Background: Although recent international guidelines have been published on the management of critically ill patients with the novel coronavirus disease 2019 (COVID-19), there is a vital need to develop clinical practice guidelines tailored to the context of Saudi Arabia. Methods: The Saudi Critical Care Society (SCCS) is the sponsor for this guideline. The expert panel consisted of 19 members. All members completed the World Health Organization Conflict of Interest Form. The expert panel formulated questions on the management of critically ill patients in the intensive care unit with COVID-19. Panel members identified relevant studies. The panel used the categories of Grading Recommendations, Assessment, Development, and Evaluation (GRADE) to assess the confidence in the evidence. Results: The SCCS expert panel issued 53 statements; of which 7 were strong recommendations, 9 were best practice statements, 32 were weak recommendations, and we were not able to issue recommendations in 5 instances. The statements covered different aspects of the critical illness in COVID-19 patients, including: infection control; therapeutic interventions; supportive care; and crisis management. Conclusion: The SCCS guidelines on the management of critically ill COVID-19 patients have been based on the best available evidence and tailored to the context of Saudi Arabia. These guidelines will be updated periodically to incorporate new evidence.

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Background: Saudi registered nurses (RNs) currently comprise 30% of Saudi Arabia's nursing workforce, and turnover/attrition rates remain problematic. No studies exploring Saudi RNs' experiences of acute care work and/or the factors that influence their decision to continue working were located. Purpose: To construct an insightful understanding of the acute care workplace experiences of female Saudi RNs and factors affecting retention. Methods: Snowball sampling was used to recruit 26 female acute care Saudi RNs who were interviewed about their workplace experiences. A constructivist grounded theory approach was used to code and categorize data to construct a shared understanding reflective of the experiences of participants and the researcher as both constructing the meanings given. Results: Shared understandings of patients' culture, religion, and language were assisting Saudi RNs to feel competent in making a unique contribution to patient care. Although participants reported negative impacts from some workplace policies, they were able to create their own identity and to find their own place by creating a career identity as Saudi-Muslim nurses. Successfully creating this unique nursing identity enhanced their motivation, work commitment, and competence; however, difficulties were encountered in accommodating work conditions and working as a minority group within a workplace largely staffed by foreign nurses. Conclusion: Saudi nurses' acute care workplace experiences were found to be complex and challenging and significantly affected by the lack of supportive policies designed to help them to keep working clinically. Implications for Nursing Policy: Workplace retention of Saudi RNs is an organizational issue that needs wide discussion to enable continuing clinical work of Saudi female nurses.

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Background: COVID-19 is a worldwide pandemic that was first reported in China, and has spread to almost all nations. Measures of containment and control practiced by governments and authorities may benefit from prediction of the extent and peaks of spread to properly prepare to face the pandemic. Aim: The aim of the study was to predict the peak numbers of mortality, intensive care unit (ICU) admission, hospitalization, and positive cases and the time of their occurrence. Settings and Design: The study design is of a mathematical prediction model of prediction of spread of infectious disease, based on data from Saudi Arabia. Materials and Methods: We utilized a SEIR predictive model that divides the population into compartments and utilizes mathematical equations to predict the dynamics of the infection and its peak. The model exploited data from reliable sources on the Internet, and is – by design – based on certain assumptions. Statistical Analysis: Predefined mathematical equations that incorporate different parameters and assumptions were used for statistical analysis. Results: We estimated an R 0 value for our model of 2.2, and the model predicted a peak incidence of the pandemic around July 26, 2020. The peak mortality was predicted at 99,749 persons, predicted peak ICU admission of 70,246 patients, and peak hospitalization of 11,997,936 patients; all these predicted values were out of a total of predicted 14,049,104.83 COVID-19-positive cases. Conclusion: The COVID-19 pandemic in Saudi Arabia is predicted to peak by the end of July 2020, and may pose a serious burden on health-care systems already in shortage. Proper crisis management and effective resource utilization is crucial to safely overcome the pandemic, in addition to continuing control measures at least till the predicted peak time is over.

