Shuaibi
- Department of Medical Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia
| | - Ali Al Qarni
- Department of Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Mufareh Alkatheri
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raed H. Al Hazme
- Department of Health Informatics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Biomedical Informatics, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Ramesh Kumar Vishwakarma
- Department of Bioinformatics and Biostatistics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Statistics Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Omar Aldibasi
- Department of Bioinformatics and Biostatistics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Saeed Alshahrani
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Ashraf Attia
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | | | - Ahmed Mady
- Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Anesthesiology and Intensive Care, Tanta University Hospital, Tanta, Egypt
| | | | - Huda Ahmad Mhawish
- Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Fahad Al-Hameed
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Khalid Alghamdi
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Adnan Alghamdi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghaleb A. Almekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Saleh Abdorabo Haider Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hussain Ali Al Haji
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Al Mutairi
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nabiha Tashkandi
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shatha Othman Alabbasi
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Tariq Al Shehri
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Emad Moftah
- Rehabilitation Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Basim Kalantan
- Rehabilitation Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amal Matroud
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Brintha Naidu
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salha Al Zayer
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Victoria Burrows
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Zayneb Said
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | | | | | - Majdi Muhammad
- Department of Intensive Care, Gurayat General Hospital, AlGurayat, Saudi Arabia
| | | | | | | | - Kamel Ibrahim
- Department of Intensive Care, King Khalid General Hospital, Majmaah, Saudi Arabia
| | - Mwafaq AlHomsi
- Department of Intensive Care, Buraydah Central Hospital, AlQassim, Saudi Arabia
| | - Asma Rayan Al Harbi
- Department of Intensive Care, King Fahad Specialist Hospital, AlQassim, Saudi Arabia
| | - Adel Saleem
- Department of Intensive Care, King Faisal Hospital, Makkah, Saudi Arabia
| | - Ejaz Masih
- Department of Intensive Care, King Khaled Hospital, Tabuk, Saudi Arabia
| | | | | | - Jaffar Al Mubarak
- Respiratory Services, King Khalid General Hospital, Hafer Al Batin, Saudi Arabia
| | | | - Ali Al Hassan
- Department of Intensive Care, King Khalid Hospital, Najran, Saudi Arabia
| | - Sadiyah Al Muoalad
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ammar Abdullah Alzahrani
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Jamal Chalabi
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Ahmad Qureshi
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Madinah, Saudi Arabia
| | - Maryam Al Ansari
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia
| | - Hend Sallam
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alyaa Elhazmi
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Fawziah Alkhaldi
- Nursing Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulrauf Malibary
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Ababtain
- Respiratory Services, Royal Commission Health Services Program, Jubayl, Saudi Arabia
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sean M. Berenholtz
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Alamer A, Asdaq SMB, AlYamani M, AlGhadeer H, Alnasser ZH, Aljassim Z, Albattat M, Alhajji A, Alrashed A, Mozari Y, Aledrees A, Almuhainy B, Abraham I, Alamer A. Characteristics of mechanically ventilated COVID-19 patients in the Al-Ahsa Region of Saudi Arabia: a retrospective study with survival analysis. Ann Saudi Med 2022; 42:165-173. [PMID: 35658584 PMCID: PMC9167461 DOI: 10.5144/0256-4947.2022.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND About 5-10% of coronavirus disease 2019 (COVID-19) infected patients require critical care hospitalization and a variety of respiratory support, including invasive mechanical ventilation. Several nationwide studies from Saudi Arabia have identified common comorbidities but none were focused on mechanically ventilated patients in the Al-Ahsa region of Saudi Arabia. OBJECTIVES Identify characteristics and risk factors for mortality in mechanically ventilated COVID-19 patients. DESIGN Retrospective chart review SETTING: Two general hospitals in the Al-Ahsa region of Saudi Arabia PATIENTS AND METHODS: We included mechanically ventilated COVID-19 patients (>18 years old) admitted between 1 May and 30 November 2020, in two major general hospitals in the Al-Ahsa region, Saudi Arabia. Descriptive statistics were used to characterize patients. A multivariable Cox proportional hazards (CPH) model was used exploratively to identify hazard ratios (HR) of predictors of mortality. MAIN OUTCOME MEASURES Patient characteristics, mortality rate, extubation rate, the need for re-intubation and clinical complications during hospitalization. SAMPLE SIZE AND CHARACTERISTICS 154 mechanically ventilated COVID-19 patients with median (interquartile range) age of 60 (22) years; 65.6% male. RESULTS Common comorbidities were diabetes (72.2%), hypertension (67%), cardiovascular disease (14.9%) and chronic kidney disease (CKD) (14.3%). In the multivariable CPH model, age >60 years old (HR=1.83, 95% CI 1.2-2.7, P=.002), CKD (1.61, 95% CI 0.9-2.6, P=.062), insulin use (HR=0.65, 95% CI 0.35-.08, P<.001), and use of loop diuretics (HR=0.51, 95% CI 0.4, P=.037) were major predictors of mortality. CONCLUSION Common diseases in mechanically ventilated COVID-19 patients from the Al-Ahsa region were diabetes, hypertension, other cardiovascular diseases, and CKD in this exploratory analysis. LIMITATIONS Retrospective, weak CPH model performance. CONFLICTS OF INTEREST None.
