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  1. Yaseen MO, Saif A, Khan TM, Yaseen M
    Disaster Med Public Health Prep, 2022 Oct;16(5):1922-1928.
    PMID: 33762050 DOI: 10.1017/dmp.2021.92
    OBJECTIVE: Good hand hygienic practices are considered an important factor to curb the transmission and emergence of SARS-CoV -2. Various studies, conducted previously during the outbreaks of SARS-CoV and MERS-CoV, have ascertained the effectiveness of adopting good hand hygienic practices to curb the emergence of these viruses. This study aims to explore public hand hygienic practices during the peak pandemic period.

    METHOD: A descriptive cross-sectional study was conducted among the general population of Pakistan to investigate the knowledge and perception about hand hygiene, self-reported hand hygiene practices, adherence to hand hygienic guidelines, and barriers to optimal hand hygiene. Kruskal-Wallis test, Mann-Whitney U test, and Regression model were used for statistical analysis.

    RESULTS: There was a significant difference in area-based knowledge (P = 0.026), beliefs (P = 0.027), and practices (P = 0.002) regarding hand hygiene. The results of regression analysis revealed that people in urban areas were more likely to have better knowledge (β = 0.108, CI = 0.076 - 0.05, P = 0.008) and better adherence (β = 0.115, CI = 0.514 - 2.68, P = 0.004) to hand hygienic practices.

    CONCLUSION: Advertisements on television and other electronic media with appealing slogans could be effective in making people more compliant to optimal hand hygienic practices.

  2. Al Khalaf MS, Al Ehnidi FH, Al-Dorzi HM, Tamim HM, Abd-Aziz N, Tangiisuran B, et al.
    Ann Thorac Med, 2015 Apr-Jun;10(2):132-6.
    PMID: 25829965 DOI: 10.4103/1817-1737.150731
    RATIONALE: Sepsis is a leading cause of intensive care unit (ICU) admissions worldwide and a major cause of morbidity and mortality. Limited data exist regarding the outcomes and functional status among survivors of severe sepsis and septic shock.
    OBJECTIVES: This study aimed to determine the functional status among survivors of severe sepsis and septic shock a year after hospital discharge.
    METHODS: Adult patients admitted between April 2007 and March 2010 to the medical-surgical ICU of a tertiary hospital in Saudi Arabia, were included in this study. The ICU database was investigated for patients with a diagnosis of severe sepsis or septic shock. Survival status was determined based on hospital discharge. Patients who required re-admission, stayed in ICU for less than 24 hours, had incomplete data were all excluded. Survivors were interviewed through phone calls to determine their functional status one-year post-hospital discharge using Karnofsky performance status scale.
    RESULTS: A total of 209 patients met the eligibility criteria. We found that 38 (18.1%) patients had severe disability before admission, whereas 109 (52.2%) patients were with severe disability or died one-year post-hospital discharge. Only one-third of the survivors had good functional status one-year post-discharge (no/mild disability). After adjustment of baseline variables, age [adjusted odds ratio (aOR) = 1.03, 95% confidence interval (CI) = 1.01-1.04] and pre-sepsis functional status of severe disability (aOR = 50.9, 95% CI = 6.82-379.3) were found to be independent predictors of functional status of severe disability one-year post-hospital discharge among survivors.
    CONCLUSIONS: We found that only one-third of the survivors of severe sepsis and septic shock had good functional status one-year post-discharge (no/mild disability). Age and pre-sepsis severe disability were the factors that highly predicted the level of functional status one-year post-hospital discharge.
    KEYWORDS: Disability; functional status; septic shock; severe sepsis
  3. Ahmad W, Ur Rahman A, Ahmad I, Yaseen M, Mohamed Jan B, Stylianakis MM, et al.
    Nanomaterials (Basel), 2021 Jan 14;11(1).
    PMID: 33466855 DOI: 10.3390/nano11010203
    In this study, oxidative desulfurization (ODS) of modeled and real oil samples was investigated using manganese-dioxide-supported, magnetic-reduced graphene oxide nanocomposite (MnO2/MrGO) as a catalyst in the presence of an H2O2/HCOOH oxidation system. MnO2/MrGO composite was synthesized and characterized by scanning electron microscope (SEM), energy dispersive X-ray spectroscopy (EDX), Fourier transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD) analyses. The optimal conditions for maximum removal of dibenzothiophene (DBT) from modeled oil samples were found to be efficient at 40 °C temperature, 60 min reaction time, 0.08 g catalyst dose/10 mL, and 2 mL of H2O2/formic acid, under which MnO2/MrGO exhibited intense desulfurization activity of up to 80%. Under the same set of conditions, the removal of only 41% DBT was observed in the presence of graphene oxide (GO) as the catalyst, which clearly indicated the advantage of MrGO in the composite catalyst. Under optimized conditions, sulfur removal in real oil samples, including diesel oil, gasoline, and kerosene, was found to be 67.8%, 59.5%, and 51.9%, respectively. The present approach is credited to cost-effectiveness, environmental benignity, and ease of preparation, envisioning great prospects for desulfurization of fuel oils on a commercial level.
  4. Jameel HT, Panatik SA, Nabeel T, Sarwar F, Yaseen M, Jokerst T, et al.
    Psychol Res Behav Manag, 2020;13:193-201.
    PMID: 32158288 DOI: 10.2147/PRBM.S243722
    Background: Schizophrenia is a mental disorder that causes the social breakdown of relationships with others. Patients with schizophrenia interpret reality and verbal communication in an abnormal way. They experience great difficulty in building and maintaining of social relationships within society. They also experience barriers in communication and motivation that hinder their readiness for treatment. The willingness of patients with schizophrenia to be treated improves mental illness, social support and other health-related issues. The main purpose of this study was to explore the relationship between social support and willingness for treatment in patients with Schizophrenia.

