Mohd Basri Mat Nor

• MB.BCh.BAO, LRCP&SI, M.Med Anaesthesiology, EDIC
• Professor and Senior Consultant at International Islamic University Malaysia

Background Approximately half of all antimicrobial prescriptions in intensive care units (ICUs) may be inappropriate, including those prescribed when not needed, in unnecessary combinations or for longer durations than needed. Inappropriate prescribing is costly, exposes patients to unnecessary side-effects and drives population-level antimicrobial...

Appropriate antifungal therapy is a major determinant of survival in critically ill patients with invasive fungal disease. We sought to describe whether contemporary dosing of antifungals achieves therapeutic exposures in critically ill patients. In a prospective, open-label, multicenter pharmacokinetic study, intensive care unit (ICU) patients pre...

Background This study evaluates the predictive performance of prognostic models derived from low- and middle-income country (LMIC) data using a multinational Asian critical care dataset. The research also seeks to identify opportunities for improving these models' accuracy and utility in clinical research and for international benchmarking of criti...

Background The effectiveness of reducing healthcare-associated infections (HCAIs) depends on increasing healthcare providers’ awareness, skills, and adherence to standard practices. Mhealth applications provide an innovative approach to enhancing access to information and resources while reducing time and expenses. Objective The study aimed to dev...

Background Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors (RF) in Asia. Methods From 03/27/2004 to 02/11/2022, we conducted a multinational multicenter prospective cohort study in 281 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, P...

Background: Age is a significant consideration for intensive care unit (ICU) admission. However, the reported associations between increasing age and mortality vary across studies, and data in the local context of Malaysia are lacking. The objective of the present study was to determine the impact of increasing age on ICU mortality. Methods: A retr...

Background Central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs) across Latin America exceed those in high-income countries significantly. Methods We implemented the INICC multidimensional approach, incorporating an 11-component bundle, in 122 ICUs spanning nine Asian countries. We computed the CLABSI rate usi...

Background: Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden. Methods: We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAU...

Background There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late...

Objective To identify urinary catheter (UC)–associated urinary tract infection (CAUTI) incidence and risk factors. Design A prospective cohort study. Setting The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries. Participants The study included...

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 adm...

Background Infection prevention measures are the gold standard for preventing the spread of hospital-acquired infections (HAIs). COVID-19 pandemic caused major disruptions in infection prevention measures, and this has implications on the rate of HAIs. This study assessed the impact of COVID-19 pandemic on the rate and the types of HAIs at Sultan A...

Background Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous pre...

Background and objective: Healthcare datasets are plagued by issues of data scarcity and class imbalance. Clinically validated virtual patient (VP) models can provide accurate in-silico representations of real patients and thus a means for synthetic data generation in hospital critical care settings. This research presents a realistic, time-varyin...

Background: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in 235 ICUs in 8 Asian countries: India, Malaysia, Mongolia, Nepal, Pakistan, the Philippines, Thailand, and Vietnam. Methods: From 01/01/2014 to 02/12/2022 we conducted a prospective cohort study. To estimate CAUTI incidence, t...

Background The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment. Methods We conducted an international, retrospective cohort st...

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 proto...

Objective To describe whether contemporary dosing of antifungal drugs achieves therapeutic exposures in critically ill patients that are associated with optimal outcomes. Adequate antifungal therapy is a key determinant of survival of critically ill patients with fungal infections. Critical illness can alter an antifungal agents’ pharmacokinetics,...

Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous pr...

New technologies are being developed and marketed to healthcare facilities all over the world as a way to stop healthcare- associated infections. The Internet of Things and artificial intelligence have been created with a variety of capabilities to improve people's health, offer necessary services, and monitor their health The potential adoption of...

Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous pr...

Objective Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Design Prospective cohort study. Setting This study was conducted across 743 ICUs of 282 hospital...

Introduction: Sepsis is the leading cause of intensive care unit (ICU) admission. Delayed recognition of sepsis is associated with increased morbidity and mortality. Monocyte distribution width (MDW) represents the width of a set of monocyte volume values, which increases as infections progress in severity. This study evaluated the diagnostic and p...

Background and objective Respiratory mechanics of mechanically ventilated patients evolve significantly with time, disease state and mechanical ventilation (MV) treatment. Existing deterministic data prediction methods fail to comprehensively describe the multiple sources of heterogeneity of biological systems. This research presents two respirator...

Background Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors. Material and Methods We conducted a prospective cohort study, between 03/27/2004 and 02/11/2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mong...

Introduction: This work aims to establish the practicality of simple point-of-care (POC) measurements of procal-citonin (PCT) coupled with the standard PCT-guided antibiotic treatment discontinuation algorithm to guide the cessation of antibiotic treatment in intensive care unit (ICU). Methods: In this randomised-controlled trial, 80 adult patients...