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Affiliation(s)
- Amnah Alamer
- From the Department of Internal Medicine, King Faisal University, Al Hasa, Saudi Arabia
| | | | - Mohammad AlYamani
- From the Department of Pharmacy Practice, AMaarefa University, Riyadh, Saudi Arabia
| | - Hussain AlGhadeer
- From the Department of Internal Medicine, King Fahad Hospital, Hofuf, Saudi Arabia
| | - Zahra H Alnasser
- From the Department of Internal Medicine, King Fahad Hospital, Hofuf, Saudi Arabia
| | - Zainab Aljassim
- From the Department of Internal Medicine, King Fahad Hospital, Hofuf, Saudi Arabia
| | - Maryam Albattat
- From the Department of Internal Medicine, King Fahad Hospital, Hofuf, Saudi Arabia
| | - Ahmed Alhajji
- From the Department of Internal Medicine, King Fahad Hospital, Hofuf, Saudi Arabia
| | - Ahmed Alrashed
- From the Clinical Pharmacy Department, King Fahad Medical City, Riyadh Saudi Arabia
| | - Yahya Mozari
- From the Clinical Pharmacy Department, King Fahad Medical City, Riyadh Saudi Arabia
| | - Abrar Aledrees
- From the Department of Primary Health, Primary Health Care Clinics, Al Ahsa, Saudi Arabia
| | - Badr Almuhainy
- From the Department of Internal Medicine, King Fahad Hospital, Hofuf, Saudi Arabia
| | - Ivo Abraham
- From the Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ahmad Alamer
- From the Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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5
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Metkus TS, Lindsley J, Fair L, Riley S, Berry S, Sahetya S, Hsu S, Gilotra NA. Quality of Heart Failure Care in the Intensive Care Unit. J Card Fail 2021; 27:1111-1125. [PMID: 34625130 DOI: 10.1016/j.cardfail.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 01/02/2023]
Abstract
Patients with heart failure (HF) who are seen in an intensive care unit (ICU) manifest the highest-risk, most complex and most resource-intensive disease states. These patients account for a large relative proportion of days spent in an ICU. The paradigms by which critical care is provided to patients with HF are being reconsidered, including consideration of various multidisciplinary ICU staffing models and the development of acute-response teams. Traditional HF quality initiatives have centered on the peri- and postdischarge period in attempts to improve adherence to guideline-directed therapies and reduce readmissions. There is a compelling rationale for expanding high-quality efforts in treating patients with HF who are receiving critical care so we can improve outcomes, reduce preventable harm, improve teamwork and resource use, and achieve high health-system performance. Our goal is to answer the following question: For a patient with HF in the ICU, what is required for the provision of high-quality care? Herein, we first review the epidemiology of HF syndromes in the ICU and identify relevant critical care and quality stakeholders in HF. We next discuss the tenets of high-quality care for patients with HF in the ICU that will optimize critical care outcomes, such as ICU staffing models and evidence-based management of cardiac and noncardiac disease. We discuss strategies to mitigate preventable harm, improve ICU culture and conduct outcomes review, and we conclude with our summative vision of high-quality of ICU care for patients with HF; our vision includes clinical excellence, teamwork and ICU culture.
