Overview
To provide exemplary safe and high-quality care for critically ill patients, utilize cutting-edge
innovation and research to improve patient outcomes, educate tomorrow's leaders in the management of
acute life-threatening illnesses, and promote critical care profession locally and worldwide
Intensive Care Department Leadership
Dr. Yaseen Arabi
Chairman, Intensive Care Department
Dr. Abdulaziz Al-Dawood
Deputy Chairman, Intensive Care Department
Dr. Salim Baharoon
Section Head, General Intensive Care Unit (GICU)
Dr. Saad Al-Qahtani
Section Head, Critical Care Response Team (CCRT)
Dr. Hasan Al-Dorzi
Section Head, Medical Intensive Care Unit (MICU) & Trauma ICU (TICU)
Dr. Haytham Tlayjeh
Section Head, Transplant Oncology ICU (TOICU)
Dr. Basel Al Raiy
Section Head, Respiratory ICU (RICU)
Dr. Tarek Al-Dabbagh
Section Head, Surgical ICU (SICU)
Dr. Raymond Khan
Section Head, Neuro Critical Care Unit (NCCU)
Dr. Alawi Alsaeedi
Section Head, Progressive Recovery Unit (PRU)
Dr. Farhan Al-Enezi
Program Director, ICU Residency Training Program
Dr. Fahad Al-Rubayan
Program Director, ICU Fellowship Training Program
Critical Care Initiatives
Critical Care Initiatives aim to improve patient care and experience, facilitate workflow,
standardize practice among all National Guard Regions, monitor processes and outcomes,
create multidisciplinary teams, and automate documentation.
Those initiatives are as the following:
-
Family Support Program and Patient Experience Improvement in the Intensive Care
Department:
This program aims to support the patient's family in the intensive care units and improve
their experience to provide the highest level of patient and family-centered care.
It is a multidisciplinary cooperation between the patient experience department, social
service, Nursing, Respiratory therapist, and ICU Physicians to conduct a weekly meeting
with the patients' families and discuss their experience. Families are also engaged in the
ICU round with the treating team to explain the treatment plan and answer all their questions.
The I-protect project uses a wireless monitor to connect the patients in the ward to the
I-protect command center 24/7 to capture the clinical deterioration early.
The Early mobility project aims to maintain baseline mobility and functional capacity,
decrease the incidence of delirium, and decrease ventilator days and hospital length of stay.
A multidisciplinary team performs the project, including the treating physician, ICU nurse,
and physiotherapist or occupational therapist.
The ICU Handover Project aims to improve the process of the ICU patient handover by creating
a handover system in the electronic medical records (BESTCare) which can be filled up by the
team and prioritize the patient issues.
The Daily Goals Project aims to create a system-based checklist to be filled by the ICU nurse
and ICU physician with documentation in the electronic medical records system (BestCare).
The purpose is to ensure that the essential checklist of the patient plan of care has been completed.
- Simulation and patient safety
ICU simulation project is designed mainly to allow the acquisition of clinical skills through
deliberate practice rather than an apprentice learning style. Simulation provides a safe
simulation environment for the training using advanced technology and high-fidelity manikins.
A monthly schedule is arranged with different learning topics for ICU multidisciplinary team
members (residents, fellows, nurses, & respiratory therapists), such as safety patient
scenarios and skill training sessions, for example, Central line insertion, intubation, and
clinical scenarios.
- Extracorporeal Membrane Oxygenation (ECMO) project in the ICU
This ICU project aims to improve the clinical situation of ECMO "Extracorporeal Membrane
Oxygenation" patients by training more staff on dealing with ECMO patients and troubleshooting
in the simulation lab.
- National Approach to Standardize and Improve Mechanical Ventilation (NASAM) Project
To optimize the care of patients on mechanical ventilators.
Its main elements: Appropriate management of sedation, Timely weaning/discontinuation of
mechanical ventilation, Timely and appropriate level of physiotherapy.
- Critical care point of care ultrasound project
This project aims to improve the patient's diagnostic accuracy, minimize the time to diagnosis
and time to definitive management, enhance procedural safety, and decrease ICU Morbidity by
designing a critical care ultrasound competency. A primary focus is to train more ICU residents
& fellows and ensure their privileging on how to use it.
- Virtual family visit and patient experience (Zyarati)
An ICU-led project aims to offer a safe and convenient approach to virtually communicating with
patients and their families, mainly when hospital visits were restricted during the COVID-19 pandemic.
They were implemented in the different regions over the Ministry of the National Guard Health Affairs.