Objective To identify risk factors for mortality in intensive care units (ICUs) in Asia. Design Prospective cohort study. Setting The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. Participants Patients aged >18 years a...

Background: Whilst timely clinical characterisation of infections caused by novel SARS-CoV-2 variants is necessary for evidence-based policy response, individual-level data on infecting variants are typically only available for a minority of patients and settings. Methods: Here, we propose an innovative approach to study changes in COVID-19 hospita...

Background Whilst timely clinical characterisation of infections caused by novel SARS-CoV-2 variants is necessary for evidence-based policy response, individual-level data on infecting variants are typically only available for a minority of patients and settings. Methods Here, we propose an innovative approach to study changes in COVID-19 hospital...

Background The association between interleukin-6 (IL-6) and serum albumin (ALB) with mortality in critically ill elderly patients, either as stand-alone biomarkers or in combination, has been scarcely reported. We, therefore, aimed to investigate the prognostic value of the IL-6-to-albumin ratio in this special population. Patients and methods Thi...

Purpose: To develop a set of actionable quality indicators for critical care suitable for use in low- or middle-income countries (LMICs). Methods: A list of 84 candidate indicators compiled from a previous literature review and stakeholder recommendations were categorised into three domains (foundation, process, and quality impact). An expert pa...

Background Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in...

Background The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients. Methods Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and Europea...

Mechanical ventilation (MV) provides respiratory support for critically ill patients in the intensive care unit (ICU). Waveform data output by the ventilator provides valuable physiological and diagnostic information. However, existing systems do not provide full access to this information nor allow for real-time, non-invasive data collection. Ther...

Background and Objective Model-based and personalised decision support systems are emerging to guide mechanical ventilation (MV) treatment for respiratory failure patients. However, model-based treatments require resource-intensive clinical trials prior to implementation. This research presents a framework for generating virtual patients for testin...

Introduction: Creatinine kinetics denotes that under steady-state conditions, creatinine production (G) will equal creatinine excretion rate (E). The glomerular filtration (GFR) is impaired when excretion is less than production. The kinetic estimate of GFR (keGFR) and E/G ratio were proposed as a more accurate estimate of GFR in acute settings wi...

Background: Early detection of bacterial coinfection in severe dengue remains challenging. Point-of-care (POC) procalcitonin (PCT) may be used for this role, but it needs to be investigated. We evaluated the performance of POC PCT for early detection of bacterial coinfection in patients with severe dengue admitted to the intensive care units (ICU)....

Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries...

Introduction: Prediction of long-term prognosis or outcome in the intensive care unit (ICU) is important for prognostication and administration purposes. Sequential Organ Failure Assessment (SOFA) score was developed to estimate organ failure in sepsis patients. However, organ failures have been associated with mortality, and hence SOFA score has b...

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World...

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 (a) the prevalence, causes, and outcomes of sepsis as a reason for ICU admission and (b) sepsis bundle (antibiotic...

Sepsis is an important cause of morbidity and mortality in elderly patients, but there is a scarcity of data on sepsis in this specific cohort. We performed this study to review the impact of sepsis on outcomes in elderly patients admitted to our local intensive care unit (ICU). This was a secondary analysis of prospectively collected data of 159 c...

Background Whilst timely clinical characterisation of infections caused by novel SARS-CoV-2 variants is necessary for evidence-based policy response, individual-level data on infecting variants are typically only available for a minority of patients and settings. Methods Here, we propose an innovative approach to study changes in COVID-19 hospital...

Background Predictive equations (PEs) for estimating resting energy expenditure (REE) that have been developed from acute phase data may not be applicable in the late phase and vice versa. This study aimed to assess whether separate PEs are needed for acute and late phases of critical illness and to develop and validate PE(s) based on the results o...

Background and objective : Mechanical ventilation (MV) provides breathing support for acute respiratory distress syndrome (ARDS) patients in the intensive care unit, but is difficult to optimise. Too much, or too little of pressure or volume support can cause further ventilator-induced lung injury, increasing length of MV, cost and mortality. Patie...

Introduction: Accurate assessment of glomerular filtration rate (GFR) is important in the critically ill. Kinetic estimate of GFR (keGFR) considers the changes of creatinine, creatinine production rate, and volume of distribution, hence postulated to be a more accurate estimate of GFR, where there are rapidly changing kidney functions. We evaluated...

Background and objective Mechanical ventilation (MV) is the primary form of care for respiratory failure patients. MV settings are based on general clinical guidelines, intuition, and experience. This approach is not patient-specific and patients may thus experience suboptimal, potentially harmful MV care. This study presents the Stochastic integra...

Identifying mental health illness poses a dilemma, particularly the distinction between heart disease and severe stress. Without early intervention, it can be escalating into psychiatric disorder and suicide. A 44-year-old man sought cardiologist consultation for the "heart disease" symptoms. As a medical laboratory technician in charge, his commit...

