1
|
Honarmand K, Sirimaturos M, Hirshberg EL, Bircher NG, Agus MSD, Carpenter DL, Downs CR, Farrington EA, Freire AX, Grow A, Irving SY, Krinsley JS, Lanspa MJ, Long MT, Nagpal D, Preiser JC, Srinivasan V, Umpierrez GE, Jacobi J. Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024: Executive Summary. Crit Care Med 2024; 52:649-655. [PMID: 38240482 DOI: 10.1097/ccm.0000000000006173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Affiliation(s)
- Kimia Honarmand
- Division of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, ON, Canada
- GUIDE Canada, McMaster University, Hamilton, ON, Canada
| | - Michael Sirimaturos
- System Critical Care Pharmacy Services Leader, Houston Methodist Hospital, Houston, TX
| | - Eliotte L Hirshberg
- Adult and Pediatric Critical Care Specialist, University of Utah School of Medicine, Salt Lake City, UT
| | - Nicholas G Bircher
- Department of Nurse Anesthesia, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Michael S D Agus
- Harvard Medical School and Division Chief, Medical Critical Care, Boston Children's Hospital, Boston, MA
| | | | | | | | - Amado X Freire
- Pulmonary Critical Care and Sleep Medicine at the University of Tennessee Health Science Center, Memphis, TN
| | | | - Sharon Y Irving
- Department of Nursing and Clinical Care Services-Critical Care, University of Pennsylvania School of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA
| | - James S Krinsley
- Director of Critical Care, Emeritus, Vagelos Columbia University College of Physicians and Surgeons, Stamford Hospital, Stamford, CT
| | - Michael J Lanspa
- Division of Critical Care, Intermountain Medical Center, Salt Lake City, UT
| | - Micah T Long
- Department of Anesthesiology, Division of Critical Care, University of Wisconsin School of Medicine & Public Health, Madison, WI
| | - David Nagpal
- Division of Cardiac Surgery, Critical Care Western, London Health Sciences Centre, London, ON, Canada
| | - Jean-Charles Preiser
- Medical Director for Research and Teaching, Erasme Hospital, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Vijay Srinivasan
- Departments of Anesthesiology, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | |
Collapse
|
2
|
Honarmand K, Sirimaturos M, Hirshberg EL, Bircher NG, Agus MSD, Carpenter DL, Downs CR, Farrington EA, Freire AX, Grow A, Irving SY, Krinsley JS, Lanspa MJ, Long MT, Nagpal D, Preiser JC, Srinivasan V, Umpierrez GE, Jacobi J. Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024. Crit Care Med 2024; 52:e161-e181. [PMID: 38240484 DOI: 10.1097/ccm.0000000000006174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
RATIONALE Maintaining glycemic control of critically ill patients may impact outcomes such as survival, infection, and neuromuscular recovery, but there is equipoise on the target blood levels, monitoring frequency, and methods. OBJECTIVES The purpose was to update the 2012 Society of Critical Care Medicine and American College of Critical Care Medicine (ACCM) guidelines with a new systematic review of the literature and provide actionable guidance for clinicians. PANEL DESIGN The total multiprofessional task force of 22, consisting of clinicians and patient/family advocates, and a methodologist applied the processes described in the ACCM guidelines standard operating procedure manual to develop evidence-based recommendations in alignment with the Grading of Recommendations Assessment, Development, and Evaluation Approach (GRADE) methodology. Conflict of interest policies were strictly followed in all phases of the guidelines, including panel selection and voting. METHODS We conducted a systematic review for each Population, Intervention, Comparator, and Outcomes question related to glycemic management in critically ill children (≥ 42 wk old adjusted gestational age to 18 yr old) and adults, including triggers for initiation of insulin therapy, route of administration, monitoring frequency, role of an explicit decision support tool for protocol maintenance, and methodology for glucose testing. We identified the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the GRADE approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak or as a good practice statement. In addition, "In our practice" statements were included when the available evidence was insufficient to support a recommendation, but the panel felt that describing their practice patterns may be appropriate. Additional topics were identified for future research. RESULTS This guideline is an update of the guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. It is intended for adult and pediatric practitioners to reassess current practices and direct research into areas with inadequate literature. The panel issued seven statements related to glycemic control in unselected adults (two good practice statements, four conditional recommendations, one research statement) and seven statements for pediatric patients (two good practice statements, one strong recommendation, one conditional recommendation, two "In our practice" statements, and one research statement), with additional detail on specific subset populations where available. CONCLUSIONS The guidelines panel achieved consensus for adults and children regarding a preference for an insulin infusion for the acute management of hyperglycemia with titration guided by an explicit clinical decision support tool and frequent (≤ 1 hr) monitoring intervals during glycemic instability to minimize hypoglycemia and against targeting intensive glucose levels. These recommendations are intended for consideration within the framework of the patient's existing clinical status. Further research is required to evaluate the role of individualized glycemic targets, continuous glucose monitoring systems, explicit decision support tools, and standardized glycemic control metrics.
