1
|
MacKinnon KM, Seshadri S, Mailman JF, Sy E. Impact of Rounding Checklists on the Outcomes of Patients Admitted to ICUs: A Systematic Review and Meta-Analysis. Crit Care Explor 2024; 6:e1140. [PMID: 39162653 PMCID: PMC11338257 DOI: 10.1097/cce.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES To evaluate the effectiveness of ICU rounding checklists on outcomes. DATA SOURCES Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar) were searched from inception to May 10, 2024. STUDY SELECTION Cohort studies, case-control studies, and randomized controlled trials comparing the use of rounding checklists to no checklists were included. Other article types were excluded. DATA EXTRACTION The primary outcome was in-hospital mortality. Secondary outcomes included ICU and 30-day mortality; hospital and ICU length of stay (LOS); duration of mechanical ventilation; and frequency of catheter-associated urinary tract infections, central line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia. Additional outcomes included healthcare provider perceptions of checklists. DATA SYNTHESIS Pooled estimates were obtained using an inverse-variance random-effects meta-analysis model. Certainty of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. There were 30 included studies (including > 32,000 patients) in the review. Using an ICU rounding checklist was associated with reduced in-hospital mortality (risk ratio [RR] 0.80; 95% CI, 0.70-0.92; 12 observational studies; 17,269 patients; I2 = 48%; very low certainty of evidence). The use of an ICU rounding checklist was also associated with reduced ICU mortality (8 observational studies, p = 0.006), 30-day mortality (2 observational studies, p < 0.001), hospital LOS (11 observational studies, p = 0.02), catheter-associated urinary tract infections (CAUTI) (6 observational studies, p = 0.01), and CLABSI (6 observational studies, p = 0.02). Otherwise, there were no significant differences with using ICU rounding checklists on other patient-related outcomes. Healthcare providers' perceptions of checklists were generally positive. CONCLUSIONS The use of an ICU rounding checklist may improve in-hospital mortality, as well as other important patient-related outcomes. However, well-designed randomized studies are necessary to increase the certainty of evidence and determine which elements should be included in an ICU rounding checklist.
Collapse
Affiliation(s)
| | - Samuel Seshadri
- College of Medicine, University of Saskatchewan, Regina, SK, Canada
| | - Jonathan F. Mailman
- College of Medicine, University of Saskatchewan, Regina, SK, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Pharmacy Department, Royal Jubilee Hospital, Vancouver Island Health Authority, Victoria, BC, Canada
| | - Eric Sy
- College of Medicine, University of Saskatchewan, Regina, SK, Canada
- Department of Critical Care, Saskatchewan Health Authority, Regina, SK, Canada
| |
Collapse
|
2
|
Padte S, Samala Venkata V, Mehta P, Tawfeeq S, Kashyap R, Surani S. 21st century critical care medicine: An overview. World J Crit Care Med 2024; 13:90176. [PMID: 38633477 PMCID: PMC11019625 DOI: 10.5492/wjccm.v13.i1.90176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/28/2023] [Accepted: 01/24/2024] [Indexed: 03/05/2024] Open
Abstract
Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units (ICUs). This abstract provides a concise summary of the latest developments in critical care, highlighting key areas of innovation. Recent advancements in critical care include Precision Medicine: Tailoring treatments based on individual patient characteristics, genomics, and biomarkers to enhance the effectiveness of therapies. The objective is to describe the recent advancements in Critical Care Medicine. Telemedicine: The integration of telehealth technologies for remote patient monitoring and consultation, facilitating timely interventions. Artificial intelligence (AI): AI-driven tools for early disease detection, predictive analytics, and treatment optimization, enhancing clinical decision-making. Organ Support: Advanced life support systems, such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support. Infection Control: Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections. Ventilation Strategies: Precision ventilation modes and lung-protective strategies to minimize ventilator-induced lung injury. Sepsis Management: Early recognition and aggressive management of sepsis with tailored interventions. Patient-Centered Care: A shift towards patient-centered care focusing on psychological and emotional well-being in addition to medical needs. We conducted a thorough literature search on PubMed, EMBASE, and Scopus using our tailored strategy, incorporating keywords such as critical care, telemedicine, and sepsis management. A total of 125 articles meeting our criteria were included for qualitative synthesis. To ensure reliability, we focused only on articles published in the English language within the last two decades, excluding animal studies, in vitro/molecular studies, and non-original data like editorials, letters, protocols, and conference abstracts. These advancements reflect a dynamic landscape in critical care medicine, where technology, research, and patient-centered approaches converge to improve the quality of care and save lives in ICUs. The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.
