Early recognition of severe sepsis and septic shock is challenging. The aim of this study was to determine the diagnostic accuracy of an electronic alert system in detecting severe sepsis or septic shock among emergency department (ED) patients. An electronic sepsis alert system was developed as a part of a quality-improvement project for severe sepsis and septic shock. The system screened all adult ED patients for a combination of systemic inflammatory response syndrome and organ dysfunction criteria (hypotension, hypoxemia or lactic acidosis). This study included all patients older than 14 years who presented to the ED of a tertiary care academic medical center from Oct. 1, 2012 to Jan. 31, 2013. As a comparator, emergency medicine physicians or the critical care physician identified the patients with severe sepsis or septic shock. In the ED, vital signs were manually entered into the hospital electronic heath record every hour in the critical care area and every two hours in other areas. We also calculated the time from the alert to the intensive care unit (ICU) referral. Of the 49,838 patients who presented to the ED, 222 (0.4%) were identified to have severe sepsis or septic shock. The electronic sepsis alert had a sensitivity of 93.18% (95% CI, 88.78% - 96.00%), specificity of 98.44 (95% CI, 98.33% – 98.55%), positive predictive value of 20.98% (95% CI, 18.50% – 23.70%) and negative predictive value of 99.97% (95% CI, 99.95% – 99.98%) for severe sepsis and septic shock. The alert preceded ICU referral by a median of 4.02 hours (Q1 - Q3: 1.25–8.55). Our study shows that electronic sepsis alert tool has high sensitivity and specificity in recognizing severe sepsis and septic shock, which may improve early recognition and management.
This study aims to identify factors that influence the adoption of artificial intelligence in teaching and learning environments in Saudi universities in light of the Unified Theory of Acceptance and Use of Technology, as well as proposals that effectively support the adoption of artificial intelligence (AI) in Saudi universities' teaching and learning environments. The study employs a qualitative approach based on a semi-structured interview, with the participation of 17 faculty members from Saudi universities specialising in educational technology. According to the Unified Theory of Acceptance and Use of Technology, the study's findings show that there are four aspects that affect how artificial intelligence is adopted in teaching and learning settings in Saudi universities. The facilitating conditions rank first in terms of positive impact, followed by performance expectancy in second, effort expectancy in third, and social influence in fourth place. The study makes a number of recommendations to encourage the use of artificial intelligence in Saudi universities, including teaching faculty members how to use artificial intelligence in the classroom, emphasising the benefits of implementing AI for educational leaders, offering AI tools, programmes, and technical support, as well as offering faculty members incentives and promoting scientific research in the area of AI in higher education. KEYWORDS Educational technology, E-learning, education, higher education, integration, Unified Theory of Acceptance and Use of Technology (UTAUT)
Background: Ventilator-associated pneumonia (VAP) is defined as a pneumonia that develops more than 48 to 72 hours after endotracheal intubation. VAP incidence and mortality rates can be reduced dramatically by following VAP bundles. Since there are no studies that focused exclusively on critical care respiratory therapists’ knowledge, this study was conducted. The aim of this study is to assess the critical care respiratory therapists’ knowledge regarding evidence-based guidelines for preventing VAP. Methods: A descriptive cross-sectional study was conducted at King Abdulaziz Medical City (KAMC), Riyadh during June – August 2019. The participants were Respiratory Therapists working in the Critical Care area. To evaluate the level of critical care respiratory therapists’ knowledge regarding evidence-based guidelines for the prevention of VAP a valid and reliable questionnaire that consisted of 9 non-pharmacological strategies to prevent VAP was used. The data was analyzed using SPSS 22. Results: The study included 90 participants (72.2%) were males. Forty six percent were aged between 21-30 years and 53% had ≥ 7 years of experience. The results showed that the mean knowledge score of the participants was 4 questions out of 9 and the majority (56%) were below the average knowledge score. There was no significant relationship between gender and the knowledge score; however, statistical significance was observed between experience and the knowledge score (P =0.009). As the experience increases so does the knowledge score. Conclusions: The study concludes that critical care respiratory therapists’ knowledge in KAMC was below the average. In order to increase their knowledge, they need to focus more on educational programs to help reduce the incidence of VAP.