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Affiliation(s)
- Thomas S Metkus
- The Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | - Linda Fair
- Johns Hopkins Hospital, Baltimore, Maryland
| | - Sarah Riley
- The Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen Berry
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarina Sahetya
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Hsu
- The Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nisha A Gilotra
- The Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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6
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Arabi YM, Tlayjeh H, Aldekhyl S, Al-Dorzi HM, Abdukahil SA, Al Harbi MK, Al Haji H, Al Mutairi M, Al Zumai O, Al Qasim E, Al Wehaibi W, Al Qahtani S, Al-Hameed F, Chalabi J, Alshahrani M, Albrahim T, Alharthy A, Mady A, Bin Eshaq A, Al Bshabshe AA, Al Aseri Z, Al Duhailib Z, Kharaba A, Alqahtani R, Al Ghamdi A, Altalag A, Alghamdi K, Almaani M, Algethamy H, Al Aqeily A, Al Baseet F, Al Samannoudi H, Al Obaidi M, Ismaiel YT, Al-Fares AA. Helmet Non-Invasive Ventilation for COVID-19 Patients (Helmet-COVID): study protocol for a multicentre randomised controlled trial. BMJ Open 2021; 11:e052169. [PMID: 34446500 PMCID: PMC8392742 DOI: 10.1136/bmjopen-2021-052169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Non-invasive ventilation (NIV) delivered by helmet has been used for respiratory support of patients with acute hypoxaemic respiratory failure due to COVID-19 pneumonia. The aim of this study was to compare helmet NIV with usual care versus usual care alone to reduce mortality. METHODS AND ANALYSIS This is a multicentre, pragmatic, parallel randomised controlled trial that compares helmet NIV with usual care to usual care alone in a 1:1 ratio. A total of 320 patients will be enrolled in this study. The primary outcome is 28-day all-cause mortality. The primary outcome will be compared between the two study groups in the intention-to-treat and per-protocol cohorts. An interim analysis will be conducted for both safety and effectiveness. ETHICS AND DISSEMINATION Approvals are obtained from the institutional review boards of each participating institution. Our findings will be published in peer-reviewed journals and presented at relevant conferences and meetings. TRIAL REGISTRATION NUMBER NCT04477668.
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Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Haytham Tlayjeh
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sara Aldekhyl
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hasan M Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sheryl Ann Abdukahil
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammad Khulaif Al Harbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Anesthesia, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Husain Al Haji
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Al Mutairi
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Omar Al Zumai
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eman Al Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Wedyan Al Wehaibi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saad Al Qahtani
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fahad Al-Hameed
- Intensive Care Department, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Jamal Chalabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
| | - Mohammed Alshahrani
- Departments of Emergency and Critical Care, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Talal Albrahim
- Department of Critical Care, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | | | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Abdulhadi Bin Eshaq
- Intensive Care Department, King Khalid Hospital Najran, Najran, Saudi Arabia
| | - Ali A Al Bshabshe
- College of Medicine, King Khalid University, Abha, Saudi Arabia
- Intensive Care Department, Aseer Central Hospital, Abha, Saudi Arabia
| | - Zohair Al Aseri
- Departments of Emergency Medicine and Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zainab Al Duhailib
- Adult Critical Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ayman Kharaba
- Pulmonary and Critical Care Departments, King Fahad Hospital Madinah, Madinah, Saudi Arabia
| | - Rakan Alqahtani
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Adnan Al Ghamdi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali Altalag
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khalid Alghamdi
- Intensive Care Department, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Mohammed Almaani
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ahmad Al Aqeily
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faisal Al Baseet
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hashem Al Samannoudi
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Al Obaidi
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Yassin T Ismaiel
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman A Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Kuwait
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7
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Kazzaz YM, Alkhalaf H, Alharbi M, Al Shaalan M, Almuneef M, Alshehri A, Alali H, AlHarbi T, Alzughaibi N, Alatassi A, Mahmoud AH, Aljuhani T, AlSaad A, Alqanatish J, Aldubayee M, Malik A, Al Amri A, Al Shebil S, Al Onazi M, Al Mutrafy AF, Al Moamary MS. Hospital preparedness and management of pediatric population during COVID-19 outbreak. Ann Thorac Med 2020; 15:107-117. [PMID: 32831931 PMCID: PMC7423210 DOI: 10.4103/atm.atm_212_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023] Open
Abstract
With the recent pandemic of Coronavirus disease-2019 (COVID-19), there has been a higher number of reported cases in children more than to the prior Corona Virus-related diseases, namely, severe acute respiratory syndrome and the Middle East respiratory syndrome. The rate of COVID-19 in children is lower than adults; however, due to high transmission rate, the number of reported cases in children has been increasing. With the rising numbers among children, it is imperative to develop preparedness plans for the pediatric population at the hospital level, departmental level, and patient care areas. This paper summarizes important considerations for pediatric hospital preparedness at the hospital level that includes workforce, equipment, supply; capacity planning, and infection prevention strategies, it also span over the management of COVID-19 pediatric patients in high-risk areas such as critical care areas, Emergency Department and operative rooms.