Collapse
Affiliation(s)
- Smitesh Padte
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | | | - Priyal Mehta
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | - Sawsan Tawfeeq
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | - Rahul Kashyap
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
- Department of Research, WellSpan Health, York, PA 17403, United States
- Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Salim Surani
- Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
| |
Collapse
|
3
|
Neves VC, Locatelli CGR, Ramalho O, Miranda BS, Koliski A, Nunes ML, Carreiro JE. Pediatric unplanned extubation risk score: A predictive model for risk assessment. Heart Lung 2023; 62:50-56. [PMID: 37307654 DOI: 10.1016/j.hrtlng.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Unplanned extubation is one of the most common preventable adverse events associated with invasive mechanical ventilation. OBJECTIVE This research study aimed to develop a predictive model to identify the risk of unplanned extubation in a pediatric intensive care unit (PICU). METHODS This single-center, observational study was conducted at the PICU of the Hospital de Clínicas. Patients were included based on the following criteria: aged between 28 days and 14 years, intubated, and using invasive mechanical ventilation. RESULTS Over 2 years, 2,153 observations were made using the Pediatric Unplanned Extubation Risk Score predictive model. Unplanned extubation occurred in 73 of 2,153 observations. A total of 286 children participated in the application of the Risk Score. This predictive model was created to categorize the following significant risk factors: 1) inadequate placement and fixation of the endotracheal tube (odds ratio 2.00 [95%CI,1.16-3.36]), 2) Insufficient level of sedation (odds ratio 3.00 [95%CI,1.57-4.37]), 3) age ≤ 12 months (odds ratio 1.27 [95%CI,1.14-1.41]), 4) presence of airway hypersecretion (odds ratio 11.00 [95%CI,2,58-45.26]) inadequate family orientation and/or nurse to patient ratio (odds ratio 5.00 [95%CI,2.64-7.99]), and 6) weaning period from mechanical ventilation (odds ratio 3.00 [95%CI,1.67-4.79]) and 5 risk enhancement factors. CONCLUSIONS The scoring system demonstrated effective sensitivity for estimating the risk of UE with the observation of six aspects, which overlap as an isolated risk factor or are associated with a risk enhancement factors.
Collapse
Affiliation(s)
- Valéria C Neves
- Pediatric Intensive Care Unit, Complexo Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil; Department of Pediatrics, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil.
| | - Camila G R Locatelli
- Department of Pediatrics, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil
| | - Olivia Ramalho
- Pediatric Intensive Care Unit, Complexo Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil
| | - Bruno S Miranda
- Pediatric Intensive Care Unit, Complexo Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil
| | - Adriana Koliski
- Pediatric Intensive Care Unit, Complexo Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil; Department of Pediatrics, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil
| | - Mônica L Nunes
- Department of Pediatrics, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil
| | - José E Carreiro
- Pediatric Intensive Care Unit, Complexo Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil; Department of Pediatrics, Universidade Federal do Paraná (UFPR), Curitiba, (PR), Brazil
| |
Collapse
|
4
|
Miranda BS, Neves VC, Albuquerque YDP, de Souza EF, Koliski A, Cat MNL, Carreiro JE. Fitness checklist model for spontaneous breathing tests in pediatrics. CRITICAL CARE SCIENCE 2023; 35:66-72. [PMID: 37712731 PMCID: PMC10275306 DOI: 10.5935/2965-2774.20230312-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/26/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To evaluate whether a model of a daily fitness checklist for spontaneous breathing tests is able to identify predictive variables of extubation failure in pediatric patients admitted to a Brazilian intensive care unit. METHODS This was a single-center, cross-sectional study with prospective data collection. The checklist model comprised 20 items and was applied to assess the ability to perform spontaneous breathing tests. RESULTS The sample consisted of 126 pediatric patients (85 males (67.5%)) on invasive mechanical ventilation, for whom 1,217 daily assessments were applied at the bedside. The weighted total score of the prediction model showed the highest discriminatory power for the spontaneous breathing test, with sensitivity and specificity indices for fitness failure of 89.7% or success of 84.6%. The cutoff point suggested by the checklist was 8, with a probability of extubation failure less than 5%. Failure increased progressively with increasing score, with a maximum probability of predicting extubation failure of 85%. CONCLUSION The extubation failure rate with the use of this model was within what is acceptable in the literature. The daily checklist model for the spontaneous breathing test was able to identify predictive variables of failure in the extubation process in pediatric patients.
