Gladis Kabil's research while affiliated with Westmead Hospital and other places

Publications (5)

Article
Full-text available
Background: Appropriate and timely administration of intravenous fluids to patients with sepsis-induced hypotension is one of the mainstays of sepsis management in the emergency department (ED), however, fluid resuscitation remains an ongoing challenge in ED. Our study has been undertaken with two specific aims: firstly, for patients with sepsis,...
Article
Full-text available
Background: Early intravenous fluids for patients with sepsis presenting with hypoperfusion or shock in the emergency department remains one of the key recommendations of the Surviving Sepsis Campaign guidelines to reduce mortality. However, compliance with the recommendation remains poor. While several interventions have been implemented to impro...
Article
Objective To investigate the association between timing and volume of intravenous fluids administered to ED patients with suspected infection and all-cause in-hospital mortality. Methods Retrospective cohort study of ED presentations at four metropolitan hospitals in Sydney, Australia, between October 2018 and May 2019. Patients over 16 years of a...
Article
Full-text available
Background Severe sepsis can lead to organ failure and death if immediate treatment, such as intravenous fluids and antibiotics, are not commenced within the first hour. Time - critical initiation of intravenous fluids which in other words is early goal directed fluid resuscitation has not always been given its clinical priority. This qualitative s...

Citations

... 32 Taken together with our study's findings, one may argue that quality initiatives focusing on the rapid initiation of fluids may be worthwhile and feasible. 33 However, in the example of antibiotic initiation, while findings have suggested that earlier is better, 7,34 a recent meta-analysis did not find a mortality difference when antibiotics were administered within one hour compared to three hours of sepsis onset. 35 As such, antibiotic stewards and others have warned of the potential dangers of overtreatment for undifferentiated patients. ...
... 29 Conversely, a multicentre retrospective analysis did not find an association between mortality and time to completion of a fluid bolus up to 12 hours, although a small effect was found when patients who completed the fluid bolus between 12 and 24h are included. 30 An Australian study among patients with infection presenting to the ED found an association between a larger volume of IV fluid in the first 24 hours and reduced in-hospital mortality, 31 while a Chinese observational study found the lowest mortality among septic shock patients who received an initial IV fluid volume of 20-30mL/kg compared to both the group who received <20mL/kg and those who received >30mL/kg. 32 ...
... The mostreported barriers and facilitators were system-related. The reported barriers included (a) the lack of written sepsis treatment protocols or guidelines adopted as hospital policy [22,23]; (b) the complexity and atypical presentation of the early symptoms of sepsis [19]; (c) nurses' poor level of education and clinical experience [1,12]; (d) the lack of sepsis educational programs or training workshops for nurses [22,23]; (e) the high comorbid burden among patients with sepsis, which complicates the critical thinking process of sepsis management [19]; (f) nurses' deficits in knowledge related to sepsis treatment protocols and guidelines [22][23][24]; (g) the lack of mentorship programs in which junior nurses' actions/activities are strictly supervised by experienced nurses [17,23]; (h) heavy workloads or high patient-nurse ratios [22]; (i) the shortage of well-trained and experienced physicians, particularly in EDs [19,22,23]; (j) the lack of awareness related to antibiotic use for patients with sepsis [19,22]; (k) the lack of IV access and unavailability of ICU beds [25]; (l) the non-use of drug combinations for the treatment of sepsis [22,26,27], and (m) poor teamwork and communication skills among healthcare professionals [22,26]. Only three facilitators of sepsis assessment and management were identified in the reviewed studies. ...