    Methods: The qualitative research approach was used to solicit and capture more in-depth information from participants. The research design was phenomenological in nature. A cross-sectional survey method was employed. The sample consisted of twenty female patients diagnosed with schizophrenia, seven psychiatrists, and seven psychologists. A semi-structured interview guide was developed to collect the data. The interview guide covered three themes. The first theme included four questions for patients with schizophrenia. The second theme consisted of six questions for the psychiatrists and the third theme included two questions for the psychologists. Interview data were analysed through frame workanalysis.

    Results: The results of the study showed that social support plays an essential role in the improvement of patients with schizophrenia. Psychiatrists with the help of medication and therapies reduce the negativity and anxiety level of patients and motivate patients to accept treatment. Through counseling, psychologists help patients with schizophrenia build social skills such as the ability to engage in eye contact.

    Conclusion: It is revealed that the social support is closely related to the willingness for treatment in patients with schizophrenia. Therefore, social support is recommended in the course of treatment of patients with schizophrenia.

  5. Kamal A, Nazari V M, Yaseen M, Iqbal MA, Ahamed MBK, Majid ASA, et al.
    Bioorg Chem, 2019 09;90:103042.
    PMID: 31226469 DOI: 10.1016/j.bioorg.2019.103042
    Three benzimidazolium salts (III-V) and respective selenium adducts (VI-VIII) were designed, synthesized and characterized by various analytical techniques (FT-IR and NMR 1H, 13C). Selected salts and respective selenium N-Heterocyclic carbenes (selenium-NHC) adducts were tested in vitro against Cervical Cancer Cell line (Hela), Breast Adenocarcinoma cell line (MCF-7), Retinal Ganglion Cell line (RGC-5) and Mouse Melanoma Cell line (B16F10) using MTT assay and the results were compared with standard drug 5-Fluorouracil. Se-NHC compounds and azolium salts showed significant anticancer potential. Molecular docking studies of compounds (VI, VII and VIII) showed strong binding energies and ligand affinity toward following angiogenic factors: VEGF-A (vascular endothelial growth factor A), EGF (human epidermal growth factor), HIF (Hypoxia-inducible factor) and COX-1 (Cyclooxygenase-1) suggesting that the anticancer activity of adducts (VI, VII and VIII) may be due to their strong anti-angiogenic effect. In addition, compounds III-VIII were screened for their antibacterial and antifungal potential. Adduct VI was found to be potent anti-fungal agent against A. Niger with zone of inhibition (ZI) value 27.01 ± 0.251 mm which is better than standard drug Clotrimazole tested in parallel.
  6. Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al.
    JAMA Intern Med, 2015 Mar;175(3):363-71.
    PMID: 25581712 DOI: 10.1001/jamainternmed.2014.7386
    Little data exist on end-of-life care practices in intensive care units (ICUs) in Asia.
  7. Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al.
    Intensive Care Med, 2016 Jul;42(7):1118-27.
    PMID: 27071388 DOI: 10.1007/s00134-016-4347-y
    PURPOSE: To compare the attitudes of physicians towards withholding and withdrawing life-sustaining treatments in intensive care units (ICUs) in low-middle-income Asian countries and regions with those in high-income ones, and to explore differences in the role of families and surrogates, legal risks, and financial considerations between these countries and regions.