Collapse
Affiliation(s)
- Bruno Silva Miranda
- Complexo do Hospital de Clínicas, Faculdade de Medicina,
Universidade Federal do Paraná - Curitiba (PR), Brazil
| | - Valéria Cabral Neves
- Complexo do Hospital de Clínicas, Faculdade de Medicina,
Universidade Federal do Paraná - Curitiba (PR), Brazil
| | - Yessa do Prado Albuquerque
- Complexo do Hospital de Clínicas, Faculdade de Medicina,
Universidade Federal do Paraná - Curitiba (PR), Brazil
| | - Emilly Freitas de Souza
- Complexo do Hospital de Clínicas, Faculdade de Medicina,
Universidade Federal do Paraná - Curitiba (PR), Brazil
| | - Adriana Koliski
- Complexo do Hospital de Clínicas, Faculdade de Medicina,
Universidade Federal do Paraná - Curitiba (PR), Brazil
| | - Mônica Nunes Lima Cat
- Complexo do Hospital de Clínicas, Faculdade de Medicina,
Universidade Federal do Paraná - Curitiba (PR), Brazil
| | - José Eduardo Carreiro
- Complexo do Hospital de Clínicas, Faculdade de Medicina,
Universidade Federal do Paraná - Curitiba (PR), Brazil
| |
Collapse
|
5
|
Maran E, Matsuda LM, Cavalcanti AB, Magalhães AMMD, Marcon SS, Haddad MDCFL, Matta ACG, Costa MAR. Effects of multidisciplinary rounds and checklist in an Intensive Care Unit: a mixed methods study. Rev Bras Enferm 2022; 75:e20210934. [PMID: 36169502 DOI: 10.1590/0034-7167-2021-0934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/18/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the implementation of multidisciplinary checklist-directed rounds before health indicators and multidisciplinary team perception of an Intensive Care Unit. METHODS a mixed methods study, with an explanatory sequential design, carried out at a hospital in southern Brazil, from September 2020 to August 2021. The integration of quantitative and qualitative data was combined by connection. RESULTS after the implementation of checklist-directed rounds, there was a significant reduction in hospital stay from ventilator-associated pneumonia, urinary tract infection and daily invasive device use. The investigated practice is essential for comprehensive care, harm reduction, effective work and critical patient safety. CONCLUSIONS the multidisciplinary rounds with checklist use reduced data on health indicators of critically ill patients and was considered a vital practice in the intensive care setting.
Collapse
Affiliation(s)
- Edilaine Maran
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil.,Universidade Estadual do Paraná. Paranavaí, Paraná, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Dos Santos Alves DF, Moraes ÉS, Conti PBM, Bueno GCV, de Souza TH, Pereira EOP, Brandão MB, Peterlini MAS, Pedreira MLG. A Pediatric Intensive Care Checklist for Interprofessional Rounds: The R-PICniC Study. Am J Crit Care 2022; 31:383-389. [PMID: 36045045 DOI: 10.4037/ajcc2022533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The use of checklists in the pediatric intensive care unit can help improve the quality of care and patient safety. OBJECTIVES To build and validate a checklist for use in interprofessional rounds in a pediatric intensive care unit. METHODS This methodological study was conducted in a 20-bed pediatric intensive care unit serving children up to 14 years old. A checklist prototype was constructed through review of the literature and achievement of consensus among the professionals providing care in the unit. Content validation was performed using a modified Delphi technique involving specialists with more than 5 years of experience in pediatric intensive care, methodological studies, and patient safety. Content validity ratios were calculated for the elements of the checklist, which were considered valid when they reached values greater than 0.78. The checklist was tested for usability, application time, and effects on patient care, and feedback was obtained from potential users. RESULTS Before content validation, the checklist contained 11 domains, 32 items, and 6 daily goals. The invitation to validate content was sent to 86 specialists, and content validity was achieved after 2 rounds of evaluation, with the checklist elements having content validity ratios ranging from 0.94 to 0.97. The mean application time of the checklist was 5 minutes. The final version consisted of 11 domains, 33 items, and 8 daily goals. CONCLUSIONS This study resulted in a useful and valid instrument for application in interprofessional rounds that was tailored to the needs of local health care professionals.