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Affiliation(s)
- Yasser M. Kazzaz
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hamad Alkhalaf
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Musaed Alharbi
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Al Shaalan
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maha Almuneef
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali Alshehri
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hamza Alali
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Talal AlHarbi
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Hematology Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nezar Alzughaibi
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaleem Alatassi
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Department of Quality and Patient Safety, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmed Haroun Mahmoud
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Talal Aljuhani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmad AlSaad
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Jubran Alqanatish
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Aldubayee
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Amna Malik
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Asma Al Amri
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saleh Al Shebil
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Milfi Al Onazi
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatrics Emergency, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah F. Al Mutrafy
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatrics Emergency, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohamed S. Al Moamary
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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8
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Alqahtani JS, AlAhmari MD, Alshamrani KH, Alshehri AM, Althumayri MA, Ghazwani AA, AlAmoudi AO, Alsomali A, Alenazi MH, AlZahrani YR, Alqahtani AS, AlRabeeah SM, Arabi YM. Patient-Ventilator Asynchrony in Critical Care Settings: National Outcomes of Ventilator Waveform Analysis. Heart Lung 2020; 49:630-636. [PMID: 32362397 DOI: 10.1016/j.hrtlng.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-ventilator asynchrony (PVA) is a prevalent and often underrecognized problem in mechanically ventilated patients. Ventilator waveform analysis is a noninvasive and reliable means of detecting PVAs, but the use of this tool has not been broadly studied. METHODS Our observational analysis leveraged a validated evaluation tool to assess the ability of critical care practitioners (CCPs) to detect different PVA types as presented in three videos. This tool consisted of three videos of common PVAs (i.e., double-triggering, auto-triggering, and ineffective triggering). Data were collected via an evaluation sheet distributed to 39 hospitals among the various CCPs, including respiratory therapists (RTs), nurses, and physicians. RESULTS A total of 411 CCPs were assessed; of these, only 41 (10.2%) correctly identified the three PVA types, while 92 (22.4%) correctly detected two types and 174 (42.3%) correctly detected one; 25.3% did not recognize any PVA. There were statistically significant differences between trained and untrained CCPs in terms of recognition (three PVAs, p < 0.001; two PVAs, p = 0.001). The majority of CCPs who identified one or zero PVAs were untrained, and such differences among groups were statistically significant (one PVA, p = 0.001; zero PVAs, p = 0.004). Female gender and prior training on ventilator waveforms were found to increase the odds of identifying more than two PVAs correctly, with odds ratios (ORs) (95% confidence intervals [CIs]) of 1.93 (1.07-3.49) and 5.41 (3.26-8.98), respectively. Profession, experience, and hospital characteristics were not found to correlate with increased odds of detecting PVAs; this association generally held after applying a regression model on the RT profession, with the ORs (95% CIs) of prior training (2.89 [1.28-6.51]) and female gender (2.49 [1.15-5.39]) showing the increased odds of detecting two or more PVAs. CONCLUSION Common PVAs detection were found low in critical care settings, with about 25% of PVA going undetected by CCPs. Female gender and prior training on ventilator graphics were the only significant predictive factors among CCPs and RTs in correctly identifying PVAs. There is an urgent need to establish teaching and training programs, policies, and guidelines vis-à-vis the early detection and management of PVAs in mechanically ventilated patients, so as to improve their outcomes.
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Affiliation(s)
- Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; UCL Respiratory, University College London, London, UK.
| | - Mohammed D AlAhmari
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; Chief Executive Officer (CEO), Rural Healthcare Networks, Eastren Province Health Cluster, Saudi Arabia
| | - Khalid H Alshamrani
- Department of Respiratory Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah M Alshehri
- Department of Respiratory Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mashhour A Althumayri
- Department of Respiratory Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah A Ghazwani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Asma O AlAmoudi
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Amal Alsomali
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Meshal H Alenazi
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Yousef R AlZahrani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdullah S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Saad M AlRabeeah
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Intensive Care Department, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia
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