To evaluate the outcomes of cirrhotic patients admitted to the intensive care unit (ICU) following cardiac arrest.This was a single centre retrospective study of all the cirrhotic patients, admitted to the ICU at King Abdulaziz Medical City, Riyadh, Saudi Arabia, after a successful cardiac arrest resuscitation, from 1999 to 2017. The characteristics of the hospital survivors and non-survivors were compared.A total of 76 patients were admitted to the ICU during the study period, with a median age of 64 years. In addition to cirrhosis, the patients had other chronic comorbidities, including chronic renal disease (32.9%) and diabetes (47%). Of this group, 67 (88.2%) died in the hospital, and 54 (71%) died while in ICU. Compared to the group who survived, all non-survivors required mechanical ventilation and had a higher median APACHE II score of 38 (p=0.006), a lower median Glasgow coma score (GCS) of 3 (p=0.0003), and a higher median lactic acid of 6.4 mmol/L (p=0.032). On multivariable logistic regression analysis, the important predictors of hospital mortality were APACHE II score (p=0.006), bilirubin level (p=0.008) and GCS (p=0.005).Cirrhotic patients admitted to the ICU following cardiac arrest have high mortality. Patients with higher APACHE II scores, higher bilirubin and lower GCS have higher risk of in-hospital mortality.
BACKGROUND: Community-acquired pneumonia (CAP) is a common reason for intensive care unit (ICU) admission and sepsis. Acute kidney injury (AKI) is a frequent complication of community-acquired pneumonia and is associated with increased short- and long-term morbidity and mortality and healthcare costs. OBJECTIVE: Describe the prevalence of AKI in patients with CAP requiring mechanical ventilation and evaluate its association with inhospital mortality. DESIGN: Retrospective cohort SETTING: Intensive care unit PATIENTS AND METHODS: We included patients with CAP on mechanical ventilation. Patients were categorized according to the development of AKI in the first 24 hours of ICU admission using the Kidney Disease Improving Global Outcomes (KDIGO) classification from no AKI, stage 1 AKI, stage 2 AKI, and stage 3 AKI. MAIN OUTCOME MEASURES: The primary outcome was hospital mortality. Secondary outcomes were ICU mortality, hospital and ICU length of stay, ventilation duration, tracheostomy, and renal replacement therapy requirement. RESULTS: Of 1536 patients included in the study, 829 patients (54%) had no AKI while 707 (46%) developed AKI. In-hospital mortality was 288/829 (34.8%) for patients with no AKI, 43/111 (38.7%) for stage 1 AKI, 86/216 (40%) for stage 2 AKI, and 196/380 (51.7%) for stage 3 AKI ( P <.0001). Multivariate analysis revealed that stages 1, 2, or 3 AKI compared to no AKI were not independently associated with in-hospital mortality. Older age, vasopressor use; decreased Glasgow coma scale, PaO 2 /Fio 2 ratio and platelet count, increased bilirubin, lactic acid and INR were associated with increased mortality while female sex was associated with reduced mortality. CONCLUSION: Among mechanically ventilated patients with CAP, AKI was common and was associated with higher crude mortality. The higher mortality could not be attributed alone to AKI, but rather appeared to be related to multi-organ dysfunction. LIMITATIONS: Single-center retrospective study with no data on baseline serum creatinine and the use of estimated baseline creatinine distributions based on the MDRD (Modification of Diet in Renal Disease)equation which may lead to an overestimation of AKI. Second, we did not have data on the microbiology of pneumonia, appropriateness of antibiotic therapy or the administration of other medications that have been demonstrated to be associated with AKI.
Background: Inpatient medical consultations have become an essential service in the specialty of Internal Medicine. Research in this new subspecialty will help improve the quality as well as the cost-effectiveness of this vital service.
Method: Data for all patients who were referred to the service were entered in a pre-designed form.
Results: One hundred and seventy-six adult patients with an average age of 53.3 years were seen by the service over a 4 months period. Consultations to the service were primarily from the departments of Surgery (110, 62.50%), Obstetrics and Gynecology (57, 32.39%). Co-morbidities were common specially diabetes mellitus (59.1%) and hypertension (41.5%). Most of the consultations were for emergency patients (99, 56.3%) rather than for electively (77, 43.7%) admitted cases. For operative patients, there was an equal share between pre- and post-operative cases (58.8% and 58.0% respectively). Prior referral to outpatient pre-operative clinics was unsatisfactory with the service requesting postponements of surgery for 22.1 percent of pre-operative cases. The major reasons for referral to the service were diabetes mellitus (49.4%), hypertension (30.7%) and respiratory problems (22.7%). Thirty-three percent of cases had more than one reason for referral. Active intervention by the service was frequent. The average length of care under the service was 5.2 days with a range of 1 to 90 days.