Collapse
Affiliation(s)
- Kimia Honarmand
- Division of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, ON, Canada
- GUIDE Canada, McMaster University, Hamilton, ON, Canada
| | - Michael Sirimaturos
- System Critical Care Pharmacy Services Leader, Houston Methodist Hospital, Houston, TX
| | - Eliotte L Hirshberg
- Adult and Pediatric Critical Care Specialist, University of Utah School of Medicine, Salt Lake City, UT
| | - Nicholas G Bircher
- Department of Nurse Anesthesia, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Michael S D Agus
- Harvard Medical School and Division Chief, Medical Critical Care, Boston Children's Hospital, Boston, MA
| | | | | | | | - Amado X Freire
- Pulmonary Critical Care and Sleep Medicine at the University of Tennessee Health Science Center, Memphis, TN
| | | | - Sharon Y Irving
- Department of Nursing and Clinical Care Services-Critical Care, University of Pennsylvania School of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA
| | - James S Krinsley
- Director of Critical Care, Emeritus, Vagelos Columbia University College of Physicians and Surgeons, Stamford Hospital, Stamford, CT
| | - Michael J Lanspa
- Division of Critical Care, Intermountain Medical Center, Salt Lake City, UT
| | - Micah T Long
- Department of Anesthesiology, Division of Critical Care, University of Wisconsin School of Medicine & Public Health, Madison, WI
| | - David Nagpal
- Division of Cardiac Surgery, Critical Care Western, London Health Sciences Centre, London, ON, Canada
| | - Jean-Charles Preiser
- Medical Director for Research and Teaching, Erasme Hospital, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Vijay Srinivasan
- Departments of Anesthesiology, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | |
Collapse
|
3
|
Bhatt-Mehta V, Buck ML, Chung AM, Farrington EA, Hagemann TM, Hoff DS, LaRochelle JM, Pettit RS, Phan H, Potts AL, Smith KP, Parrish RH. Recommendations for meeting the pediatric patient's need for a clinical pharmacist: a joint opinion of the Pediatrics Practice and Research Network of the American College of Clinical Pharmacy and the Pediatric Pharmacy Advocacy Group. Pharmacotherapy 2013; 33:243-51. [PMID: 23386600 DOI: 10.1002/phar.1246] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Children warrant access to care from clinical pharmacists trained in pediatrics. The American College of Clinical Pharmacy Pediatrics Practice and Research Network (ACCP Pediatrics PRN) released an opinion paper in 2005 with recommendations for improving the quality and quantity of pediatric pharmacy education in colleges of pharmacy, residency programs, and fellowships. Although progress has been made in increasing the availability of pediatric residencies, there is still much to be done to meet the direct care needs of pediatric patients. The purpose of this joint opinion paper is to outline strategies and recommendations for expanding the quality and capacity of pediatric clinical pharmacy practitioners by elevating the minimum expectations for pharmacists entering pediatric practice, standardizing pediatric pharmacy education, expanding the current number of pediatric clinical pharmacists, and creating an infrastructure for development of pediatric clinical pharmacists and clinical scientists. These recommendations may be used to provide both a conceptual framework and action items for schools of pharmacy, health care systems, and policymakers to work together to increase the quality and quantity of pediatric training, practice, and research initiatives.