Over 10,000 video calls were made between the ICU patients and their families in 2021, with a family
satisfaction rate of 85%.
-
Stepped-wedge cluster randomized controlled trial of early electronic notification of sepsis
in hospitalized ward patients (SCREEN) project
The main goal of this critical care initiative is to improve the care of the ward's patients
with sepsis through early detection using electronic alert systems.
This system was implemented end of 2019 to include 45 wards in five National Guard hospitals,
which led to the acceleration of medical and nursing care provided to patients.
Critical Care Response Team
Critical care rapid response team is a team of specially trained practitioners who work collaboratively
with hospital ward staff to identify, assess and respond to the needs of seriously ill patients before
developing progressive and irreversible deterioration.
CCRT is activated to stabilize the patient's condition, integrate their care with the primary team,
and provide education and support.
CCRT Aims to reduce cardiac arrests outside the ICUs. The CCRT team comprises ICU consultants, ICU staff
physicians, critical care nurses, & ICU respiratory therapists.
CCRT was established in 2007, which reduced cardiac arrests in the wards, decreased complications, and
expedited emergency service for emergency patients.
Intensive Care Department Research and Studies
Ongoing trials:
- Replacing Protein via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients
Randomized Controlled Trial (REPLENISH Trial)
It is an open-label multicenter, multinational randomized-controlled trial sponsored by King Abdullah
International Research Center. This study aims to compare the effect of high protein intake (with the
addition of whey protein) compared to a moderate amount (no added protein) from day 5 of ICU till
discharge or day 90 on outcomes in critically ill patients. The patient will be under the study from day
5 to ICU
Discharge or day 90, whichever comes first.
This study aims to enroll 2502 patients in collaboration between National Guard hospitals: Riyadh,
Al-Ahsa, MADINAH, and Jeddah.
And also other hospitals in the Kingdom, such as King Faisal Specialist Hospital and Research Center,
King Saud Medical City in Riyadh, King Abdulaziz University Hospital in Jeddah, King Fahd Medical City
in Riyadh, Prince Sultan Military Medical City in Riyadh, King Khalid University, Asir Central Hospital
In addition: Other hospitals in the Middle East, such as Al-Amiri Hospital - Kuwait.
- A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia
REMAP-CAP
REMAP-CAP is a global network of leading experts, institutions, and research networks. With over 250
participating worldwide, REMAP-CAP
REMAP-CAP uses a novel and innovative adaptive trial design to evaluate several treatment options
simultaneously and efficiently. This design can adapt in the event of pandemics and increases the
likelihood that patients will receive the treatment that is most likely to be effective for them.
Community-acquired pneumonia (CAP) is a syndrome in which individuals who have not been hospitalized
recently develop an acute infection of the lungs. Bacterial and viral infections are responsible for the
vast majority of CAP.
Patients eligible for participation in REMAP-CAP will be randomized to receive one intervention in each
of one or more categories of treatment ("domains"). These interventions can be tested
simultaneously.
- Proportional Assist Ventilation for Minimizing the Duration of Mechanical Ventilation: The
PROMIZING Study (PROMIZING)
Mechanical ventilation is the most common form of life support required by most patients who receive
treatment in intensive care units. Although mechanical ventilation is essential in such situations, it
can induce weakness of the respiratory muscles, which may lead to prolonged dependence on the
ventilator. Prolonged dependence on mechanical ventilation is associated with worse patient outcomes and
high costs to the healthcare system.
Pressure support ventilation (PSV) is the most frequently used mode of ventilation for assisting the
breathing of patients during the recovery phase of acute respiratory failure. Proportional assist
ventilation (PAV) is a newer method of mechanical ventilation that delivers assistance to breathe in
proportion to the patient's effort. This method may preserve respiratory muscle function while
supporting the patient's need for respiratory assistance.
Several studies have shown short-term advantages of PAV over PSV, including improved patient-ventilator
synchronization, improved adaptability to changes in patient effort, and improved sleep quality. No
studies show either method's superiority for clinically important outcomes.
Our study will compare PAV to PSV using a randomized controlled trial. Our study is designed to
demonstrate that PAV reduces time on mechanical ventilation by at least 1.5 days.
