1
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Holub L, Szabó BG, Závorszky L, Hümpfner R, Andréka P, Karvaly GB, Lakatos B. [Pharmacokinetic and pharmacodynamic considerations of antibiotic therapy among critically ill adult patients with sepsis]. Orv Hetil 2024; 165:403-415. [PMID: 38493416 DOI: 10.1556/650.2024.33001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 03/19/2024]
Abstract
A szepszis életet veszélyeztető, komplex klinikai állapot, melynek kezelése
jelentős kihívást és számottevő költségráfordítást jelent a betegellátás
számára. A szepszis által előidézett patofiziológiai változások jelentős
mértékben megváltoztatják a gyógyszerek és a szervezet kölcsönhatását,
megnehezítve az optimális gyógyszerelést. A kapillárisszivárgás jelensége,
valamint az ellátás során alkalmazott folyadékterápia hatására megemelkedhet
egyes antibiotikumok megoszlási térfogata. A hypalbuminaemia következtében
megnövekedett szabad frakció a nagy fehérjekötődésű antibiotikumok gyorsabb
eliminációját okozhatja. A megnövekedett perctérfogat és a vascularis ellenállás
csökkenése a fiatalabb betegpopulációkban megnövekedett renalis clearance-t
idézhet elő. A betegek nagyobb hányadában azonban a hipoperfúzió miatt szepszis
indukálta akut veseelégtelenség jellemző, melynek hatására a renalis clearance
csökken. A klinikai képet tovább árnyalja, ha vesepótló vagy extracorporalis
membránoxigenizációs kezelést alkalmazunk. Az antibiotikumok fizikai-kémiai
jellemzői meghatározzák, hogy a patofiziológiai változások milyen mértékben
befolyásolják az egyes gyógyszermolekulák farmakokinetikai paramétereit. A
várttól eltérő gyógyszer-expozíciót előidéző folyamatok ellensúlyozására a
farmakokinetikai-farmakodinamikai indexek, valamint a fizikokémiai értékek
ismeretében többféle klinikai stratégia áll rendelkezésre. A terápia racionális
szempontok szerint történő személyre szabásával és a terápiás gyógyszerszint
monitorozásával növelhető a hatékonyság, és csökkenthető az
antibiotikumrezisztencia kialakulásának esélye. Orv Hetil. 2024; 165(11):
403–415.
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Affiliation(s)
- Lili Holub
- 1 Gottsegen György Országos Kardiovaszkuláris Intézet, Intézeti Gyógyszertár Budapest Magyarország
| | - Bálint Gergely Szabó
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika, Infektológiai Tanszéki Csoport Budapest Magyarország
- 3 Semmelweis Egyetem, Doktori Iskola Budapest Magyarország
- 4 Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Hematológiai és Őssejt-transzplantációs Osztály Budapest, Albert Flórián út 5-7., 1097 Magyarország
- 5 Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Infektológiai Osztály Budapest Magyarország
- 6 Gottsegen György Országos Kardiovaszkuláris Intézet, Kardiovaszkuláris Intenzív Terápiás Osztály Budapest Magyarország
| | - Lőrinc Závorszky
- 3 Semmelweis Egyetem, Doktori Iskola Budapest Magyarország
- 6 Gottsegen György Országos Kardiovaszkuláris Intézet, Kardiovaszkuláris Intenzív Terápiás Osztály Budapest Magyarország
- 7 Észak-pesti Centrumkórház - Honvédkórház Budapest Magyarország
| | - Rózsa Hümpfner
- 1 Gottsegen György Országos Kardiovaszkuláris Intézet, Intézeti Gyógyszertár Budapest Magyarország
| | - Péter Andréka
- 3 Semmelweis Egyetem, Doktori Iskola Budapest Magyarország
- 6 Gottsegen György Országos Kardiovaszkuláris Intézet, Kardiovaszkuláris Intenzív Terápiás Osztály Budapest Magyarország
| | - Gellért Balázs Karvaly
- 3 Semmelweis Egyetem, Doktori Iskola Budapest Magyarország
- 8 Semmelweis Egyetem, Általános Orvostudományi Kar, Laboratóriumi Medicina Intézet, Tömegspektrometriai és Elválasztástechnikai Laboratórium Budapest Magyarország
| | - Botond Lakatos
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Hematológiai Klinika, Infektológiai Tanszéki Csoport Budapest Magyarország
- 3 Semmelweis Egyetem, Doktori Iskola Budapest Magyarország
- 5 Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Infektológiai Osztály Budapest Magyarország
- 6 Gottsegen György Országos Kardiovaszkuláris Intézet, Kardiovaszkuláris Intenzív Terápiás Osztály Budapest Magyarország
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2
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Schrijver IT, Herderschee J, Théroude C, Kritikos A, Leijte G, Le Roy D, Brochut M, Chiche JD, Perreau M, Pantaleo G, Guery B, Kox M, Pickkers P, Calandra T, Roger T. Myeloid-Derived Suppressor-like Cells as a Prognostic Marker in Critically Ill Patients: Insights from Experimental Endotoxemia and Intensive Care Patients. Cells 2024; 13:314. [PMID: 38391927 PMCID: PMC10887109 DOI: 10.3390/cells13040314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Patients admitted to the intensive care unit (ICU) often experience endotoxemia, nosocomial infections and sepsis. Polymorphonuclear and monocytic myeloid-derived suppressor cells (PMN-MDSCs and M-MDSCs) can have an important impact on the development of infectious diseases, but little is known about their