Collapse
Affiliation(s)
- Varsha Bhatt-Mehta
- Department of Pharmacy, Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Abstract
Drug-induced liver injury (DILI) encompasses a spectrum of clinical disease ranging from mild biochemical abnormalities to acute liver failure. The majority of adverse liver reactions are idiosyncratic, occurring in most instances 5-90 days after the causative medication was last taken. The diagnosis of DILI is clinical, based on history, probability of the suspect medication as a cause of liver injury and exclusion of other hepatic disease. DILI can be hepatocellular (predominant rise in alanine transaminase), cholestatic (predominant rise in alkaline phosphatase) or mixed liver injury. An elevated bilirubin level more than twice the upper limit of normal in patients with hepatocellular liver injury implies severe DILI, with a mortality of approximately 10% and with an incidence rate of 0.7-1.3 per 100,000. Although acute liver failure is rare, 13-17% of all acute liver failure cases are attributed to idiosyncratic drug reactions. Response to drug withdrawal may be delayed up to 1 year with cholestatic liver injury with occasional subsequent progressive cholestasis known as the vanishing bile duct syndrome. Overall, chronic disease may occur in up to 6% even if the offending drug is withdrawn. Antibiotics and NSAIDs are the most common cause of DILI. Statins rarely cause significant liver injury whereas antiretroviral therapy is associated with hepatotoxicity in 10% of treated patients. Multiple mechanisms of DILI have been implicated, including TNF-alpha-activated apoptosis, inhibition of mitochondrial function and neoantigen formation. Risk factors for DILI include age, sex and genetic polymorphisms of drug-metabolising enzymes such as cytochrome P450. In patients with human immunodeficiency virus, the presence of chronic viral hepatitis increases the risk of antiretroviral therapy hepatotoxicity. Over the next decade, the combination of accurate case ascertainment of DILI via clinical networks and the application of genomics and proteomics will hopefully lead to accurate prediction of risk of DILI, so that pharmacotherapy can be optimised with avoidance of adverse hepatic events.
Collapse
Affiliation(s)
- S Hyder Hussaini
- Royal Cornwall Hospital Trust, Cornwall Gastrointestinal Unit, Truro, TR1 3LJ, UK.
| | | |
Collapse
|
5
|
Abstract
A retrospective evaluation was conducted to determine which children admitted for fever and neutropenia required empiric vancomycin therapy, and to develop a clinical pathway for appropriate treatment. Chart review identified 109 admissions of 36 pediatric oncology patients for fever and neutropenia, of which 88 were eligible for analysis. Blood cultures isolated 17 gram-positive organisms; coagulase-negative staphylococci and viridans group streptococci were cultured most frequently (82%). We concluded that previous high-dose cytarabine therapy, inflamed central access site, and hypotension or septic shock are possible indicators of febrile, neutropenic patients at high risk for gram-positive pathogen isolation. These predictors then were used to determine which children would receive empiric vancomycin therapy.
Collapse
Affiliation(s)
- K G Adcock
- University of North Carolina Hospitals and Clinics, University of North Carolina School of Pharmacy, Chapel Hill, USA
| | | | | |
Collapse
|
6
|
Abstract
OBJECTIVE To describe a case of pemoline-induced liver failure resulting in liver transplantation. CASE SUMMARY A 9-year-old white boy, diagnosed with attention deficit/hyperactivity disorder (ADHD) and treated with pemoline, developed signs and symptoms of liver failure. Pemoline therapy was discontinued, but the patient's liver function continued to decline. Ultimately, a liver transplantation was required. DISCUSSION Pemoline, an agent used in ADHD treatment, has been associated with hepatotoxicity with the majority of cases occurring in pediatric patients. To our knowledge, this is the second reported case of pemoline-induced liver failure resulting in liver transplantation. The mechanism of action remains unclear, with several hypotheses being postulated including hypersensitivity reactions, dose-related phenomena, and autoimmune-mediated reactions. CONCLUSIONS With increasing evidence linking pemoline to liver failure, this agent should not be considered first-line therapy for ADHD. Prior to initiating therapy, baseline liver function tests should be obtained and closely monitored, and parents and patients should be educated on the signs and symptoms of liver toxicity.
Collapse
Affiliation(s)
- K G Adcock
- University of North Carolina Hospitals and Clinics, Chapel Hill 27514, USA
| | | | | | | |
Collapse
|
7
|
Abstract
The optimal management strategies for cancer chemotherapy and radiotherapy-induced mucositis have not been identified. In 1989, the National Institutes of Health (NIH) published a consensus statement outlining a standardized approach for the prevention and treatment of oral complications. The purpose of this survey was to identify the national treatment practices for oral mucositis, mucocutaneous Herpes simplex virus infections, and oral candidiasis, and to compare them to the NIH guidelines. Surveys were mailed to clinical pharmacists at 200 hospitals throughout the United States. Sixty-two of the 200 questionnaires were completed and returned. Institutions used a diversity of agents, generating substantial variability in mucositis prophylaxis and treatment protocols. Many of these therapies included products or combinations of ingredients that lack proven clinical efficacy. Mucositis management strategies for hospitalized patients vary widely at US hospitals. Coordinated, controlled studies are needed to identify optimal therapies for these patients.
