Sami Alsolamy

Islamic Views on Artificial Nutrition and Hydration in Terminally Ill Patients

Withholding and withdrawing artificial nutrition and hydration from terminally ill patients poses many ethical challenges. The literature provides little information about the Islamic beliefs, attitudes, and laws related to these challenges. Artificial nutrition and hydration may be futile and reduce quality of life. They can also harm the terminally ill patient because of complications such as aspiration pneumonia, dyspnea, nausea, diarrhea, and hypervolemia. From the perspective of Islam, rules governing the care of terminally ill patients are derived from the principle that injury and harm should be prevented or avoided. The hastening of death by the withdrawal of food and drink is forbidden, but Islamic law permits the withdrawal of futile, death-delaying treatment, including life support. Nutritional support is considered basic care and not medical treatment, and there is an obligation to provide nutrition and hydration for the dying person unless it shortens life, causes more harm than benefit, or is contrary to an advance directive that is consistent with Islamic law. The decision about withholding or withdrawing artificial nutrition and hydration from the terminally ill Muslim patient is made with informed consent, considering the clinical context of minimizing harm to the patient, with input from the patient, family members, health care providers, and religious scholars.

Critically Ill Patients with Middle East Respiratory Syndrome Coronavirus Infection

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Ultrasonography for the diagnosis of patients with clinically suspected skin and soft tissue infections: a systematic review of the literature.

Background In patients presenting with skin and soft tissue infections (SSTI), the use of ultrasound may lead to a more accurate distinction between cellulitis and abscess compared with clinical assessment alone. Objectives This systematic review aims to determine the diagnostic accuracy of ultrasound for detecting skin abscesses. In addition, it aims to assess the impact of using ultrasound on management decisions in patients with SSTI. Methods We searched relevant electronic databases for primary studies including MEDLINE, EMBASE, and CINAHL. We searched conference proceedings, checked references of retrieved articles, and contacted field experts. Two reviewers assessed the quality of each full-text publication using a modified QUADAS-2 tool. Results Five studies (n=710) fulfilled our inclusion criteria. Four studies compared the diagnostic accuracy of ultrasound with clinical examination alone (n=584). Most studies reported an improvement in diagnostic accuracy. The sensitivity of ultrasound ranged from 89 to 98% and the specificity ranged from 64 to 88%. However, the sensitivity of clinical assessment ranged from 75 to 90% and the specificity ranged from 55 to 83%; most of these results did not reach statistical significance. Sensitivity was further improved in cases of indeterminate clinical assessment. Two studies (n=176) examined the impact of ultrasound on management decisions. Use of ultrasound has led to significant and appropriate changes in management decisions in 16 to 39% of patients. Conclusion The use of ultrasound could potentially improve diagnostic accuracy and lead to improved management decisions in patients with SSTI, especially in cases of indeterminate clinical assessment. Most of our findings did not achieve statistical significance. Further research is required to confirm these findings.

Application of Failure Mode Effect Analysis to Improve the Care of Septic Patients Admitted Through the Emergency Department.

Background Failure mode effect analysis (FMEA) is a proactive multistep tool used to analyze risks, identify failures before they occur, and prioritize preventive measures. Methods A multidisciplinary team trained on FMEA methodology analyzed the process of treatment of septic patients and recorded processes under 3 major phases (recognition of severe sepsis, referral, and resuscitation). The team identified potential failure modes in each process; assigned severity, occurrence, and detection scores for each; and calculated the risk priority numbers (RPNs). Finally, higher-priority failure modes (RPN of ≥300) were analyzed to redesign the care process. Results We identified 27 processes and 48 failure modes with a mean RPN of 270. Twenty-two high-risk failures were identified by RPN of 300 or higher. All identified critical processes were related to phase 1 (recognition of sepsis) and phase 3 (resuscitation). The most critical process seemed to be related to the initial workup and treatment of septic patients, with 4 potential failure modes and a total RPN of 1485. Conclusions Patient safety and care reliability issues are a major concern in health care. This study suggests that tools such as FMEA can enable a detailed analysis of the care process of septic patients by outlining potential failure modes and guiding improvement efforts.