Conclusions: The service needs to be structured with regards to staff education and training; emphasizing on diabetes mellitus, hypertension and respiratory problems care. A joint interdepartmental effort along the above lines and better use of the pre-operative outpatient clinics are recommended.
Critically ill patients may develop bleeding caused by stress ulceration. Acid suppression is commonly prescribed for patients at risk of stress ulcer bleeding. Whether proton pump inhibitors are more effective than histamine 2 receptor antagonists is unclear.To determine the efficacy and safety of proton pump inhibitors vs. histamine 2 receptor antagonists for the prevention of upper gastrointestinal bleeding in the ICU.We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, ACPJC, CINHAL, online trials registries (clinicaltrials.gov, ISRCTN Register, WHO ICTRP), conference proceedings databases, and reference lists of relevant articles.Randomized controlled parallel group trials comparing proton pump inhibitors to histamine 2 receptor antagonists for the prevention of upper gastrointestinal bleeding in critically ill patients, published before March 2012.Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. The primary outcomes were clinically important upper gastrointestinal bleeding and overt upper gastrointestinal bleeding; secondary outcomes were nosocomial pneumonia, ICU mortality, ICU length of stay, and Clostridium difficile infection. Trial authors were contacted for additional or clarifying information.Fourteen trials enrolling a total of 1,720 patients were included. Proton pump inhibitors were more effective than histamine 2 receptor antagonists at reducing clinically important upper gastrointestinal bleeding (relative risk 0.36; 95% confidence interval 0.19-0.68; p = 0.002; I = 0%) and overt upper gastrointestinal bleeding (relative risk 0.35; 95% confidence interval 0.21-0.59; p < 0.0001; I = 15%). There were no differences between proton pump inhibitors and histamine 2 receptor antagonists in the risk of nosocomial pneumonia (relative risk 1.06; 95% confidence interval 0.73-1.52; p = 0.76; I = 0%), ICU mortality (relative risk 1.01; 95% confidence interval 0.83-1.24; p = 0.91; I = 0%), or ICU length of stay (mean difference -0.54 days; 95% confidence interval -2.20 to 1.13; p = 0.53; I = 39%). No trials reported on C. difficile infection.In critically ill patients, proton pump inhibitors seem to be more effective than histamine 2 receptor antagonists in preventing clinically important and overt upper gastrointestinal bleeding. The robustness of this conclusion is limited by the trial methodology, differences between lower and higher quality trials, sparse data, and possible publication bias. We observed no differences between drugs in the risk of pneumonia, death, or ICU length of stay.
Abstract Background In December 2019, SARS-CoV-2 caused a global pandemic with a viral infection called COVID-19. The disease usually causes respiratory symptoms but in a small proportion of patients can lead to a pneumonitis, Adult Respiratory Distress Syndrome and death. Invasive Mechanical Ventilation (IMV) is considered a life-saving treatment for COVID-19 patients and a huge demand for IMV devices was reported globally. This review aims to provide insight on the initial IMV practises for COVID-19 patients in the initial phase of the pandemic. Methods Electronic databases (Embase and MEDLINE) were searched for applicable articles using relevant keywords. The references of included articles were hand searched. Articles that reported the use of IMV in adult COVID-19 patients were included in the review. The NIH quality assessment tool for cohort and cross-sectional studies was used to appraise studies. Results 106 abstracts were identified from the databases search, of which 16 were included. 5 studies were included in the meta-analysis. In total, 9988 patients were included across all studies. The overall cases of COVID-19 requiring IMV ranged from 2–77%. Increased age and pre-existing comorbidities increased the likelihood of IMV requirement. The reported mortality rate in patients receiving IMV ranged between 50–100%. On average, IMV was required and initiated between 10–10.5 days from symptoms onset. When invasively ventilated, COVID-19 patients required IMV for a median of 10–17 days across studies. Little information was provided on ventilatory protocols or management strategies and were inconclusive. Conclusion In these initial reporting studies for the first month of the pandemic, patients receiving IMV were older and had more pre-existing co-morbidities than those who did not require IMV. The mortality rate was high in COVID-19 patients who received IMV. Studies are needed to evaluate protocols and modalities of IMV to improve outcomes and identify the populations most likely to benefit from IMV.