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Intensive care unit (ICU) cost analysis has not been extensively addressed in the Kingdom of Saudi Arabia. We have implemented cost analysis (2015–2016) at the largest polyvalent ICU of the Kingdom (King Saud Medical City). Our block model analysis assimilated both modified Therapeutic Intervention Scoring System (TISS) and Omega scoring points to evaluate the overall cost; while, specific utilization elements were included in such as medication, procedural, laboratory, radiology, physiotherapy, nursing/physician, and overhead/other costs. The overall cost (Saudi Riyals [SAR]/ICU patient/day) averaged for TISS/Omega scores and adjusted for 2015–2016 inflation rates was approximately 23.269 (TISS: 167 points; Omega: 173 points generating predictive costs scores which were approximating the aforementioned score [R² validated 0.91 and 0.90, respectively, all P < 0.005). Thereafter, we have applied effective antibiotic stewardship program and control of procedural supplies, novel administration policies, diversification of the ergonomy and clinical orientation, early mobilization of patients, increase of by-the-bed critical care ultrasound applications and decrease in the length of stay. The cost was reduced to 19.800 SAR (15%) in 2017–2018 that is comparable to international standards. Preliminary follow-up cost analysis (2019) is confirming projections of stabilizing the ICU cost <18.000 SAR (4790 USD)/patient/day. Our budget-cut policy has provided the department with a vital investment space to integrate new therapeutic technologies.

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Background: Health-care professionals work long hours, handle demanding patient loads, and make important decisions under conditions of uncertainty. These uncertain conditions have been shown to be associated with negative emotional and psychological outcomes for health-care professionals. In addition, they have been shown to lead to anxiety, depression, and other psychological and interpersonal strains, ultimately compromising the quality of patient care. Purpose: The purpose of this study is to evaluate the mental health issues of health-care providers including anxiety, depression, behavioral control, positive effect, and general distress. Methods: This is a cross-sectional study using a self-administered questionnaire. The questionnaire was distributed to health-care providers working at governmental and private health sectors in Saudi Arabia from January to April 2016. The questionnaire included a demographic survey and the Mental Health Inventory. Forty-five (45%) staff members completed the questionnaire. Results: Health-care professionals scored higher within the psychological distress, anxiety, depression, and loss of behavioral emotional control domains, indicating greater psychological distress. Females scored more on the depression domain than male participants. Further, physicians scored higher on the general positive effect domain than other health-care providers. Non-Saudi health-care providers scored higher on psychological distress scale than Saudi participants. Multiple regression analysis indicated that general positive effect, emotional ties, and life satisfaction were predictors of psychological well-being; on the other hand, anxiety, depression, and loss of behavioral/emotional control were predictors of psychological distress. Conclusion: High psychological distress may result from stressors associated with high work demands, workload, staff shortage, fear of infection, licensing board, fear of losing job, fear of reaction from leadership, peer, and patients and their families. Implication for Nursing Policy: Organizational supportive programs should be developed to enhance the psychological well-being of health-care professionals. These programs may decrease staff stress, anxiety, and depression and contribute to improve psychological well-being.

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Introduction: High-fidelity simulation (HFS) has recently been used for undergraduate nursing students to simplify their learning. The aim of the current study was to explore Saudi novice nursing students perceptions of satisfaction and self-confidence with HFS and to determine if there is any correlation between participants' demographic characteristics and satisfaction and self-confidence learning scale. Methods: A descriptive quantitative study was performed to recruit Saudi participants through Saudi Arabian Cultural Mission (SACM). Data were collected over a 3-month period from February, 2017 to May, 2017 through online survey was posted on SACM's official Facebook page. The survey used the Student Satisfaction and Self-Confidence in Learning tool. A total of (n = 76) Saudi undergraduate nursing students were participated. Data were analyzed using SPSS. Results: The findings revealed that satisfaction and self-confidence had a high mean score which indicates that the majority of the students were satisfied and self-confidence with the HFS experience. No significant correlations were found between the demographic characteristics and student satisfaction and self-confidence except that those who are in the prelicensure program had a significantly higher satisfaction score (P = 0.03) than students who had a bachelor or other degrees. Furthermore, a strong correlation between students' satisfaction and self-confidence in learning was found (P < 0.0001) indicating that these factors were correlated. Conclusions: This study has further confirmed that satisfaction and self-confidence are associated with the HFS experience. HFS prepare novice nursing students for real-life experience and promote the transition to a professional career. Nurse educators should be trained in the use of simulation as a teaching strategy. In addition, nursing faculty needs to consider students perception about the simulation when designing, performing, and evaluating.

