Characteristics of Critical Care Pharmacy Services in Saudi Arabia.

Purpose: Critical care pharmacists (CCPs) in intensive care units (ICUs) are associated with improved patient outcomes, reduced adverse events (ADEs), and reduced mortality rates. This study aimed to describe the activities and pharmacy services provided by CCP in ICUs in hospitals in Saudi Arabia (SA). Methods: In this cross-sectional prospective study, a questionnaire was electronically sent to CCPs practicing in SA between September 2022 and January 2023. A modified version of a previously published and validated survey was sent to the Saudi Critical Care and Emergency Specialty Network. The questionnaire focused on four CCP activities: clinical, educational, scholarly, and administrative. The level of services was similarly classified into three domains: fundamental, optimal, and desirable. The responses were analyzed using descriptive statistics. Results: The study surveyed 44 CCPs in SA, with a response rate of 52.3%. These CCPs were predominantly located in the central (47.8%) and eastern (30.4%) regions. Hospitals' ICU bed capacity ranged from 10 to 100, with 82% reporting mixed medical and surgical ICUs. Most CCPs had 4-10 years of critical care experience, and 60% held advanced degrees, with a substantial portion having completed PGY-1 and PGY-2 pharmacy residencies. CCPs were actively involved in patient care, with 86.9% participating in multidisciplinary rounds five days a week. They were engaged in clinical, educational, and administrative activities, with 82.6% involved in retrospective research and educational activities. Furthermore, 78.2% were engaged in pharmacy and therapeutic committees, 56.5% in critical care committees, and 56.5% in pharmacy department policy development. Conclusion: The study reveals that CCPs in SA play integral roles in ICU patient care and contribute significantly to clinical, educational, and administrative activities. The study highlights the need for standardized CCP-to-patient ratios and further support for CCPs to expand their services, thus contributing to enhanced healthcare quality.

Evaluation of the use of methylprednisolone and dexamethasone in asthma critically ill patients with COVID-19: a multicenter cohort study.

BACKGROUND: Previous studies have shown mortality benefits with corticosteroids in Coronavirus disease-19 (COVID-19). However, there is inconsistency regarding the use of methylprednisolone over dexamethasone in COVID-19, and this has not been extensively evaluated in patients with a history of asthma. This study aims to investigate and compare the effectiveness and safety of methylprednisolone and dexamethasone in critically ill patients with asthma and COVID-19. METHODS: The primary endpoint was the in-hospital mortality. Other endpoints include 30-day mortality, respiratory failure requiring mechanical ventilation (MV), acute kidney injury (AKI), acute liver injury, length of stay (LOS), ventilator-free days (VFDs), and hospital-acquired infections. Propensity score (PS) matching, and regression analyses were used. RESULTS: A total of one hundred-five patients were included. Thirty patients received methylprednisolone, whereas seventy-five patients received dexamethasone. After PS matching (1:1 ratio), patients who received methylprednisolone had higher but insignificant in-hospital mortality in both crude and logistic regression analysis, [(35.0% vs. 18.2%, P = 0.22) and (OR 2.31; CI: 0.56 - 9.59; P = 0.25), respectively]. There were no statistically significant differences in the 30-day mortality, respiratory failure requiring MV, AKI, acute liver injury, ICU LOS, hospital LOS, and hospital-acquired infections. CONCLUSIONS: Methylprednisolone in COVID-19 patients with asthma may lead to increased in-hospital mortality and shorter VFDs compared to dexamethasone; however, it failed to reach statistical significance. Therefore, it is necessary to interpret these data cautiously, and further large-scale randomized clinical trials are needed to establish more conclusive evidence and support these conclusions.

Point prevalence of delirium among critically ill patients in Saudi Arabia: A multicenter observational study.

Background: Delirium in critically ill patients is independently associated with poor clinical outcomes. There is a scarcity of published data on the prevalence of delirium among critically ill patients in Saudi Arabia. Therefore, we sought to determine, in a multicenter fashion, the prevalence of delirium in critically ill patients in Saudi Arabia and explore associated risk factors. Methods: A cross-sectional point prevalence study was conducted on January 28, 2020, at 14 intensive care units (ICUs) across 3 universities and 11 other tertiary care hospitals in Saudi Arabia. Delirium was screened once using the Intensive Care Delirium Screening Checklist. We excluded patients who were unable to participate in a valid delirium assessment, patients admitted with traumatic brain injury, and patients with documented dementia in their medical charts. Results: Of the 407 screened ICU patients, 233 patients were enrolled and 45.9% were diagnosed with delirium. The prevalence was higher in mechanically ventilated patients compared to patients not mechanically ventilated (57.5% vs. 33.6%; P < 0.001). In a multivariate model, risk factors independently associated with delirium included age (adjusted odds ratio [AOR], 1.021; 95% confidence interval [CI], 1.01-1.04; P = 0.008), mechanical ventilation (AOR, 2.39; 95% CI, 1.34-4.28; P = 0.003), and higher severity of illness (AOR, 1.01; 95% CI, 1.001-1.021; P = 0.026). Conclusion: In our study, delirium remains a prevalent complication, with distinct risk factors. Further studies are necessary to investigate long-term outcomes of delirium in critically ill patients in Saudi Arabia.