    METHODS: Questionnaire study conducted in May-December 2012 on 847 physicians from 255 ICUs in 10 low-middle-income countries and regions according to the World Bank's classification, and 618 physicians from 211 ICUs in six high-income countries and regions.

    RESULTS: After we accounted for personal, ICU, and hospital characteristics on multivariable analyses using generalised linear mixed models, physicians from low-middle-income countries and regions were less likely to limit cardiopulmonary resuscitation, mechanical ventilation, vasopressors and inotropes, tracheostomy and haemodialysis than those from high-income countries and regions. They were more likely to involve families in end-of-life care discussions and to perceive legal risks with limitation of life-sustaining treatments and do-not-resuscitate orders. Nonetheless, they were also more likely to accede to families' requests to withdraw life-sustaining treatments in a patient with an otherwise reasonable chance of survival on financial grounds in a case scenario (adjusted odds ratio 5.05, 95 % confidence interval 2.69-9.51, P 

  8. Shehabi Y, Serpa Neto A, Howe BD, Bellomo R, Arabi YM, Bailey M, et al.
    Intensive Care Med, 2021 Apr;47(4):455-466.
    PMID: 33686482 DOI: 10.1007/s00134-021-06356-8
    PURPOSE: To quantify potential heterogeneity of treatment effect (HTE), of early sedation with dexmedetomidine (DEX) compared with usual care, and identify patients who have a high probability of lower or higher 90-day mortality according to age, and other identified clusters.

    METHODS: Bayesian analysis of 3904 critically ill adult patients expected to receive invasive ventilation > 24 h and enrolled in a multinational randomized controlled trial comparing early DEX with usual care sedation.

    RESULTS: HTE was assessed according to age and clusters (based on 12 baseline characteristics) using a Bayesian hierarchical models. DEX was associated with lower 90-day mortality compared to usual care in patients > 65 years (odds ratio [OR], 0.83 [95% credible interval [CrI] 0.68-1.00], with 97.7% probability of reduced mortality across broad categories of illness severity. Conversely, the probability of increased mortality in patients ≤ 65 years was 98.5% (OR 1.26 [95% CrI 1.02-1.56]. Two clusters were identified: cluster 1 (976 patients) mostly operative, and cluster 2 (2346 patients), predominantly non-operative. There was a greater probability of benefit with DEX in cluster 1 (OR 0.86 [95% CrI 0.65-1.14]) across broad categories of age, with 86.4% probability that DEX is more beneficial in cluster 1 than cluster 2.

    CONCLUSION: In critically ill mechanically ventilated patients, early sedation with dexmedetomidine exhibited a high probability of reduced 90-day mortality in older patients regardless of operative or non-operative cluster status. Conversely, a high probability of increased 90-day mortality was observed in younger patients of non-operative status. Further studies are needed to confirm these findings.

  9. Shehabi Y, Howe BD, Bellomo R, Arabi YM, Bailey M, Bass FE, et al.
    N Engl J Med, 2019 Jun 27;380(26):2506-2517.
    PMID: 31112380 DOI: 10.1056/NEJMoa1904710
    BACKGROUND: Dexmedetomidine produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU). The use of dexmedetomidine as the sole or primary sedative agent in patients undergoing mechanical ventilation has not been extensively studied.

    METHODS: In an open-label, randomized trial, we enrolled critically ill adults who had been undergoing ventilation for less than 12 hours in the ICU and were expected to continue to receive ventilatory support for longer than the next calendar day to receive dexmedetomidine as the sole or primary sedative or to receive usual care (propofol, midazolam, or other sedatives). The target range of sedation-scores on the Richmond Agitation and Sedation Scale (which is scored from -5 [unresponsive] to +4 [combative]) was -2 to +1 (lightly sedated to restless). The primary outcome was the rate of death from any cause at 90 days.