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Cardiac arrest (CA) is a catastrophic world-wide health problem with substantial human and financial costs. Ongoing cerebral vasoconstriction and cerebral hypoxia during the early post-resuscitation period may contribute to the often poor neurological outcome in CA survivors. Arterial carbon dioxide (PaCO2) is the major determinant of cerebral blood flow and an increased PaCO2 (hypercapnia) markedly increases cerebral blood flow and oxygenation. This paper reports on the background and method of The TAME Cardiac Arrest trial (Clinicaltrials.gov (NCT03114033) which is a phase III multi-center, randomized, parallel-group, controlled trial. The trial will determine if targeted therapeutic mild hypercapnia (TTMH) (PaCO₂50-55mmHg) during mechanical ventilation improves neurological outcome at 6 months compared to targeted normocapnia (TN) (PaCO₂35-45 mmHg) in resuscitated CA patients. The intervention is cost-free and will be applied over the first 24-hours of ICU care. A total of 1700 adult resuscitated CA patients from ICUs around the world will be enrolled. When completed the TAME Cardiac Arrest trial will provide unprecedented insights that will transform the care of resuscitated CA patients admitted to the intensive care unit (ICU) around the world. Moreover, this therapy is cost free and, if shown to be effective, will improve thousands of lives, transform clinical practice, and yield major financial savings.

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Pressure injury (PI) is common in critically ill patients and is largely preventable. Prevention of PI in the intensive care unit (ICU) depends on routine risk assessment and implementation of preventive measures, such as adequate nutritional support, proper positioning and repositioning, mobilization, proper skin care, use of appropriate pressure-redistributing surfaces, and application of skin protective dressings. The available evidence suggests that a multifaceted approach is usually required. In addition, there is a need for high-quality studies to guide PI prevention in ICU patients.

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Healthcare-associated infections (HAI) are a preventable cause of morbidity and mortality in the Kingdom of Saudi Arabia and internationally. They are associated with increased length of stay, mortality, antibiotics cost, and overall hospital cost. About 250,000 central line-associated bloodstream infections (CLABSI) occur in the US yearly, with a rate of 0.8 per CL-days and attributed mortality of 12%–25%. CLABSI constitutes 14.2%–38.5% of HAIs in the Kingdom, with rates varying from 2.2 to 29.7/1000 CL-days and crude device-associated mortality of 16.8%–41.9%. This article highlights the scope of the problem and outlines preventive strategies.