Collapse
Affiliation(s)
- Daniela Fernanda Dos Santos Alves
- Daniela Fernanda dos Santos Alves is a professor of pediatric nursing, School of Nursing, State University of Campinas, Brazil, and a postdoctorate fellow, São Paulo School of Nursing, Federal University of São Paulo, São Paulo, Brazil
| | - Érika Sana Moraes
- Érika Sana Moraes is a PhD student, Clinical Hospital, State University of Campinas
| | | | | | | | | | | | - Maria Angélica Sorgini Peterlini
- Maria Angélica Sorgini Peterlini is a professor of pediatric nursing, São Paulo School of Nursing, Federal University of São Paulo
| | - Mavilde Luz Gonçalves Pedreira
- Mavilde Luz Gonçalves Pedreira is a professor of pediatric nursing, São Paulo School of Nursing, Federal University of São Paulo
| |
Collapse
|
7
|
Pignatiello GA. Discussion Guide for the Alves Article. Am J Crit Care 2022; 31:390-391. [PMID: 36045035 DOI: 10.4037/ajcc2022284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Grant A Pignatiello
- Grant A. Pignatiello is a National Institutes of Health Clinical Research KL2 Scholar and an instructor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
8
|
Maran E, Matsuda LM, Cavalcanti AB, Magalhães AMMD, Marcon SS, Haddad MDCFL, Matta ACG, Costa MAR. Efeitos de rounds multidisciplinares e checklist em Unidade de Terapia Intensiva: estudo de método misto. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0934pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivos: analisar a implementação de rounds multidisciplinares direcionados por checklist frente aos indicadores de saúde e a percepção da equipe multiprofissional de uma Unidade de Terapia Intensiva. Métodos: estudo de método misto, com desenho sequencial explanatório, realizado em um hospital do sul do Brasil, no período de setembro de 2020 a agosto de 2021. A integração dos dados quantitativos e qualitativos foi combinada por conexão. Resultados: após a implementação dos rounds direcionados por checklist, constatou-se redução significativa no tempo de internação por pneumonias associadas à ventilação mecânica, infecção do trato urinário e nos dias de uso de dispositivos invasivos. A prática investigada é essencial para o cuidado integral, a redução de danos, o trabalho eficaz e a segurança do paciente crítico. Conclusões: os rounds multidisciplinares com uso de checklist reduziram os dados dos indicadores de saúde de pacientes críticos e foi considerado como prática vital no cenário de cuidados intensivos.
Collapse
Affiliation(s)
- Edilaine Maran
- Universidade Estadual de Maringá, Brazil; Universidade Estadual do Paraná, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Maran E, Matsuda LM, Magalhães AMMD, Marcon SS, Oliveira JLCD, Cavalcanti AB, Haddad MDCFL, Reis GAXD. Round multiprofissional com checklist: associação com a melhoria na segurança do paciente em terapia intensiva. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.202100348.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RESUMO Objetivo Verificar a associação entre round multiprofissional com uso de checklist e práticas de segurança do paciente por profissionais de saúde de uma unidade de terapia intensiva. Método Estudo de método misto, delineado pela abordagem sequencial explanatória, realizado em um hospital do sul do Brasil. Os dados quantitativos foram analisados por meio de regressão de Poisson e os dados qualitativos, pela análise de conteúdo. Fez-se a análise integrada por meio da combinação explicada/conectada. Resultados No período pós-implementação dos rounds com uso sistemático de checklist houve melhora significativa da profilaxia de tromboembolia venosa, sedação leve, redução dos dias de uso de ventilação mecânica, cateter venoso central e de sonda vesical de demora. Conclusão O round multiprofissional com uso sistemático de checklist, associado com a melhoria nas práticas de segurança do paciente, foi considerado como uma estratégia que assegura melhores cuidados em terapia intensiva e favorece a satisfação no trabalho.
Collapse
Affiliation(s)
- Edilaine Maran
- Universidade Estadual de Maringá, Brasil; Universidade Estadual do Paraná, Brasil
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Maran E, Matsuda LM, Magalhães AMMD, Marcon SS, Oliveira JLCD, Cavalcanti AB, Haddad MDCFL, Reis GAXD. Multiprofessional round with checklist: association with the improvement in patient safety in intensive care. Rev Gaucha Enferm 2022; 43:e20210348. [DOI: 10.1590/1983-1447.2022.202100348.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT Objective To verify the association between a multiprofessional round with the use of checklists and patient safety practices by health professionals in an intensive care unit. Method Mixed-method study, delineated by the sequential explanatory approach, conducted in a hospital in southern Brazil. Quantitative data were analyzed using Poisson regression, and qualitative data, using content analysis. The integrated analysis was performed through the explained/connected combination. Results In the post-implementation period of the rounds with systematic use of the checklist, there was a significant improvement in the prophylaxis of venous thromboembolism, light sedation, reduction in the days of use of mechanical ventilation, central venous catheter and indwelling urinary catheter. Conclusion The multiprofessional round with the systematic use of checklist, associated with the improvement in patient safety practices, was considered as a strategy that ensures better care in intensive care and favors job satisfaction.