    RESULTS: We enrolled 4000 patients at a median interval of 4.6 hours between eligibility and randomization. In a modified intention-to-treat analysis involving 3904 patients, the primary outcome event occurred in 566 of 1948 (29.1%) in the dexmedetomidine group and in 569 of 1956 (29.1%) in the usual-care group (adjusted risk difference, 0.0 percentage points; 95% confidence interval, -2.9 to 2.8). An ancillary finding was that to achieve the prescribed level of sedation, patients in the dexmedetomidine group received supplemental propofol (64% of patients), midazolam (3%), or both (7%) during the first 2 days after randomization; in the usual-care group, these drugs were administered as primary sedatives in 60%, 12%, and 20% of the patients, respectively. Bradycardia and hypotension were more common in the dexmedetomidine group.

    CONCLUSIONS: Among patients undergoing mechanical ventilation in the ICU, those who received early dexmedetomidine for sedation had a rate of death at 90 days similar to that in the usual-care group and required supplemental sedatives to achieve the prescribed level of sedation. More adverse events were reported in the dexmedetomidine group than in the usual-care group. (Funded by the National Health and Medical Research Council of Australia and others; SPICE III ClinicalTrials.gov number, NCT01728558.).

  10. Shehabi Y, Serpa Neto A, Bellomo R, Howe BD, Arabi YM, Bailey M, et al.
    Am J Respir Crit Care Med, 2023 Apr 01;207(7):876-886.
    PMID: 36215171 DOI: 10.1164/rccm.202206-1208OC
    Rationale: The SPICE III (Sedation Practice in Intensive Care Evaluation) trial reported significant heterogeneity in mortality with dexmedetomidine treatment. Supplemental propofol was commonly used to achieve desirable sedation. Objectives: To quantify the association of different infusion rates of dexmedetomidine and propofol, given in combination, with mortality and to determine if this is modified by age. Methods: We included 1,177 patients randomized in SPICE III to receive dexmedetomidine and given supplemental propofol, stratified by age (>65 or ⩽65 yr). We used double stratification analysis to produce quartiles of steady infusion rates of dexmedetomidine while escalating propofol dose and vice versa. We used Cox proportional hazard and multivariable regression adjusted for relevant clinical variable to evaluate the association of sedative dose with 90-day mortality. Measurements and Main Results: Younger patients (598 of 1,177 [50.8%]) received significantly higher doses of both sedatives compared with older patients to achieve comparable sedation depth. On double stratification analysis, escalating infusion rates of propofol to 1.27 mg/kg/h at a steady dexmedetomidine infusion rate (0.54 μg/kg/h) was associated with reduced adjusted mortality in younger but not older patients. This was consistent with multivariable regression modeling (hazard ratio, 0.59; 95% confidence interval, 0.43-0.78; P 
  11. Ahmad W, Ahmad Q, Yaseen M, Ahmad I, Hussain F, Mohamed Jan B, et al.
    Nanomaterials (Basel), 2021 Sep 13;11(9).
    PMID: 34578688 DOI: 10.3390/nano11092372
    The current study reports the effect of different wt. ratios of copper oxide nanoparticle (CuO-NPs) and reduced graphene oxide (rGO) as fillers on mechanical, electrical, and thermal properties of waste polystyrene (WPS) matrix. Firstly, thin sheets of WPS-rGO-CuO composites were prepared through solution casting method with different ratios, i.e., 2, 8, 10, 15 and 20 wt.% of CuO-NPs and rGO in WPS matrix. The synthesized composite sheets were characterized by Fourier transform infrared spectroscopy (FTIR), energy dispersive X-ray (EDX), X-ray diffraction (XRD) analysis, scanning electron microscopy (SEM) and thermal gravimetric analysis (TGA). The electrical conductance and mechanical strength of the prepared composites were determined by using LCR meter and universal testing machine (UTM). These properties were dependent on the concentrations of CuO-NPs and rGO. Results display that the addition of both fillers, i.e., rGO and CuO-NPs, collectively led to remarkable increase in the mechanical properties of the composite. The incorporation of rGO-CuO: 15% WPS sample, i.e., WPS-rGO-CuO: 15%, has shown high mechanical strength with tensile strength of 25.282 MPa and Young modulus of 1951.0 MPa, respectively. Similarly, the electrical conductance of the same composite is also enhanced from 6.7 × 10-14 to 4 × 10-7 S/m in contrast to WPS at 2.0 × 106 Hz. The fabricated composites exhibited high thermal stability through TGA analysis in terms of 3.52% and 6.055% wt. loss at 250 °C as compared to WPS.
  12. Yaseen M, Rawat SK, Khan U, Sarris IE, Khan H, Negi AS, et al.
    Nanotechnology, 2023 Sep 14;34(48).
    PMID: 37625394 DOI: 10.1088/1361-6528/acf3f6
    The customization of hybrid nanofluids to achieve a particular and controlled growth rate of thermal transport is done to meet the needs of applications in heating and cooling systems, aerospace and automotive industries, etc. Due to the extensive applications, the aim of the current paper is to derive a numerical solution to a wall jet flow problem through a stretching surface. To study the flow problem, authors have considered a non-Newtonian Eyring-Powell hybrid nanofluid with water and CoFe2O4and TiO2nanoparticles. Furthermore, the impact of a magnetic field and irregular heat sink/source are studied. To comply with the applications of the wall jet flow, the authors have presented the numerical solution for two cases; with and without a magnetic field. The numerical solution is derived with a similarity transformation and MATLAB-based bvp4c solver. The value of skin friction for wall jet flow at the surface decreases by more than 50% when the magnetic fieldMA=0.2is present. The stream function value is higher for the wall jet flow without the magnetic field. The temperature of the flow rises with the dominant strength of the heat source parameters. The results of this investigation will be beneficial to various applications that utilize the applications of a wall jet, such as in car defrosters, spray paint drying for vehicles or houses, cooling structures for the CPU of high-processor laptops, sluice gate flows, and cooling jets over turbo-machinery components, etc.
  13. Phua J, Faruq MO, Kulkarni AP, Redjeki IS, Detleuxay K, Mendsaikhan N, et al.
    Crit Care Med, 2020 05;48(5):654-662.
    PMID: 31923030 DOI: 10.1097/CCM.0000000000004222
    OBJECTIVE: To assess the number of adult critical care beds in Asian countries and regions in relation to population size.

