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   2020| December  | Volume 4 | Issue 5  
    Online since December 7, 2020

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High-Flow Nasal Cannula for Patients with COVID-19 Acute Hypoxemic Respiratory Failure
Hassan M Alshaqaq, Zohair A Al Aseri, Mohammed Saeed Alshahrani
December 2020, 4(5):6-9
High-flow nasal cannula (HFNC) is a noninvasive oxygenation modality that delivers heated and humidified oxygen. It possesses several advantages due to the unique physiological effects on the lung and ventilation mechanics compared to other modes of oxygen therapy. The use of HFNC is tolerable, comfortable, and easy to set up. Current evidence indicates that the use of HFNC in critically ill patients with coronavirus disease 2019 (COVID-19)-acute hypoxemic respiratory failure (AHRF) is noninferior to noninvasive ventilation in the reduction of endotracheal intubation rate. Early identification of HFNC failure is vital to avoid delaying intubation. However, multiple knowledge gaps exist, and unpowered observational studies limit HFNC incorporation into strong recommendations. The low dispersion of particles demonstrates the feasibility of HFNC; yet, an appropriate setting and precautions should be maximized. Here, we review the recent evidence of HFNC implications in the management of patients with COVID-19-AHRF.
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Critical Care Surge Capacity in Saudi Arabia in Response to COVID-19 Pandemic
Zohair A Al Aseri, Tareef Alaama, Waleed Alhazzani, Faisal Al-Suwaidan, Yaseen M Arabi
December 2020, 4(5):14-17
Preparedness for coronavirus disease 2019 (COVID-19) started early in the Kingdom of Saudi Arabia before the World Health Organization declared COVID-19 as a pandemic. In this article, we narratively describe critical care surge planning in Saudi Arabia from an organizational perspective. In Saudi Arabia, the surge capacity response focused on seven domains, critical care surge capacity codes, communications, staff, space structure, supply, and strategies.
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Reengineering Workflow in the Intensive Care Units during COVID-19 Pandemic

December 2020, 4(5):40-42
Coronavirus disease-2019 (COVID-19) has led to a pandemic that pushed many intensive care units (ICUs) worldwide beyond their limits. To maintain efficient critical care services and to protect critical care staff, reengineering the ICU workflow became a necessity. The care of COVID-19 patients occurred in designated ICUs. High-efficiency particulate air filters were installed in rooms that did not have negative pressure. Non-ICU wards were used for care of critically ill patients. Handover between physicians, multidisciplinary rounds, and entry into the ICU were changed to avoid large gathering inside the units. Tiered staffing approach was used to maintain an adequate nurse-to-patient ratio. The care of non-COVID-19 patients took place in clean ICUs by a dedicated medical team to avoid cross contamination. As visitation was prohibited during the pandemic, communication with families of patients was done via advanced telecommunication methods such as videoconferencing. To protect ICU staff, appropriate donning and doffing of personal protective equipment were monitored and corrected by qualified personnel. Reuse or extended use of such equipment was carried out due to supply shortage.
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A National Initiative: Training Nonintensivists in Critical Care, an Educational Response to the COVID-19 Pandemic

December 2020, 4(5):34-39
The World Health Organization declared COVID-19 a pandemic in March 2020. It is accepted that the associated severe acute respiratory syndrome requires intensive care unit (ICU) management. Therefore, considering the rapid spread of the disease, a specific educational response in the form of a critical care course was designed for non-ICU physicians. The course involved purpose-driven learning that used backward education design, the six-step curriculum process, and blended learning. The course included critical care essentials, COVID-19 infection prevention and control, nontechnical skills, and physician wellness. The course was implemented in two parts: A self-directed online knowledge-focused component and a practical hands-on approach to ensure non-ICU physicians gained the necessary critical care skills. The practical simulation-based part was implemented combined with infection control measures. The central coordination team provided on-going scientific, organizational, and logistical support for this non-ICU physician course that would directly address the identified need for surge capacity planning.
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Clinical Pharmacy Service in the Intensive Care Unit during COVID-19 Pandemic

December 2020, 4(5):18-20
Critical care pharmacist is essential member of the intensive care unit (ICU) multidisciplinary team. ?During COVID-19 pandemic, ICU pharmacists showed their vital role in conceptualizing, appraising, and drafting prevention and treatment protocols, as well as evaluating the available evidence and providing the best references to develop national and institutional guidelines in COVID-19 management. In addition, their responsibilities include ensuring that the patient is receiving the safe and effective treatment. In addition, during this pandemic, clinical pharmacists around the Kingdom played a crucial role in mitigation of drug shortages.
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Successful Rapid Deployment of Intensive Care Services in Response to the COVID-19 Pandemic: A Case Study in Saudi Arabia