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Background: In recent years, patients' safety has become high priority for health-care organizations. It has been documented that poor knowledge and compliance of health-care providers toward hand hygiene have contributed to poor patient safety outcomes. College students of health sciences may not receive adequate education and training on hand hygiene best practices. Objectives: To assess the health profession students' knowledge, attitude, and practice toward hand hygiene and to investigate the factors associated with poor hand hygiene knowledge and practice. Methods: This cross-sectional, correlational, descriptive study was conducted at King Saud Bin Abdulaziz University for Health Sciences performing clinical rotations at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A proportional sampling was used to calculate the required proportions that reflect the size of student population form each of the three colleges. A total of 270 students including 140 medical, 83 nursing, and 47 respiratory therapy students who were selected using a simple random sampling method were included in the study. An adapted and validated knowledge, attitude, and practice (KAP) questionnaire was used to assess four domains: general information, knowledge, self-reported compliance to the WHO 5 Moments of Hand Hygiene, and general satisfaction on received education. Results: The overall average of knowledge score was 81.13 points out of 100. The results revealed that the knowledge score of hand hygiene was higher for nursing school (84.22 ± 12.98), followed by medical school (81.71 ± 11.31) and then respiratory therapy program (75.53 ± 11.76). The results also showed that students who took courses covering hand hygiene scored higher in knowledge score (83.28 ± 11.3) as compared to students who did not take such courses (75.16 ± 12.89). In the compliance domain, the results showed that there were no significant differences in compliance of hand hygiene between students in all categories. In terms of overall student satisfaction with hand hygiene education and training, the results showed that nursing students have higher satisfaction score (72.7%) than their counterparts in medical school (48.3%) and respiratory therapy program (49.7%). Conclusion: Hand hygiene knowledge among students was generally good, and the highest was among nursing students and the lowest among respiratory therapy students. The compliance of students toward the WHO 5 Moments of Hand Hygiene did not vary across different colleges. Improved knowledge was found to be associated with improved compliance with hand hygiene best practices. Recommendations: Increasing the academic focus on hand hygiene in both the curriculum and clinical rotations with periodic standardized educational courses and focusing on hands-on workshops could have a positive impact on the knowledge and practice of hand hygiene for current health sciences students and future health-care providers. Future studies are needed to assess the hand hygiene KAP among students in hospital settings using observation of actual practice.

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Aims: A systematized review aimed to identify the impact of basic electrocardiogram (ECG) training courses on qualified nurses. Background: ECG plays a crucial role in helping to diagnose, follow-up, and detect any abnormalities in patients' conditions. Nurses often work on the frontline in hospitals and are the ones who initially assess patients' conditions. According to the British Heart Foundation (n. d), 26% of all mortality in the UK is attributable to heart and circulatory diseases. Methodology: A comprehensive, systematized review was undertaken using the AMED, EMBASE, CINAHL, and MEDLINE databases. Thematic analysis was then used to synthesis the findings from the studies selected. Ten papers were selected following the application of inclusion and exclusion criteria. Conclusion: Basic ECG training courses were found to improve nurses' knowledge, compared to those who did not possess ECG training, the quality of care was seen better among nurses who had received ECG courses, and even patient outcomes were improved in the total number of myocardial infarction events in hospital which was decreased compared to before the intervention. Cardiac care nurses had better ECG interpretation skills than other nurses regardless if they took ECG courses or not.

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Krait (elapid snake) bite may be painless, without evidence of flange marks, and the patient is many times unaware of the bite. This may present as unexplained neuroparalysis and deep coma with absent brainstem reflexes, and it may look like brain death. We present a case of such unexplained neuroparalysis who was diagnosed on clinical ground, and the patient was completely recovered with anti-snake venom (ASV) and supportive treatment. A high index of suspicious, background history of the patient and timely empirical ASV therapy can save the patient from a coma with unexplained neuroparalysis from definite death.

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Hypophosphatemia is a common electrolyte abnormality in our day-to-day practice in Intensive Care Unit. Severe hypophosphatemia is usually multifactorial and can lead to devastating consequences such as cardiac arrest. Phosphate replacement can be considered in severe symptomatic hypophosphatemia. We describe a patient of chronic alcoholic and diabetic who presented with diabetic ketoacidosis, right-lung pneumonia, and septic shock. Subsequently, the patient developed recurrent cardiac arrest. Both hypophosphatemia and phosphate-induced hypocalcemia were attributed to be the cause of this recurrent cardiac arrest.

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We report a 29-year-old female patient known to have lupus nephritis on immunosuppression and peritoneal dialysis who developed large bilateral spontaneous pneumothorax and mediastinal emphysema. The patient showed signs of tension pneumothorax and pneumomediastinum; however, she adamantly refused chest tubes insertion. Recovery was noted within 18 h of high-flow oxygen with normalization of chest image.