    DESIGN: Cross-sectional observational study.

    SETTING: Twenty-three Asian countries and regions, covering 92.1% of the continent's population.

    PARTICIPANTS: Ten low-income and lower-middle-income economies, five upper-middle-income economies, and eight high-income economies according to the World Bank classification.

    INTERVENTIONS: Data closest to 2017 on critical care beds, including ICU and intermediate care unit beds, were obtained through multiple means, including government sources, national critical care societies, colleges, or registries, personal contacts, and extrapolation of data.

    MEASUREMENTS AND MAIN RESULTS: Cumulatively, there were 3.6 critical care beds per 100,000 population. The median number of critical care beds per 100,000 population per country and region was significantly lower in low- and lower-middle-income economies (2.3; interquartile range, 1.4-2.7) than in upper-middle-income economies (4.6; interquartile range, 3.5-15.9) and high-income economies (12.3; interquartile range, 8.1-20.8) (p = 0.001), with a large variation even across countries and regions of the same World Bank income classification. This number was independently predicted by the World Bank income classification on multivariable analysis, and significantly correlated with the number of acute hospital beds per 100,000 population (r = 0.19; p = 0.047), the universal health coverage service coverage index (r = 0.35; p = 0.003), and the Human Development Index (r = 0.40; p = 0.001) on univariable analysis.

    CONCLUSIONS: Critical care bed capacity varies widely across Asia and is significantly lower in low- and lower-middle-income than in upper-middle-income and high-income countries and regions.

