Validation of the arabic version of the epworth sleepiness scale

The Epworth Sleepiness Scale [ESS] is a questionnaire widely used in developed countries to measure daytime sleepiness and diagnose sleep disorders. This study aimed to develop an ESS questionnaire for the Arabic population [ArESS], to determine ArESS internal consistency, and to measure ArESS test-retest reproducibility. It also investigated whether the normal range of ESS scores of healthy people in different cultures are similar. The original ESS questionnaire was translated from English to Arabic and back-translated to English. In both the English and Arabic translations of the survey, ESS consists of eight different situations. The subject was asked to rate the chance of dozing in each situation on a scale of 0-3 with total scores ranging between 0 [normal sleep] and 24 [very sleepy]. An Arabic translation of the ESS questionnaire was administered to 90 healthy subjects. Item analysis revealed high internal consistency within ArESS questionnaire [Cronbach's alpha = 0.86 in the initial test, and 0.89 in the retest]. The test-retest intra-class correlation coefficient [ICC] shows that the test-retest reliability was substantially high: ICC = 0.86 [95% confidence interval: 0.789-0.909, p-value < 0.001]. The difference in ArESS scores between the initial test and retest was not significantly different from zero [average difference = -0.19, t = -0.51, df = 89, p-value = 0.611]. In this study, the averages of the ESS scores [6.3 +/- 4.7, range 0-20 in the initial test and 6.5 +/- 5.3, range 0-20 in the retest] are considered high in Western cultures. The study shows that the ArESS is a valid and reliable tool that can be used in Arabic-speaking populations to measure daytime sleepiness. The current study has shown that the average ESS score of healthy Arabian subjects is significantly higher than in Western cultures

Changing sedation practices in the intensive care unit- protocol implementation, multifaceted multidisciplinary approach and teamwork

Sedation protocols have demonstrated effectiveness in improving ICU sedation practices. However, the importance of multifaceted multidisciplinary approach on the success of such protocols has not been fully examined. The study was conducted in a tertiary care medical-surgical ICU as a prospective, 4-pronged, observational study describing a quality improvement initiative that employs 2 types of controlled comparisons: a [before and after] comparison related to intense education of ICU clinicians and nurses about sedation and analgesia in the ICU, and a comparison of protocolized versus non-protocolized care. Patients were assigned alternatively to receive sedation by a goal-directed protocol using the Riker Sedation-Agitation Scale [SAS] or by standard practice. A multifaceted multidisciplinary educational program was initiated including the use of point of use reminders, directed educational efforts, and opinion leaders. This included several lectures and in-services and the routine availability of at least one member of this group to answer questions. We included all consecutive patients receiving mechanical ventilation, who were judged by their treating team to require intravenous sedation. The following data was collected: demographics, Acute Physiology and Chronic Health Evaluation [APACHE] II score and Simplified Acute Physiology score [SAPS] II, daily doses of analgesics and sedatives, duration of mechanical ventilation, ICU length of stay [LOS] and ventilator associated pneumonia [VAP] incidence. To examine the effect of the multifaceted multidisciplinary approach, we compared the first 3 months to the second 3 months in the following 4 groups: Gl no protocol group in the first 3 months, G2 protocol group in first 3 months, G3 no protocol group in the second 3 months, G4 protocol group in the second 3 months. After ICU day 3, SAS in the groups G2, G3 and G4 became higher than in Gl reflecting [lighter] levels of sedation. There were significant reductions in the use of analgesics and sedatives in the protocol group after 3 months. This was associated with a reduction in VAP rate and trends towards shorter mechanical ventilation duration and hospital length of stay [LOS]. The implementation of a multifaceted multidisciplinary approach including the use of point of use reminders, directed educational efforts, and opinion leaders along with sedation protocol led to significant changes in sedation practices and improvement in patients' outcomes. Such approach appears to be critical for the success of ICU sedation protocol

Hypokalemic paralysis mimicking Guillian Barre syndrome and causing acute respiratory failure

A 33-year-old female patient admitted to the ICU with ascending muscle weakness leading to acute hypercapneic respiratory failure. She gave a 10-day history of severe diarrhea and vomiting. Laboratory work up revealed severe hypokalemia, mixed metabolic and respiratory acidosis, and renal impairment. Continuous potassium replacement produced rapid and complete recovery from quadriplegia and respiratory failure without requirement for mechanical ventilation

Improving resource utilization in the intensive care units a challenge For Saudi hospitals

In the face of increasing demand of intensive care services in the Kingdom of Saudi Arabia, as well as the high cost of delivering such services, systematic steps must be undertaken in order to ensure optional utilization and fair allocation of resources. Strategies start prior to intensive care units [ICU] admission by the proper selection of patients who are likely to benefit from ICU. Less resource-demanding alternatives, such as intermediate care units, should be used for low-risk patients. Do-not-resuscitate status in patients with no meaningful chance of recovery will prevent futile admissions to ICUs. Measures known to improve the efficiency of care in the ICU must be implemented, including hiring full-time qualified intensivists, switching open units to closed ones and the introduction of certain evidence-base driven management protocols. On discharge, the intermediate care units again play a role as less expensive alternative transitional area for patients who are not stable enough to go to general ward. Measures to reduce re-admissions to ICU must also be implemented. Improving ICU resource utilization requires teamwork not only the intensivists but also the administrators and other health care providers