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Objective: Pressure ulcers present a major health challenge worldwide, and critically ill patients are considered to be at the greatest risk for pressure ulcer development. A study was undertaken to evaluate the effectiveness of pressure ulcer prevention measures (“PRESSURE bundle”) compared with standard care in reducing the incidence and prevalence of sacral pressure ulcers in critically ill patients in an Intensive Care Unit (ICU) in Riyadh, Saudi Arabia. Methods: Patients were assigned to the standard care group (n = 330) or the “PRESSURE bundle” group (n = 360). The follow-up period for both treatment groups was 2 months. A pre-post study design was used where data were collected in two samples. Patients were aged 16 years or over and included all new patients admitted to the ICU who did not have but were considered at risk of developing, sacral pressure ulcers (Braden scale score <18). Results: In the PRESSURE care bundle group, there was a significant reduction (P < 0.001) in the incidence of newly developed sacral pressure ulcers in the 2 months treatment period (n = 1, 0.3%) compared with the standard care group (n = 16, 4.6%). There was also a significant reduction (P < 0.001) in the prevalence of sacral pressure ulcers in the PRESSURE care bundle group (4.75%) compared with the standard care group (22.7%) when prevalence figures were compared at the end of the treatment periods. Conclusion: The application of a group of pressure ulcer prevention measures (“PRESSURE bundle”) coincided with a reduction in incidence and prevalence of sacral pressure ulcers in critically ill patients who are at risk for developing pressure ulcers.

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Introduction: Acinetobacter baumannii is a Gram-negative Coccobacillus and is a frequent cause of hospital-acquired infections. Because some strains of A. baumannii are resistant to many antibiotics (i.e., extensively drug-resistant A. baumannii, or XDRAB), selecting antibiotics to treat infected patients is challenging. Clinical outcomes in critically ill patients with XDRAB infections are poor. In this study, we evaluated the clinical effectiveness of colistin as monotherapy and in combination with other antibiotics. Patients and Methods: A retrospective cohort study was performed on 94 critically ill patients (age ≥18 years) to assess the clinical effectiveness of treating XDRAB infections with colistin, either in monotherapy or combination with tigecycline, meropenem, or both. Clinical and microbiological data were obtained from patient records. We included patients suffering from XDRAB ventilation-associated pneumonia (VAP), or ventilator-associated tracheobronchitis (VAT), or VAT with bacteremia. Results: The mean age of the patients was 53.3 years (±23.7 years), and the mean Acute Physiology and Chronic Health Evaluation II score was 22.7 (standard deviation = 7.1). VAP and VAT with bacteremia were found in 84% and 16% of patients, respectively. Half (51%) of patients achieved microbiological clearance. The median Intensive Care Unit (ICU) stay was 29 days (interquartile range [IQR]: 17, 55) and the median mechanical ventilation (MV) duration was 21 days (IQR: 12, 42). MV duration and ICU length of stay were lower in the group of patients treated with colistin and meropenem than in those treated with colistin alone. Mortality was significantly lower in patients who received (colistin and tigecycline 30%) than in those who were treated with monotherapy (75%) with an odd ratio 0.03 (95% confidence interval: 0.00, 0.32; P < 0.01). Conclusions: Colistin-based combination treatment regimens mainly with tigecycline or with tigecycline and meropenem were associated with better treatment outcomes of XDRAB-induced VAP and VAT with bacteremia than colistin monotherapy.