  14. Leung CHC, Lee A, Arabi YM, Phua J, Divatia JV, Koh Y, et al.
    Ann Am Thorac Soc, 2021 08;18(8):1352-1359.
    PMID: 33284738 DOI: 10.1513/AnnalsATS.202008-968OC
    Rationale: There are limited data on mechanical discontinuation practices in Asia. Objectives: To document self-reported mechanical discontinuation practices and determine whether there is clinical equipoise regarding protocolized weaning among Asian Intensive Care specialists. Methods: A survey using a validated questionnaire, distributed using a snowball method to Asian Intensive Care specialists. Results: Of the 2,967 invited specialists from 20 territories, 2,074 (69.9%) took part. The majority of respondents (60.5%) were from China. Of the respondents, 42% worked in intensive care units (ICUs) where respiratory therapists were present; 78.9% used a spontaneous breathing trial as the initial weaning step; 44.3% frequently/always used pressure support (PS) alone, 53.4% intermittent spontaneous breathing trials with PS in between, and 19.8% synchronized intermittent mandatory ventilation with PS as a weaning mode. Of the respondents, 56.3% routinely stopped feeds before extubation, 71.5% generally followed a sedation protocol or guideline, and 61.8% worked in an ICU with a weaning protocol. Of these, 78.2% frequently always followed the protocol. A multivariate analysis involving a modified Poisson regression analysis showed that working in an ICU with a weaning protocol and frequently/always following it was positively associated with an upper-middle-income territory, a university-affiliated hospital, or in an ICU that employed respiratory therapists; and negatively with a low-income or lower-middle-income territory or a public hospital. There was no significant association with "in-house" intensivist at night, multidisciplinary ICU, closed ICU, or nurse-patient ratio. There was heterogeneity in agreement/disagreement with the statement, "evidence clearly supports protocolized weaning over nonprotocolized weaning." Conclusions: A substantial minority of Asian Intensive Care specialists do not wean patients in accordance with the best available evidence or current guidelines. There is clinical equipoise regarding the benefit of protocolized weaning.
  15. Phua J, Lim CM, Faruq MO, Nafees KMK, Du B, Gomersall CD, et al.
    J Intensive Care, 2021 Oct 07;9(1):60.
    PMID: 34620252 DOI: 10.1186/s40560-021-00574-4
    BACKGROUND: Asia has more critically ill people than any other part of our planet. The aim of this article is to review the development of critical care as a specialty, critical care societies and education and research, the epidemiology of critical illness as well as epidemics and pandemics, accessibility and cost and quality of critical care, culture and end-of-life care, and future directions for critical care in Asia.

    MAIN BODY: Although the first Asian intensive care units (ICUs) surfaced in the 1960s and the 1970s and specialisation started in the 1990s, multiple challenges still exist, including the lack of intensivists, critical care nurses, and respiratory therapists in many countries. This is aggravated by the brain drain of skilled ICU staff to high-income countries. Critical care societies have been integral to the development of the discipline and have increasingly contributed to critical care education, although critical care research is only just starting to take off through collaboration across groups. Sepsis, increasingly aggravated by multidrug resistance, contributes to a significant burden of critical illness, while epidemics and pandemics continue to haunt the continent intermittently. In particular, the coronavirus disease 2019 (COVID-19) has highlighted the central role of critical care in pandemic response. Accessibility to critical care is affected by lack of ICU beds and high costs, and quality of critical care is affected by limited capability for investigations and treatment in low- and middle-income countries. Meanwhile, there are clear cultural differences across countries, with considerable variations in end-of-life care. Demand for critical care will rise across the continent due to ageing populations and rising comorbidity burdens. Even as countries respond by increasing critical care capacity, the critical care community must continue to focus on training for ICU healthcare workers, processes anchored on evidence-based medicine, technology guided by feasibility and impact, research applicable to Asian and local settings, and rallying of governments for support for the specialty.

    CONCLUSIONS: Critical care in Asia has progressed through the years, but multiple challenges remain. These challenges should be addressed through a collaborative approach across disciplines, ICUs, hospitals, societies, governments, and countries.

  16. Li A, Ling L, Qin H, Arabi YM, Myatra SN, Egi M, et al.
    Am J Respir Crit Care Med, 2022 Nov 01;206(9):1107-1116.
    PMID: 35763381 DOI: 10.1164/rccm.202112-2743OC
    Rationale: Directly comparative data on sepsis epidemiology and sepsis bundle implementation in countries of differing national wealth remain sparse. Objectives: To evaluate across countries/regions of differing income status in Asia 1) the prevalence, causes, and outcomes of sepsis as a reason for ICU admission and 2) sepsis bundle (antibiotic administration, blood culture, and lactate measurement) compliance and its association with hospital mortality. Methods: A prospective point prevalence study was conducted among 386 adult ICUs from 22 Asian countries/regions. Adult ICU participants admitted for sepsis on four separate days (representing the seasons of 2019) were recruited. Measurements and Main Results: The overall prevalence of sepsis in ICUs was 22.4% (20.9%, 24.5%, and 21.3% in low-income countries/regions [LICs]/lower middle-income countries/regions [LMICs], upper middle-income countries/regions, and high-income countries/regions [HICs], respectively; P 
  17. Young PJ, Al-Fares A, Aryal D, Arabi YM, Ashraf MS, Bagshaw SM, et al.
    Crit Care Resusc, 2023 Jun;25(2):106-112.
    PMID: 37876605 DOI: 10.1016/j.ccrj.2023.04.008
    BACKGROUND: The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults with sepsis receiving unplanned invasive mechanical ventilation in the intensive care unit (ICU) is uncertain.