potential predictive value in critically ill patients. Here, we used unsupervised flow cytometry analyses to quantify MDSC-like cells in healthy subjects challenged with endotoxin and in critically ill patients admitted to intensive care units and at risk of developing infections. Cells phenotypically similar to PMN-MDSCs and M-MDSCs increased after endotoxin challenge. Similar cells were elevated in patients at ICU admission and normalized at ICU discharge. A subpopulation of M-MDSC-like cells expressing intermediate levels of CD15 (CD15int M-MDSCs) was associated with overall mortality (p = 0.02). Interestingly, the high abundance of PMN-MDSCs and CD15int M-MDSCs was a good predictor of mortality (p = 0.0046 and 0.014), with area under the ROC curve for mortality of 0.70 (95% CI = 0.4-1.0) and 0.86 (0.62-1.0), respectively. Overall, our observations support the idea that MDSCs represent biomarkers for sepsis and that flow cytometry monitoring of MDSCs may be used to risk-stratify ICU patients for targeted therapy.
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Affiliation(s)
- Irene T. Schrijver
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland (M.B.)
| | - Jacobus Herderschee
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland (M.B.)
| | - Charlotte Théroude
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland (M.B.)
| | - Antonios Kritikos
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland (M.B.)
| | - Guus Leijte
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands
| | - Didier Le Roy
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland (M.B.)
| | - Maelick Brochut
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland (M.B.)
| | - Jean-Daniel Chiche
- Service of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Matthieu Perreau
- Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1010 Lausanne, Switzerland
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1010 Lausanne, Switzerland
| | - Benoit Guery
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland (M.B.)
| | - Matthijs Kox
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands
| | - Peter Pickkers
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland (M.B.)
- Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1010 Lausanne, Switzerland
| | - Thierry Roger
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland (M.B.)
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3
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Ramírez II, Gutiérrez-Arias R, Damiani LF, Adasme RS, Arellano DH, Salinas FA, Roncalli A, Núñez-Silveira J, Santillán-Zuta M, Sepúlveda-Barisich P, Gordo-Vidal F, Blanch L. Specific Training Improves the Detection and Management of Patient-Ventilator Asynchrony. Respir Care 2024; 69:166-175. [PMID: 38267230 PMCID: PMC10898470 DOI: 10.4187/respcare.11329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Patient-ventilator asynchrony is common in patients undergoing mechanical ventilation. The proportion of health-care professionals capable of identifying and effectively managing different types of patient-ventilator asynchronies is limited. A few studies have developed specific training programs, but they mainly focused on improving patient-ventilator asynchrony detection without assessing the ability of health-care professionals to determine the possible causes. METHODS We conducted a 36-h training program focused on patient-ventilator asynchrony detection and management for health-care professionals from 20 hospitals in Latin America and Spain. The training program included 6 h of a live online lesson during which 120 patient-ventilator asynchrony cases were presented. After the 6-h training lesson, health-care professionals were required to complete a 1-h training session per day for the subsequent 30 d. A 30-question assessment tool was developed and used to assess health-care professionals before training, immediately after the 6-h training lecture, and after the 30 d of training (1-month follow-up). RESULTS One hundred sixteen health-care professionals participated in the study. The median (interquartile range) of the total number of correct answers in the pre-training, post-training, and 1-month follow-up were significantly different (12 [8.75-15], 18 [13.75-22], and 18.5 [14-23], respectively). The percentages of correct answers also differed significantly between the time assessments. Study participants significantly improved their performance between pre-training and post-training (P < .001). This performance was maintained after a 1-month follow-up (P = .95) for the questions related to the detection, determination of cause, and management of patient-ventilator asynchrony. CONCLUSIONS A specific 36-h training program significantly improved the ability of health-care professionals to detect patient-ventilator asynchrony, determine the possible causes of patient-ventilator asynchrony, and properly manage different types of patient-ventilator asynchrony.