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Background: The value of critical care pharmacists (CCPs) in intensive care units (ICUs) has been well documented, and various studies have demonstrated the positive impacts of CCPs. Despite growing evidence supporting the contributions of clinical pharmacists in general and CCPs in particular in improving patient outcomes, many hospitals in the Kingdom of Saudi Arabia (KSA) still lack clinical pharmacy services. Most studies that have measured the impacts of CCPs in ICU settings have been conducted outside Saudi Arabia, with a significant gap in the literature related to CCP-related impacts, needs and obstacles in Saudi Arabia. Objective: To evaluate the current status of CCP services and the CCP services that are needed in Saudi Arabia as well as the barriers to establishing these services. Setting: Governmental and non-governmental hospitals in the western region of the KSA. Method: This was a cross-sectional survey-based study conducted in the western region of the KSA. The questionnaire included questions investigating current CCP services, which include clinical, educational, administrative and research services. Additional questions assessed the obstacles, needs and limitations related to the development of CCP services. Main Outcome Measures: The primary outcome is to describe the current status of ICU pharmacists in the KSA. Secondary outcomes of interest are the evaluation of the need for CCP services and the identification of the main barriers to establishing these services. Results: Of the 130 hospitals with ICUs to which surveys were emailed, 94 (72%) responded. Forty-three percent of responding hospitals had an ICU multidisciplinary team structure that included a pharmacist who visited the unit during medical rounds. Up to 54% of the hospitals with CCP services had one dedicated pharmacist present at bedside and during medical rounds. Approximately 78% of the ICU pharmacists performed one or more clinical activities. Training pharmacy interns was one of the major educational activities provided by ICU pharmacists. Clinical services (42%) were the most needed services, followed by educational (14%) activities. Limited job availability was the main barriers to having CCP services among hospitals. Conclusion: Critical care pharmacists in the western region of the KSA mainly provide fundamental clinical services, with limited engagement in desirable and optimal services such as research activities. The limited CCP services in the KSA are due to several barriers that warrant national efforts from the Ministry of Health (MOH) and the Saudi Commission for Health Specialists (SCFHS).

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Patients with critical illness and high mortality risk are frequently admitted to intensive care units (ICUs). Therefore, improving the quality of healthcare for these patients is essential. Improving overall health and following best practices for patient safety are important goals in the health-care sector; especially in critically ill patients. To achieve these goals, many researches have been conducted to develop procedures, protocols and improve ICU structure and design. To discuss the effectiveness of multidisciplinary team (MDT) implementation in ICUs in the Saudi Arabian hospitals and how would this approach significantly reduce ICU mortality rates and improves the quality of healthcare. This review search of electronic search engines was conducted, including ProQuest, Medline, and Google Scholar. The search was narrowed to a total of 21 articles between 2010 and 2020 articles were included, which were found to match the inclusion criteria. Findings indicated a positive effect of the MDT care on decreasing the ICU's mortality rates. The studies reviewed have documented the necessity of successful MDT care implementation for improved survival rates. A collaborative approach by the various health-care providers-nurses, physicians, intensivists, respiratory therapists, and pharmacists–enhances patient care, improves clinical outcomes, and reduces the mortality rate.