- Bacteremia Antibiotic Length Needed for Clinical Effectiveness (BALANCE): A Randomized Controlled
Clinical Trial
Bloodstream infection means the presence of bacteria in the blood, which causes illness and is common in
patients during the hospital stay. In some people, it is the cause of hospital stay, and in others, it
develops during the hospital stay. Such infections require urgent treatment with antibiotics. Limited
literature is available to guide physicians about how long to treat these patients. Long durations of
treatment (14 days) may result in unnecessary side effects and antibiotic resistance. Recent data from
some research studies have suggested that a shorter duration of antibiotic therapy (<7 days) is as
effective as a longer duration of treatment for many infections due to bacteria. However, this has not
been confirmed/tested in patients with bloodstream infections.
The purpose of this study is to determine whether, in patients with bloodstream infection, shorter
duration antibiotic treatment (7 days) is associated with the same survival rates at 90 days compared to
those achieved with longer duration antibiotic treatment (14 days).
The current study is designed to find the best possible duration of antibiotic treatment in patients with
bloodstream infections and will answer whether patients with bloodstream infections can be treated with
a substantially shorter duration of antibiotic therapy. Establishing the optimal treatment duration for
this population will represent a major advance in health-related knowledge. Suppose shorter duration
treatment is as good as longer duration treatment. In that case, findings may also be generalizable to
non-bacteremic populations and could generate larger health-system-wide reductions in unnecessary
antimicrobial use, costs, and resistance.
- Re-EValuating the Inhibition of Stress Erosions and prophylaxis against gastrointestinal bleeding
in the critically ill (REVISE Trial) in King Abdulaziz Medical City under the supervision of King
Abdullah International Medical Research Center.
This study is a randomized control trial. It is sponsored by Canada Research Chair from the Canadian
Institute of Health Research (CIHR)-at McMaster University. This study will be conducted in Canada and
other countries. Also, it will be conducted in King Abdulaziz Medical Center (KAMC) Riyadh.
The total number expected to participate in this study is 4800 participants among global, local, and
middle eastern.
The purpose of this project is to determine in critically ill patients if pantoprazole (a drug that
decreases the acid production in the stomach) is effective in preventing bleeding from stomach ulcers or
whether it causes more problems such as lung infection (pneumonia) and bowel infection (Clostridium
difficile).
- Severe Acute Respiratory Infection Biological Sampling Study
Infectious diseases affect millions of people worldwide every year, and there is a great deal that we do
not understand about existing infections, and new infectious diseases continue to appear.
This research study will gain important information about respiratory infections, so we can find better
ways to manage and treat them in the future.
The prospective observational cohort study collaborates between the World Health Organization (WHO) and
the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC). The study is
conducted at multiple sites (to be determined by the spread of disease and availability of resources).
Patient data is collected by staff at each site, and it is submitted electronically to a protected online
database. Patient's identities will be protected, and their information will be held securely.
Furthermore, multiple studies can be done using this rich database.
Objectives of a study:
- Describe the clinical features and response to the treatment of SARI.
- Observe pathogen replication, excretion, and evolution, within the host, and identify determinants
of severity.
- Develop clinical guidance documents and offer clinical recommendations to policymakers based on
evidence obtained.
- Determine appropriate infection control measures for the various pathogens.
Intensive Care Department Publications
Fellows' and Residents' research
Fellows and residents in the Intensive Care Department are participating in research at the global and
local levels. They have contributed to many seminars and presented scientific lectures, such as The
Saudi Society of Critical Care Medicine.
Critical care fellowship and residency program
The Fellowship and Residency Program in the Intensive Care Department is a unique program. The trainee
can care for critically ill patients with supervision, including patients with trauma, organ transplant,
and extracorporeal membrane oxygenation "ECMO."
In addition, there is a simulation lab inside the division of the critical care department, which
facilitate training opportunities using simulation methods.
Moreover, fellows and residents participate in many quality projects in the intensive care unit to
improve the patients' and their families' overall quality of care.
The Compassionate Care in the Intensive Care Unit
Compassionate Care Program in the Intensive Care Unit aims to provide comprehensive, specialized and
personalized care for patients in need of intensive monitoring and care. This program involves a medical
team consisting of doctors, nurses and respiratory therapy specialists. Its goal is to offer medical,
emotional, and social support to patients and their families, providing comprehensive care that includes
accurate diagnosis and effective treatment plans.
The fundamental principles of supporting patients and their families in the ICU revolve around
comprehensive care and close interaction between the care team and the patient's family. The ICU
team strives to provide support and comfort to patients and their families through:
- Continuous communication: Effective communication among doctors, nurses and the patient's
family is crucial. This continuous connection allows for a better understanding of the patient's
condition and offers emotional support and necessary information based on their situation.
- Transparency and education: The team aims to provide clear information and a deep understanding of
the patient's condition and applied treatments, which helps alleviate stress and promote
healing. Additionally, the program offers opportunities to educate the patient's family about
the care provided during their stay in the ICU.