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Affiliation(s)
- Iván I Ramírez
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile.
- Faculty of Health Sciences, Diego Portales University, Santiago, Chile
- Division of Critical Care Medicine, Hospital Clinico de la Universidad de Chile, Santiago, Chile
- INTRehab Research Group, Santiago, Chile
| | - Ruvistay Gutiérrez-Arias
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile
- INTRehab Research Group, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - L Felipe Damiani
- Departamento de ciencias de la salud, carrera de Kinesiología (Kinesiology career), Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo S Adasme
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
- Division of Pediatric Critical Care Medicine at Hospital Clínico Red de Salud Christus-UC. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel H Arellano
- Division of Critical Care Medicine, Hospital Clinico de la Universidad de Chile, Santiago, Chile
| | - Francisco A Salinas
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile
- INTRehab Research Group, Santiago, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | | | - Juan Núñez-Silveira
- Division of Critical Care Medicine, Hospital Italiano, Buenos Aires, Argentina
| | - Milton Santillán-Zuta
- Critical Care Department, Hospital Nacional Guillermo Almenara, Lima, Perú
- Faculty of Health Science at Universidad Nacional Toribio Rodríguez de Mendoza, Amazonas, Perú
| | | | - Federico Gordo-Vidal
- Intensive Care Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
- Grupo de investigación en patología crítica, Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Lluís Blanch
- Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigacio i Innovacio Parc Taulí I3PT-CERCA, Universitat Autonoma de Barcelona, Sabadell, Spain
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4
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Quispe-Medina K, Pacheco-Aranibar J, Mamani-Ruelas A, Gamez-Bernabé C, Zapana-Begazo R, Paz-Aliaga I, Villanueva Salas J, Bernabé-Ortiz JC. Characterization of Pulmonary Bacteriobiota in Critically Ill Patients in Southern Peru through Next-Generation Sequencing Technology. Curr Issues Mol Biol 2023; 45:10041-10055. [PMID: 38132473 PMCID: PMC10742510 DOI: 10.3390/cimb45120627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Sequence variation in the 16S gene is widely used to characterize diverse microbial communities. This was the first pilot study carried out in our region where the pulmonary microbiota of critically ill patients was investigated and analyzed, with the aim of finding a specific profile for these patients that can be used as a diagnostic marker. An study of critical patients mechanically ventilated for non-respiratory indications, in a polyvalent intensive care unit, was carried out; samplee were extracted by endotracheal aspiration and subsequently the microbiota was characterized through Next-Generation Sequencing Technology (NGS). The predominant phyla among the critically ill patients were Proteobacteria, Firmicutes and Bacteroidata. In the surviving patients group, the predominant phyla were Proteobacteria, Bacteroidata and Firmicutes, in the group of deceased patients thy were Firmicutes, Proteobacteria, and Bacteroidata. We found a decrease in commensal bacteria in deceased patients and a progressive increase in in-hospital germs.
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Affiliation(s)
- Katherine Quispe-Medina
- Post-Graduate School, Universidad Católica de Santa María, Urb. San José s/n, Umacollo, Arequipa 04013, Peru; (K.Q.-M.); (R.Z.-B.); (J.V.S.)
| | - Jani Pacheco-Aranibar
- Department of Molecular Biology, Instituto de Biotecnología del ADN Uchumayo, Arequipa 04400, Peru;
| | - Angel Mamani-Ruelas
- Emergency and Critical Care Department, Hospital Nacional Carlos Alberto Seguín Escobedo—EsSalud, Calle Peral s/n, Arequipa 04001, Peru;
| | - Carlos Gamez-Bernabé
- Human Medicine School, Faculty of Health Sciences, Universidad Nacional Jorge Basadre Grohmann, Av. Miraflores s/n, Tacna 23001, Peru;
| | - Rosemary Zapana-Begazo
- Post-Graduate School, Universidad Católica de Santa María, Urb. San José s/n, Umacollo, Arequipa 04013, Peru; (K.Q.-M.); (R.Z.-B.); (J.V.S.)