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Background: There is a wide range of conditions requiring a patient to have tracheostomy tube insertion. The use of tracheostomy tubes in hospitals has increased among patients with both stable and critical conditions. Respiratory illness may make it necessary for patients to have an alternative breathing system (apart from the mouth or nose) whether as a temporary or permanent procedure. Patients have different experiences of tracheostomy tube insertion. Aims: This study aims to perform a systematic review of qualitative research into the experiences of patients treated with a tracheostomy tube. Objective: The objective of this study is to systematically appraise qualitative evidence on the experience of adult patients having a tracheostomy tube in situ. The report seeks to answer the following question: What are the experiences faced by adult patients with a tracheostomy tube in situ? Inclusion Criteria: Types of Participants: This review included any research that used qualitative methods to investigate the experiences of adult patients with tracheostomy tube insertion. Phenomenon of Interest: The phenomenon of interest was the experience of patients with a tracheostomy tube in situ either as a temporary or permanent procedure, either in hospital or in the community. Types of Studies: This review deliberated on studies that concentrated on qualitative data. The review included all study designs; for instance, phenomenology, action research, grounded theory, feminist research, and ethnography. Search Strategy: The review included all relevant studies published in Arabic and English obtained from the following databases: CINAHL, Cochrane Library, EMBASE, MEDLINE (PubMed), and Scopus and reference lists. There was no limitation on year of publication, and reference list items were searched along with keywords in the heading, abstract, and topic descriptors. Methodological Quality: The methodological quality of each study was assessed by applying the Joanna Briggs Institute's Qualitative Assessment and Review Instrument. Data Collection: The study included adult patients treated with a tracheostomy tube. The research literature was searched using the standard methodology of qualitative research. The two reviewers then applied inclusion and exclusion criteria to the studies and evaluated the findings that met the inclusion criteria on the same subject. Data Synthesis: Synthesis of all data enabled a statement to be created that explains the experiences of adult patients with a tracheostomy tube in situ in the hospital or community. The data were then characterized according to the quality of findings and the similarity of meaning. Results: Four studies met the study selection criteria and were included in the systematic review that determined the experience of patients with a tracheostomy tube in situ. There were 18 findings extracted from the included studies. These were synthesized and then grouped into seven categories in relation to similarity of meaning. The seven categories remaining were then synthesized in a meta-synthesis that produced four outcomes linked to the experiences of participants having a tracheostomy tube in situ: (i) Communication is fundamental. (ii) The experience has both physical and psychological impacts. (iii) There are long-term consequences. (iv) Staff and patients work together to achieve positive outcomes. Conclusions: In the studies appraised by the reviewers, the importance of understanding the experiences of adult patients with tracheostomy tubes in situ was clarified. Patients have a right to experience correct practices that may help them to adapt to a new lifestyle with a tracheostomy. Implications for Practice: Patients should be given support physically, psychosocially, and emotionally after tracheostomy tube insertion. In addition, nurses' awareness about patients' educational needs regarding tracheostomy care, before discharge from hospital, needs to be increased. Implications for Further Research: Further research is required to identify the ways to reduce patients' negative experiences after having a tracheostomy tube in situ.

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Acinetobacter baumannii is a common healthcare associated problem. It can cause a wide variety of nosocomial infections because of its tremendous ability of acquiring antibiotic resistance and to survive in hospital environments. It's associated with high morbidity and mortality. So it has been considered as one of the dangerous organisms by the Infectious Diseases Society of America. In Saudi Arabia, many studies highlighted the magnitude of Acinetobacter baumannii infections but most of the studies were small. We plan to conduct a large multicenter prospective study in major ICUs in Saudi Arabia to determine the prevalence and prognosis of Acinetobacter baumannii infection, resistant pattern, risk factors associated with resistant and outcomes.

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Background: Current guidelines recommend early enteral nutrition in the critically ill. Nutritional deficiencies in this population may result in unfavorable outcomes. However, enteral nutrition may be complicated with feeding intolerance, aspiration, pneumonia, and interruption of feeding. Objectives: We updated our systematic review and meta-analysis that compared the effect of postpyloric and gastric feeding on risk of pneumonia, duration of mechanical ventilation (MV), Intensive Care Unit (ICU) length of stay (LOS), gastrointestinal (GI) bleeding, aspiration, vomiting, and mortality. Methods: We searched MEDLINE, EMBASE, and clinical registries for data through April 2017 without language or date of publication restrictions. We included randomized controlled trials (RCTS) comparing postpyloric feeding to gastric feeding. Two reviewers independently screened titles and abstracts for eligibility and extracted data in duplicate. Reviewers used the Cochrane Collaboration tool to assess the risk of bias, and the Grading of Recommendations, Assessment, Development, and Evaluation methodology to assess the quality of the evidence. We used trial sequential analysis (TSA) as a sensitivity analysis to adjust for sequential testing. Results: We included 21 RCTs (1573 patients). Postpyloric feeding reduced the risk of nosocomial pneumonia (relative risk [RR] 0.73; 95% confidence interval [CI] 0.57, 0.95; P = 0.02; I² = 11%; moderate quality), ventilator-associated pneumonia (RR 0.74, 95% CI 0.57, 0.96; P = 0.02; I² = 10%, moderate quality), and duration of MV (mean difference [MD] - 2.10 days, 95% CI −3.93, −0.28; P = 0.02; I² = 67%, low quality), compared to gastric feeding. There was no difference in mortality (RR 1.07, 95% CI 0.90, 1.27; P = 0.44; I² = 0%, moderate quality), ICU LOS (MD - 1.01 days, 95% CI −3.32, 1.3; P = 0.39; I² = 84%, very low quality), aspiration (RR 0.81, 95% CI 0.4, 1.60, P = 0.54; I² = 21%, very low quality), vomiting (RR 0.97, 95% CI 0.70, 1.36, P = 0.87; I² = 33%, very low quality), and GI bleeding (RR 0.88, 95% CI 0.56, 1.38; P = 0.56; I² = 0%, very low quality). Sensitivity analysis using TSA mirrored those of conventional analyses. Conclusions: Moderate quality evidence showed that postpyloric feeding may reduce the risk of pneumonia. Low-quality evidence yielded that duration of MV is shorter with pyloric compared to gastric feeding, with no significant impact on other outcomes. Although the results are promising further assessment in large clinical trials is warranted.