Respiratory system modelling can assist clinicians in making clinical decisions during mechanical ventilation (MV) management in intensive care. However, there are some cases where the MV patients produce asynchronous breathing (asynchrony events) due to the spontaneous breathing (SB) effort even though they are fully sedated. Currently, most of th...

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, cult...

PIIS14733099210056 5X.pdf

Background and Objective Mechanical ventilation is the primary form of care provided to respiratory failure patients. Limited guidelines and conflicting results from major clinical trials means selection of mechanical ventilation settings relies heavily on clinician experience and intuition. Determining optimal mechanical ventilation settings is th...

Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries...

Introduction. Accurate assessment of glomerular filtration rate (GFR) is very important for diagnostic and therapeutic intervention. Clinically, GFR is estimated from plasma creatinine using equations such as Cockcroft–Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equations. However, t...

While lung protective mechanical ventilation (MV) guidelines have been developed to avoid ventilator-induced lung injury (VILI), a one-size-fits-all approach cannot benefit every individual patient. Hence, there is significant need for the ability to provide patient-specific MV settings to ensure safety, and optimise patient care. Model-based appro...

Objective We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low and middle income countries (LMICs). Methods The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-leve...

The rise of model-based and machine learning methods have created increasingly realistic opportunities to implement personalized, patient-specific mechanical ventilation (MV) in the ICU. These methods require monitoring of real-time patient ventilation waveform data (VWD) during MV treatment. However, there are relatively few non-invasive and/or no...

Background Conventional patient-ventilator interaction (PVI) assessment involves manual asynchronous index (AI) computation and incapable to provide in-depth information of the severity of asynchrony breathing (AB) during mechanical ventilation (MV). In this study, a novel convolutional autoencoder model (ABReCA) is developed to quantify the magnit...

INTRODUCTION: Currently, there is a lack of real-time biomarker to diagnose sepsis. Insulin sensitivity (SI) may be determined in real-time using mathematical glucose-insulin models, but its effectiveness as a diagnostic test of sepsis remains unexplored. We aimed to explore the diagnostic value of model-based SI as a new biomarker of sepsis in a m...

During mechanical ventilation (MV) of respiratory failure patients, clinicians require real time patient-specific lung condition to set MV treatment. Application of mathematical models to determine patient-specific condition in setting MV is increasingly sought after amongst clinicians. However, when the patient is breathing spontaneously during co...

Asynchronous breathing (AB) during mechanical ventilation (MV) can have adverse effect towards a patient’s recovery. Especially, the presence of AB will disrupt MV breathing profile; thus, misidentifying patient-specific condition. This paper demonstrates the ability of generative adversarial network (GAN) to reconstruct asynchronous breaths to a n...

Mechanical ventilated respiratory failure patients may experience asynchronous breathing (AB). Frequent occurrence of AB may impose detrimental effect towards patient’s condition, however, there is lack of autonomous AB detection approach impedes the explication of aetiology of AB causing underestimation of the impact of AB. This research presents...

Mechanical ventilation (MV) is a complex support tool for respiratory failure patients. However, MV is easily mismanaged, and the common practice today relies on clinician’s experience and intuition. Due to this subjectivity, along with the complex task of managing multiple interdependent MV settings, setting patient-specific optimal MV is a diffic...

Introduction: Currently, there is a lack of clinically feasible and reliable method for discriminating outcome in sepsis. We aimed to derive a new bioscore for predicting mortality in critically ill patients with sepsis using a combination of biomarkers and clinical indexes. Materials and Methods: This was a secondary analysis from a prospective st...

Introduction: Approach to managing infection in the intensive care unit (ICU) often varies between institutions and not many readily adapt to available local guidelines despite it was constructed to suite local clinical scenario. Malaysia already has two published guidelines on managing infection in the ICU but data on its compliance are largely u...

Acute kidney injury (AKI) is common in critically ill patients and often associated with higher mortality. It is commonly diagnosed using plasma creatinine, a fluid excreted by glomerular filtration. In this study, we analysed the highly nonlinear and complex behaviour within human systems of estimating glomerular filtration rate in critically ill...

Scoring tools are often used to predict patient severity of illness and mortality in intensive care units (ICU). Accurate prediction is important in the clinical setting to ensure efficient management of limited resources. However, studies have shown that the scoring tools currently in use are limited in predictive value. The aim of this study is t...

Purpose This paper presents an assessment of an automated and personalized stochastic targeted (STAR) glycemic control protocol compliance in Malaysian intensive care unit (ICU) patients to ensure an optimized usage. Patients and Methods STAR proposes 1–3 hours treatment based on individual insulin sensitivity variation and history of blood glucos...

Background: The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and to relate observed trough antibiotic concentrations to optimal targets. Methods: We per...

Background: The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and to relate observed trough antibiotic concentrations to optimal targets. Methods: We perfo...