    OBJECTIVE: The objective of this study was to summarise the protocol and statistical analysis plan for the Mega-ROX Sepsis trial.

    DESIGN SETTING AND PARTICIPANTS: The Mega-ROX Sepsis trial is an international randomised clinical trial that will be conducted within an overarching 40,000-patient registry-embedded clinical trial comparing conservative and liberal ICU oxygen therapy regimens. We anticipate that between 10,000 and 13,000 patients with sepsis who are receiving unplanned invasive mechanical ventilation in the ICU will be enrolled in this trial.

    MAIN OUTCOME MEASURES: The primary outcome is in-hospital all-cause mortality up to 90 days from the date of randomisation. Secondary outcomes include duration of survival, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and the proportion of patients discharged home.

    RESULTS AND CONCLUSIONS: Mega-ROX Sepsis will compare the effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults with sepsis who are receiving unplanned invasive mechanical ventilation in the ICU. The protocol and a prespecified approach to analyses are reported here to mitigate analysis bias.

  18. Young PJ, Al-Fares A, Aryal D, Arabi YM, Ashraf MS, Bagshaw SM, et al.
    Crit Care Resusc, 2023 Mar;25(1):53-59.
    PMID: 37876994 DOI: 10.1016/j.ccrj.2023.04.011
    BACKGROUND: The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults who have nonhypoxic ischaemic encephalopathy acute brain injuries and conditions and are receiving invasive mechanical ventilation in the intensive care unit (ICU) is uncertain.

    OBJECTIVE: The objective of this study was to summarise the protocol and statistical analysis plan for the Mega-ROX Brains trial.

    DESIGN SETTING AND PARTICIPANTS: Mega-ROX Brains is an international randomised clinical trial, which will be conducted within an overarching 40,000-participant, registry-embedded clinical trial comparing conservative and liberal ICU oxygen therapy regimens. We expect to enrol between 7500 and 9500 participants with nonhypoxic ischaemic encephalopathy acute brain injuries and conditions who are receiving unplanned invasive mechanical ventilation in the ICU.

    MAIN OUTCOME MEASURES: The primary outcome is in-hospital all-cause mortality up to 90 d from the date of randomisation. Secondary outcomes include duration of survival, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and the proportion of participants discharged home.

    RESULTS AND CONCLUSIONS: Mega-ROX Brains will compare the effect of conservative vs. liberal oxygen therapy regimens on 90-day in-hospital mortality in adults in the ICU with acute brain injuries and conditions. The protocol and planned analyses are reported here to mitigate analysis bias.

    TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ACTRN 12620000391976).

  19. Phua J, Kulkarni AP, Mizota T, Hashemian SMR, Lee WY, Permpikul C, et al.
    Lancet Reg Health West Pac, 2024 Mar;44:100982.
    PMID: 38143717 DOI: 10.1016/j.lanwpc.2023.100982
    BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of critical care. The aim of the current study was to compare the number of adult critical care beds in relation to population size in Asian countries and regions before (2017) and during (2022) the pandemic.

    METHODS: This observational study collected data closest to 2022 on critical care beds (intensive care units and intermediate care units) in 12 middle-income and 7 high-income economies (using the 2022-2023 World Bank classification), through a mix of methods including government sources, national critical care societies, personal contacts, and data extrapolation. Data were compared with a prior study from 2017 of the same countries and regions.

    FINDINGS: The cumulative number of critical care beds per 100,000 population increased from 3.0 in 2017 to 9.4 in 2022 (p = 0.003). The median figure for middle-income economies increased from 2.6 (interquartile range [IQR] 1.7-7.8) to 6.6 (IQR 2.2-13.3), and that for high-income economies increased from 11.4 (IQR 7.3-22.8) to 13.9 (IQR 10.7-21.7). Only 3 countries did not see a rise in bed capacity. Where data were available in 2022, 10.9% of critical care beds were in single rooms (median 5.0% in middle-income and 20.3% in high-income economies), and 5.3% had negative pressure (median 0.7% in middle-income and 18.5% in high-income economies).

    INTERPRETATION: Critical care bed capacity in the studied Asian countries and regions increased close to three-fold from 2017 to 2022. Much of this increase was attributed to middle-income economies, but substantial heterogeneity exists.

    FUNDING: None.

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