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Background: Many cancer patients need admission to intensive care unit (ICU). It is important to identify patients who will benefit most from ICU care. Objective: The current study aimed to identify the clinical features associated with outcomes and factors predicting ICU mortality of cancer patients at a tertiary care hospital in Riyadh, Saudi Arabia. Materials and Methods: This was a single-center, retrospective study of all adult patients with either hematological or solid cancer admitted to ICU between January 2017 and June 2018 at King Fahad Medical City, Riyadh, Saudi Arabia. Collected data included: patients' demographics, type of cancer, diagnosis, stage of disease, number of organs failure, reason for ICU admission, severity scores (Acute Physiology and Chronic Health Evaluation [APACHE] II, and Sepsis-related Organ Failure Assessment [SOFA] score), code status, interventions in the ICU, and outcomes. Results: A total of 108 cancer patients were admitted 128 times to ICU during the specified study period. Overall, mortality rate was 57% with standardized mortality rate according to the APACHE II of 0.75. Associative mortality included: vasopressor agents odds ratio (OR) = 3.44, cardiopulmonary resuscitation (CPR) before ICU admission OR = 3.35, presence of sepsis OR = 2.64, and need for invasive ventilatory support OR = 2.16. A total of 46 patients (43%) had hematological malignancies, whereas 62 (57%) had solid organ malignancies. Septic shock ranked first (44%) as the main reason for ICU admission. The mortality rate among hematological and solid organ cancer patients were 52% and 61%, respectively. The code status was do not resuscitate (DNR) in 55 patients (51%), 22% of the DNR patients were survivors. Twelve patients (22%) were DNR before ICU admission, whereas 43 (78%) were made DNR during their ICU stay. Most of ICU mortalities for both groups occurred within the first 20 days of ICU admission. Conclusion: Cancer patients admitted to ICU has high mortality rates; however, this does not preclude aggressive treatment for some. Factors associated with mortality include vasopressors, CPR, sepsis, and mechanical ventilation. Change of code status to DNR during ICU stay is common.

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Delirium is common among intensive care unit (ICU) patients; studies showed that delirium is linked to poor outcomes. Few studies have discussed delirium in the Arabic-speaking patients' population. The Saudi Critical Care Trials Group (SCCTG) is a leading entity for research and quality at ICU in Saudi Arabia. The SCCTG has worked on advancing delirium prevention and management by establishing multiple quality improvement projects as well as conducting research. The aim of this review is to highlight the effort of the SCCTG to improve delirium care at the ICU in Saudi hospitals.

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Acinetobacter is a strictly aerobic Gram-negative coccobacillus that is commonly present in hospital environment. It is considered a major healthcare problem worldwide. It can lead to different forms of severe infections, especially in critically ill patients. The prevalence of Acinetobacter infections is increasing in Saudi Arabia ,also the pattern of its antimicrobial susceptibility is changing as. Multidrug resistance and even pandrug resistance is increasing in almost all regions. Infections due to Acinetobacter are associated with high mortality reaching up to 58% in severe bloodstream infection. Additional research on Acinetobacter infections in critically ill patients in Saudi Arabia is needed.

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