Collapse
Affiliation(s)
- Edilaine Maran
- Universidade Estadual de Maringá, Brasil; Universidade Estadual do Paraná, Brasil
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Maran E, Matsuda LM, Marcon SS, Haddad MDCFL, Costa MAR, Magalhães AMMD. ADAPTATION AND VALIDATION OF A MULTIDISCIPLINARY CHECKLIST FOR ROUNDS IN THE INTENSIVE CARE UNIT. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to perform the adaptation, content validation and semantic analysis of a Multidisciplinary Checklist used in rounds in Intensive Care Units for adults. Method: a methodological study, consisting of three stages: Adaptation of the checklist, performed by one of the authors; Content validation, performed by seven judges/health professionals from a public teaching hospital in Paraná; and Semantic analysis, performed in a philanthropic hospital in the same state. Agreement of the judges and of the target audience in the content validation and semantic analysis stages was calculated using the Content Validity Index and the Agreement Index, respectively, with a minimum acceptable value of 0.80. Results: in the content validation stage, the checklist obtained a total agreement of 0.84. Of the 16 items included in the instrument, 11 (68.75%) were readjusted and four (25%) were excluded for not reaching the minimum agreement. The readjusted items referred to sedation; analgesia; nutrition; glycemic control; headboard elevation; gastric ulcer prophylaxis; prophylaxis for venous thromboembolism; indwelling urinary catheter, central venous catheter; protective mechanical ventilation and spontaneous breathing test. Regarding the items excluded, they referred to the cuff pressure of the orotracheal tube and to Nursing care measures such as taking the patient out of the bed, pressure injury prophylaxis, and ophthalmoprotection. In the semantic analysis, the final agreement of the instrument's items was 0.96. Conclusion: after two evaluation rounds by the judges, testing in critically-ill patients and high inter-evaluator agreement index, the Multidisciplinary Checklist is found with validated content suitable for use in rounds in intensive care.
Collapse
Affiliation(s)
- Edilaine Maran
- Universidade Estadual de Maringá, Brasil; Universidade Estadual do Paraná, Brasil
| | | | | | | | | | | |
Collapse
|
12
|
Sridharan K, Abbasi MY, Mulubwa M. Population Pharmacokinetics and Dose Optimization of Vancomycin in Critically Ill Children. Eur J Drug Metab Pharmacokinet 2021; 46:539-546. [PMID: 34156647 DOI: 10.1007/s13318-021-00695-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Critically ill children may exhibit varied vancomycin pharmacokinetic parameters mainly due to altered protein binding, extracellular volume, and renal elimination. The objective of this study was to assess the pharmacokinetics of vancomycin in critically ill children and determine the optimum dose regimen. METHODS This was a cross-sectional study of critically ill children admitted to a pediatric intensive care unit. They received vancomycin dose of 15 mg/kg every 8 h for mild infections or every 6 h if infection was moderate or severe. A nonlinear mixed-effects modeling approach was applied in estimating pharmacokinetic parameters using Monolix 2019R2®. We performed Monte Carlo simulations to assess and optimize the dosing regimen using Simulx®. We used the ratio of the area under the concentration-time curve up to 24 h to minimum inhibitory concentration (AUC0-24/MIC) ≥ 400 as the pharmacokinetic-pharmacodynamic target. RESULTS Fifty-eight critically ill children with 145 concentrations were included in the present study. A one-compartment pharmacokinetic model with linear elimination described the concentration-time profile well. The estimated median (95% confidence intervals) volume of distribution (Vd) was 13.3 (10.8-16.5) l and clearance (CL) was 1.23 (1.03-1.45) l/h. Creatinine clearance significantly affected the CL of vancomycin. Monte Carlo simulations revealed that a dose of either 15 mg/kg 6 hourly or 20 mg/kg 8 hourly was likely to result into most critically ill children attaining the vancomycin lead pharmacokinetic-pharmacodynamic target. CONCLUSION We established pharmacokinetic parameters of vancomycin for critically ill children. We also observed that the current dosing regimen practiced in the intensive care unit was inadequate for achieving the pharmacokinetic-pharmacodynamic target. We recommend vancomycin dose escalation in critically ill pediatric patients from 15 mg/kg 8 hourly (current dosing regimen) to either 6 hourly or 20 mg/kg 8 hourly with intense therapeutic drug monitoring for adverse effects.
Collapse
Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
| | - Mohammad Yaseen Abbasi
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Mwila Mulubwa
- Drug Discovery and Development Centre (H3D), Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| |
Collapse
|