December 2020, 4(5):3-5
The coronavirus disease-2019 (COVID-19) pandemic has triggered a significant demand to support the most affected areas of severe and acute cases inside Saudi Arabia including the application of telemedicine. During the pandemic, the intensive care unit (ICU) staff from the largest private health-care sector were deployed to support the national critical care services and overcome the shortage of ICU staff in the greatest affected regions in Saudi Arabia. This study aims to describe the administrative actions taken to manage and treat the severe cases of COVID-19 that required ICU services and the deployment of the ICU services provided by private health-care providers to the most affected areas. The ICU staff have been rapidly deployed from the largest private health-care provider in the Middle East, from Riyadh province in the Central Region of Saudi Arabia for Madinah province in the Western region. Within 10 weeks, a total of 309 patients have received ICU and tele-ICU services. Approximately, 208 ICU staff, including intensivists, nurses, respiratory therapists, clinical nutritionists, and clinical pharmacists, have been providing ICU services 24 h a day, 7 days a week. The tele-ICU command center has provided valuable support, including the expert clinical guidance and consultation from the expert ICU consultants, utilizing audio-visual telecommunication networks, and governance of quality of the ICU among other many functions. With an average of 11.82% mortality rate, no accidental re-intubation reported cases, a zero re-intubation and re-admission rate within 48 h, this approach can be successfully followed and implemented in the future for risk and crisis management at local and international levels.
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Understanding the Psychological Stress and Optimizing the Psychological Support for the Acute-Care Health-Care Workers during the COVID-19 Pandemic

December 2020, 4(5):25-27
In this narrative review, we examined the psychological issues related to healthcare workers (HCWs) in acute-care areas during the COVID-19 pandemic. PubMed was searched on 18 Aug 2020 for published articles, with the following keywords: “COVID-19”, “mental health”, “health-care workers”, “front-lines”, “psychology”, “anxiety”, “depression”, “burnout” and “stress” in various combinations. We identified 23 studies, out of which 15 were selected. Data from several international studies indicate that HCWs are prone to developing mental health problems such as anxiety, depression, and substance abuse; thus, screening and supporting the HCWs who are at bigger risk for such psychological distress is warranted. We conclude that the healthcare system should have processes for providing support to minimize possible post-traumatic consequences among HCWs.
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How the COVID-19 Pandemic Affected the Care of the Surgical Patients in the Intensive Care Unit

December 2020, 4(5):10-13
The World Health Organization has announced COVID-19 as a pandemic in late 2019. It spread around the world, and the first case in Saudi Arabia was discovered in February of 2020. All types of patients have been affected including the surgical patients. In this review, we describe how the care of the surgical patients affected by the pandemic. The types of the surgical patients during the pandemic are described. These patients could be non-COVID patients or COVID patients requiring surgery. We describe as well how we take care of these patients if they require a surgical intervention. This review is part of the collaborative initiatives of the Saudi critical care trials group.
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The Current Use of Anti-IL6 and Corticosteroids in COVID-19 Patients with Cytokine-Release Syndrome

December 2020, 4(5):21-24
Cytokine-release syndrome (CRS) includes overproduction of inflammatory cytokines, termed a “cytokine storm,” which has been observed in a large proportion of critically ill COVID-19 patients. Patients diagnosed with CRS rapidly progress to cardiovascular collapse and multi-organ failure and carry a high mortality rate. Therefore, early detection, treatment, and prevention of cytokine storms are important. Immunomodulators, such as interleukin-6 (IL-6) antagonists, have recently emerged as an alternative therapeutic option for COVID-19 patients with cytokine storms. In preparation for a clinical trial, we searched the PUBMED, EMBASE, and COCHRANE databases to obtain related publications on the use of immunotherapies in CRS and CRS with COVID-19. We also included major review articles and recent guidelines. In our proposal, we aim to evaluate the efficacy and safety of anti-IL-6 alone versus anti-IL-6 and corticosteroid combination in COVID-19 critically ill patients with CRS. Our primary outcomes are duration of mechanical ventilation and 28-day ventilator-free days.
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Saudi Critical Care Research from Middle East Respiratory Syndrome to COVID-19

December 2020, 4(5):1-2
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The Use of Simulation in Health-Care Response to COVID-19

December 2020, 4(5):28-30
In preparation for the COVID-19 pandemic, simulation came in handy in aiding health-care facilities around the world to establish strategies to manage its personnel, space, and processes through experiential learning. Simulation bloomed during the epidemic due to its flexibility and capacity to train large number of health-care professionals at different levels in a timely manner while maintaining high safety profile. This brief review aims at providing some examples of simulation use in the era of COVID-19 pandemic around the world. In addition, we will address some of the limitations that faced simulation-based learning and provide a glimpse to the future of simulation in addressing global pandemics.
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Challenges and Opportunities to Critical Care Training Programs during COVID-19 Pandemic

December 2020, 4(5):31-33
Shortly after the COVID-19 pandemic announcement, health-care systems across the world were hugely affected by the mitigation measures to contain the infection. The training programs in different specialties were compromised, and the educational process was interrupted. The training program leaders have worked effortlessly to balance the educational process’s continuation with their trainees’ safety in ways that adhere to the mitigation measures. This review briefly discusses the challenges and opportunities to critical care training programs during the COVID-19 pandemic. The main challenges were interruptions of the educational process, reduced supervision, burnout, and reduced support. On the contrary, many opportunities have emerged including exposure to a new clinical disease and disaster response, virtual education, self-directed reading and assessment, and comprehensive support.
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