Collapse
Affiliation(s)
- B A Mueller
- Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, Beech Grove, Indiana, USA
| | | | | | | | | |
Collapse
|
8
|
Farrington EA. Varicella zoster vaccine (Varivax). Pediatr Nurs 1995; 21:358-61. [PMID: 7644285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
9
|
Heulitt MJ, Farrington EA, O'Shea TM, Stoltzman SM, Srubar NB, Levin DL. Double-blind, randomized, controlled trial of papaverine-containing infusions to prevent failure of arterial catheters in pediatric patients. Crit Care Med 1993; 21:825-9. [PMID: 8504648 DOI: 10.1097/00003246-199306000-00008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To test the efficacy of the continuous infusion of papaverine-containing fluids into peripheral arterial catheters for reducing the risk of catheter failure. DESIGN Prospective, double-blind, randomized, controlled trial. SETTING Pediatric intensive care unit in a children's hospital. PATIENTS A total of 239 children, aged 3 wks to 18 yrs who had an arterial catheter inserted for clinical purposes. INTERVENTIONS Patients were randomized to receive either papaverine (60 mg/500 mL) or no additive, within the infused fluids. MEASUREMENTS AND MAIN RESULTS Data about patient demographics and potential risk factors for arterial catheter failure were collected at the time of catheter insertion, throughout the life of the catheter, and at the time of catheter removal. Catheter failure was defined as an inability to draw blood from the catheter or loss of the arterial waveform. Overall, 35 (15%) subjects had catheter failure. The risk of catheter failure was lower in patients randomized to receive papaverine (eight [7%] of 115 vs. 27 [22%] of 124; chi-square = 5.2; p = .02), and the time until failure of the catheter was longer in the papaverine group (p = .02, log-rank test). This difference persisted when controlling for potentially confounding factors. CONCLUSION In critically ill children, infusion of papaverine-containing fluids reduces the risk of failure of peripheral arterial catheters.
Collapse
Affiliation(s)
- M J Heulitt
- Department of Pediatrics, Children's Medical Center, Dallas, TX
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
The efficacy and safety of morphine sulfate was evaluated in 20 neonates requiring surgery. Following surgery, each subject received an intravenous morphine loading dose (50 micrograms/kg) followed by a continuous infusion (15 micrograms/kg/hr) for a minimum of 24 hours. Heart rate, respiratory rate, and blood pressure were frequently monitored during therapy. Blood samples were obtained following surgery and during and after morphine therapy for analysis of serum morphine and beta-endorphin content. A 12-hour urine collection was obtained 12 hours following the start of the constant morphine infusion for analysis of morphine content. The mean (+/- SD) duration of morphine infusion was 34 +/- 15 hours and a steady-rate serum morphine concentration was 39 +/- 23 ng/ml. The respective serum morphine half-life, elimination rate, and volume of distribution were 6.6 +/- 2.9 hr, 0.126 +/- 0.056 hr-1, and 5.0 +/- 6.8 liters/kg. The mean percentage of unchanged morphine recovered in the urine was 39 +/- 19 of the dose administered over 12 hours. A significant reduction in serum beta-endorphin content was observed following the onset of morphine therapy. No adverse reports were noted that could be attributed to morphine therapy. Continuous morphine therapy appears to be effective in controlling neonatal postoperative pain, as suggested by subjective nursing observations and decreased serum beta-endorphin content.
Collapse
Affiliation(s)
- E A Farrington
- Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, Indiana
| | | | | | | | | |
Collapse
|
11
|
Abstract
Alterations in response to pharmacological agents have been attributed to flow rate variation produced by intravenous infusion devices during drug delivery. A wide range of variation has been shown to occur with large-volume infusion devices. The intent of this investigation was to examine flow variation resulting from the use of selected small-volume syringe and mobile infusion devices and determine whether these devices have greater flow continuity than large-volume infusion pumps. Each syringe and mobile infusion device delivered iv fluid at three flow rates (1, 5, and 10 ml/h). The effusate was collected in a tared beaker and serial weights were measured every ten seconds using a computerized, gravimetric technique. Accuracy, continuity, and pattern of flow were determined for each of the syringe and mobile infusion devices. All of the devices produced accurate flow, within +/- 10 percent of the desired 5 and 10 ml/h rates. However, the actual iv flow rate ranged from 53 to 93 percent for the 1 ml/h rate. Continuity and pattern of flow resulting from each device were diverse. When compared with large-volume, microrate infusion devices, no significant differences could be observed. Therefore, no clear advantage to delivering drug solutions on a continuous basis can be expected from the use of small-volume devices. Specific infusion devices may be preferable for certain clinical applications; flow continuity data may be valuable when selecting an infusion device.
Collapse
Affiliation(s)
- E A Farrington
- Division of Clinical/Hospital Pharmacy, College of Pharmacy, University of Iowa, Iowa City 52242
| | | | | |
Collapse
|