- Respect and personalized care: The program promotes respect and individual care for each patient
and their family, paying close attention to specific needs and personal requests to ensure comfort
and fulfillment of desires.
- Emotional and social support: The team provides psychological and social support to the patient and
their family as much as possible, whether through psychological consultations for patients or the
provision of social services.
- Decision-making partnership: The program encourages patient and family involvement in
treatment-related decision-making processes, enabling them to feel in control and participate
actively.
These principles form the foundation for providing a supportive and stimulating environment in the ICU,
aiming to achieve the highest levels of medical care and comprehensive support for patients and their
families, ultimately aiding in a quicker and better recovery process.
Divisions
Medical ICU
Medical Intensive Care Unit (MICU) specializes in caring for high-acuity patients with complex
medical diagnoses from sepsis to respiratory failure, acute renal failure, life-threatening
gastrointestinal (GI) bleeding, and metabolic disorders. The unit consists of 21 beds; all are
single rooms.
The unit is operated by staff skilled in managing medical ICU patients on a 24/7 basis.
The multidisciplinary team consists of ICU consultants, critical care nurses, respiratory therapists,
clinical pharmacists, clinical nutritionists, physical, occupational, and speech therapists, and
social workers to provide the highest level of care to critically ill patients and their families.
Families play a vital role in the management of patients in the MICU. The medical team communicates
with families regularly through face-to-face or video calls.
Several quality improvement projects are performed in the medical ICU to improve the care of
patients.
Transplant and Oncology ICU
Transplant and Oncology ICU- TOICU is a specialized ICU for Hematology-Oncology- Hepatology and organ
transplant in King Abdullah Specialized Children Hospital with 22 beds.
TOICU cares for critically ill patients with hematological diseases such as Acute Myeloid Leukemia,
post Stem cell transplant with complications, post-organ transplant surgeries, solid organ
malignancies, post-gyne-oncology surgeries, and bleeding.
The ICU is staffed with healthcare providers who are Chemotherapy providers, chemotherapy management,
special post-organ transplant protocols and post-stem cell transplant protocols, aiming at providing
patients with cancer and blood disorders personalized, family-oriented, multidisciplinary care that
is outcome and value-driven.
Integrated patient-family-centered care is the goal of care delivery in TOICU by providing daily
rounds by ICU consultants, staff physicians, medical residents, charge nurses, primary nurses, and
ICU Respiratory therapists to provide holistic-comprehensive patient care through the utilization of
specialist, multidisciplinary care team inputs.
TOICU has a Critical Care Response Team/code blue that responds to calls from eight different units
across the hospital.
Progressive Recovery Unit
The Progressive Recovery Unit (PRU) consists of 15 monitored beds.
The Progressive Recovery Unit (PRU) specializes in managing recovering patients from critical
illnesses.
The unit's vision is to provide recovering critically ill patients with care and medical,
physical, psychological, and social support.
PRU admits and accommodates patients from the Medical ICU, General ICU, Neuro ICU, Surgical ICU, Burn
ICU, and Respiratory ICU.
PRU and the rest of the Intensive Care Units work collaboratively to get the best outcomes for
critically ill patients.
Families play a vital role for patients in (PRU). The medical team communicates with families
regularly through face-to-face or video calls.
Several quality improvement projects are performed in the PRU to improve the care of patients.
Neuro Critical Care Unit
The Neuro Critical Care Unit (NCCU) specializes in managing critically ill patients with
life-threatening conditions that affect the brain, spine, and nervous system, per international
standards and guidelines. Conditions that are treated in NCCU include hemorrhagic stroke, including
intracerebral hemorrhage, subarachnoid hemorrhage, brain aneurysm rupture, traumatic brain injury,
ischemic stroke, brain infections, acute spinal cord injury, status epilepticus, neuromuscular
diseases, such as Guillain-Barré syndrome and myasthenia gravis, post complex neuro-interventional
or neurosurgical procedures.
Intensivists, neurologists, and neurosurgeons work together with nurses, respiratory therapists,
physical therapists, occupational therapists, speech-language pathologists, nutritionists, social
workers, and case managers as a multidisciplinary team to establish safe patient-family-centered
care plans.
The unit has eight specialized, fully monitored beds, and advanced neurological technical
capabilities include intracranial pressure monitoring, therapeutic temperature modulation, and
advanced hemodynamic monitoring.
Families play a vital role for patients in the NCCU. The team communicates with families regularly,
in person or through advanced telecommunication.