Thromboprophylaxis using combined intermittent pneumatic compression and pharmacologic prophylaxis versus pharmacologic prophylaxis alone in critically ill patients: study protocol for a randomized controlled trial

Author details Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh 11426, Kingdom of Saudi Arabia. Emergency Medicine and Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. Alfaisal University, Riyadh, Kingdom of Saudi Arabia. Interdepartmental Division of Critical Care Medicine, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada. Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia. King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. Department of Critical Care Medicine, King Khalid University, Assir Central Hospital, Abha, Kingdom of Saudi Arabia. Medical/Surgical ICU, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada. Intensive Care Department, King Abdulaziz Hospital, Al Ahsa, Kingdom of Saudi Arabia. Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. International Extended Care Centers, Jeddah, Saudi Arabia. Intensive Care Royal North Shore Hospital of Sydney and Sydney Adventist Hospital, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. Received: 17 August 2016 Accepted: 17 August 2016

Statistical analysis plan for the Pneumatic CompREssion for PreVENting Venous Thromboembolism (PREVENT) trial: a study protocol for a randomized controlled trial

BackgroundThe Pneumatic CompREssion for Preventing VENous Thromboembolism (PREVENT) trial evaluates the effect of adjunctive intermittent pneumatic compression (IPC) with pharmacologic thromboprophylaxis compared to pharmacologic thromboprophylaxis alone on venous thromboembolism (VTE) in critically ill adults.Methods/designIn this multicenter randomized trial, critically ill patients receiving pharmacologic thromboprophylaxis will be randomized to an IPC or a no IPC (control) group. The primary outcome is “incident” proximal lower-extremity deep vein thrombosis (DVT) within 28 days after randomization. Radiologists interpreting the lower-extremity ultrasonography will be blinded to intervention allocation, whereas the patients and treating team will be unblinded. The trial has 80% power to detect a 3% absolute risk reduction in the rate of proximal DVT from 7% to 4%.DiscussionConsistent with international guidelines, we have developed a detailed plan to guide the analysis of the PREVENT trial. This plan specifies the statistical methods for the evaluation of primary and secondary outcomes, and defines covariates for adjusted analyses a priori. Application of this statistical analysis plan to the PREVENT trial will facilitate unbiased analyses of clinical data.Trial registrationClinicalTrials.gov, ID: NCT02040103. Registered on 3 November 2013;Current controlled trials, ID: ISRCTN44653506. Registered on 30 October 2013.

Middle East Respiratory Syndrome: Global Outbreak Data Analysis

Background: The Middle East Respiratory Syndrome coronavirus (MERS-CoV) is a new human disease initially reported from the Arabian Peninsula in September 2012. Since then, the disease has spread worldwide. We present the available demographic and epidemiological data reported by the World Health Organization (WHO). Methods: We abstracted and analyzed all disease outbreak news archives from WHO about MERS-CoV between September 23, 2012 and December 4, 2015. Results: One thousand six cases of Middle East Respiratory Syndrome (MERS) were identified, with an average age of 52.7 years and where males comprised 68.1% of the cases. Comorbidities and healthcare workers reported in 47.1% and 15.5% of cases respectively. History of camel contact was reported in 9.8% of cases and contact with a laboratory confirmed MERS-CoV case was reported in 21.6% of cases. The overall mean (SD) from symptoms onset to date of laboratory confirmation was 5.2 days (4.2 days), CI 95% [4.9-5.6]. Conclusion: Our analyses demonstrated males are predominately affected by this disease. Observing the period from date of symptoms onset to date of laboratory confirmation was shorter among female patients and patients without comorbidities. In addition, it was significantly shorter in 2015 compared with 2014. Further analysis of an available MERS-CoV database could provide better understanding and guidance for future research activities.

Pretest Probability in the Assessment of Acute Dyspnea in the ED

Figure 1 – Multivariable conditional logistic regression model, with 95% confidence intervals, of the association between attention-deficit/ hyperactivity disorder in adults and atopy defined according to condition and level of severity. The odds ratio is adjusted for age, sex, urbanization level, and other atopic diseases (asthma, eczema, and rhinitis). Asthma severity was estimated on the basis of various medication proxies (see e-Appendix 1).

Noninvasive Mechanical Ventilation in Transfusion-Related Acute Lung Injury

Transfusion-related acute lung injury (TRALI) is a clinical syndrome associated with the transfusion of blood products. Risk factors for TRALI can be categorized as patient-specific or transfusion-specific. Ventilation and oxygenation support is key to TRALI management. Noninvasive ventilation (NIV) may be helpful in mild to moderate TRALI, but clinical studies to support the use of NIV are lacking.