NCCU is equipped with advanced monitors and with different organ support modalities
Several quality improvement projects are continuously running in the NCCU to improve our care for
patients. Several quality indicators are audited and monitored, such as hand hygiene compliance,
central line-associated blood infections, ventilator-associated events, and other universal
indicators.
Trauma ICU
The Trauma ICU specializes in caring for patients with multiple injuries from severe trauma.
Procedures commonly performed to treat patients in the Trauma ICU include trauma and head injury
protocols, complex wound care and dressings, orthopedic case management, intubation, mechanical
ventilation, insertion of central lines, renal replacement therapy, chest tubes, drainage catheters,
and so on.
Trauma ICU is a closed unit comprising eight single rooms, all fitted with state-of-the-art
monitoring and equipment.
The daily multidisciplinary clinical rounds are led by an ICU consultant, including fellows,
residents, a charge nurse, bedside nurses, respiratory therapists, and a clinical pharmacist.
Specialized surgical teams support this team, such as neurosurgery, orthopedics, general and plastic
reconstructive surgery, and all medical specialties.
During the after-hours in-house coverage is provided by ICU Teams (consultants and physicians) 24
hours per day, seven days per week. Our TICU nursing team is trained and experienced in caring for
these complex case patients, complemented by solid support from wound and ostomy care specialists,
nutritionists, physical and occupational therapists, and social workers.
Families play a vital role for patients in the Trauma ICU. The Trauma
team communicates with families regularly, in person or through advanced telecommunication.
The Trauma ICU is equipped with advanced monitors and with different organ support modalities
Several quality improvement projects are continuously running in the Trauma ICU to improve our care
for patients. Several quality indicators are audited and monitored, such as hand hygiene compliance,
central line-associated blood infections, ventilator-associated events, and other universal
indicators.
Respiratory Intensive Care Unit (RICU)
RICU is a newly commissioned high-level intensity 15-bedded intensive care unit, purposely built to
care for patients with infectious and respiratory diseases safely. It is a state-of-the-art unit,
well equipped to manage infectious diseases such as COVID-19, MERS -CoV, TB, and all airborne
transmitted illnesses.
All rooms are negative pressure rooms with integrated negative pressure monitoring ensuring maximum
safety by decreasing the possibility of exposure to health workers and without compromising care for
the patient. It is also the primary unit for the ECMO "Extracorporeal Membrane
Oxygenation" program. It was set up to manage severely compromised patients with respiratory
failure who can no longer be managed safely with conventional ventilatory support alone.
RICU is equipped with staff skilled to manage all acuity and scope of ICU patients to care for any
patient with a respiratory infection or complex respiratory needs.
The multidisciplinary team in RICU consists of ICU consultants, critical care nurses, respiratory
therapists, clinical pharmacists, clinical nutritionists, physical, occupational, and speech
therapists, and social workers to provide the highest level of care to critically ill patients and
their families.
Families play a vital role for patients in (RICU). The medical team communicates with families
regularly through face-to-face or video calls.
Several quality improvement projects are performed in the respiratory ICU to improve the care of
patients.
General Intensive Care (GICU)
General ICU specializes in caring, diagnosing, and treating patients with acute illnesses. The unit
consists of 14 single beds. It uses an array of enhanced physiological monitoring systems,
organ-supportive therapies, and complex treatments that necessitate a high staff-to-patient ratio of
a highly-skilled, multi-professional team.
This team consists of ICU consultants, critical care nurses, respiratory therapists, clinical
pharmacists, clinical nutritionists, physical, occupational, and speech therapists, and social
workers to provide the highest level of care to critically ill patients and their families
Families play a vital role for patients in (GICU). The medical team communicates with families
regularly through face-to-face or video calls.
Several quality improvement projects are performed in the GICU to improve the care of patients.
Surgical Intensive Care
The Surgical Intensive Care Unit (SICU) is a multispecialty unit for critically ill patients who
require or are recovering from surgery. Patients treated at the SICU have conditions such as post
complex surgery, acute surgical illness, experiencing shock, and cardiac arrest.
SICU delivers care to patients 24/ 7. The multidisciplinary team includes intensivists, critical care
nurses, respiratory therapists, occupational therapists, and other specialists. The SICU team
collaborates closely to deliver the best treatment and excellent outcomes for our patients.
Families play a vital role for patients in (SICU). The medical team communicates with families
regularly either through face-to-face or video calls.
Several quality improvement projects are performed in the Surgical ICU to improve the care of
patients.