| | - Ivan Paz-Aliaga
- Department of Pharmacy, Biochemistry and Biotechnology, Universidad Católica de Santa María, Urb. San José s/n, Umacollo, Arequipa 04013, Peru;
| | - Jose Villanueva Salas
- Post-Graduate School, Universidad Católica de Santa María, Urb. San José s/n, Umacollo, Arequipa 04013, Peru; (K.Q.-M.); (R.Z.-B.); (J.V.S.)
| | - Julio C. Bernabé-Ortiz
- Post-Graduate School, Universidad Católica de Santa María, Urb. San José s/n, Umacollo, Arequipa 04013, Peru; (K.Q.-M.); (R.Z.-B.); (J.V.S.)
- Department of Molecular Biology, Instituto de Biotecnología del ADN Uchumayo, Arequipa 04400, Peru;
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Deana C, Vecchiarelli P, Picetti E, Molfino A. Editorial: Intermittent feeding in critically ill patients. Front Nutr 2023; 10:1295405. [PMID: 37908298 PMCID: PMC10614014 DOI: 10.3389/fnut.2023.1295405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | | | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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6
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Alnezary FS, Almutairi MS, Gonzales-Luna AJ, Thabit AK. The Significance of Bayesian Pharmacokinetics in Dosing for Critically Ill Patients: A Primer for Clinicians Using Vancomycin as an Example. Antibiotics (Basel) 2023; 12:1441. [PMID: 37760737 PMCID: PMC10525617 DOI: 10.3390/antibiotics12091441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Antibiotic use is becoming increasingly challenging with the emergence of multidrug-resistant organisms. Pharmacokinetic (PK) alterations result from complex pathophysiologic changes in some patient populations, particularly those with critical illness. Therefore, antibiotic dose individualization in such populations is warranted. Recently, there have been advances in dose optimization strategies to improve the utilization of existing antibiotics. Bayesian-based dosing is one of the novel approaches that could help clinicians achieve target concentrations in a greater percentage of their patients earlier during therapy. This review summarizes the advantages and disadvantages of current approaches to antibiotic dosing, with a focus on critically ill patients, and discusses the use of Bayesian methods to optimize vancomycin dosing. The Bayesian method of antibiotic dosing was developed to provide more precise predictions of drug concentrations and target achievement early in therapy. It has benefits such as the incorporation of personalized PK/PD parameters, improved predictive abilities, and improved patient outcomes. Recent vancomycin dosing guidelines emphasize the importance of using the Bayesian method. The Bayesian method is able to achieve appropriate antibiotic dosing prior to the patient reaching the steady state, allowing the patient to receive the right drug at the right dose earlier in therapy.
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Affiliation(s)
- Faris S. Alnezary
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah 41477, Saudi Arabia;
| | - Masaad Saeed Almutairi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim 51452, Saudi Arabia
| | - Anne J. Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX 77204, USA;
| | - Abrar K. Thabit
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah 21589, Saudi Arabia;
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7
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Cherchi V, Vetrugno L, Terrosu G, Deana C, Ventin M, Zanini V, Barbariol F, Pravisani R, Bove T, Risaliti A, Lorenzin D, Baccarani U. Association between artificial nutrition in brain dead donors and early allograft function in liver transplant recipients: an observational study. Clin Transplant 2023; 37:e15034. [PMID: 37212369 DOI: 10.1111/ctr.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/23/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The role of nutrition in donor after brain deaths (DBDs) has yet to be adequately discussed. The primary aim of this study was to investigate whether the nutritional intake in the 48 h before organ retrieval may play a role on the graft functional recovery assessed with Model for Early Allograft Function (MEAF) Score. METHODS Single-center retrospective study evaluating all liver transplants performed at the University Hospital of Udine from January 2010 to August 2020. Patients receiving grafts from DBD donors fed with artificial enteral nutrition in the 48 h prior to organ procurement (EN-group) or who did not (No-EN-group). Caloric debt was calculated using the difference between the calculated caloric needs and the effective calories delivered through enteral nutrition. RESULTS Livers from EN-group presented a lower mean MEAF score compared to the no-EN-group: 3.39 ± 1.46 versus 4.15 ± 1.51, respectively (p = .04). A positive correlation between caloric debt and the MEAF score was found within the overall population (r = .227, p = .043) as well as in EN-group (r = .306, p = .049). CONCLUSIONS Donor's nutritional intake in the final 48 h before organ procurement correlates with MEAF score, and nutrition probably plays a positive role on the functional recovery of the graft. Large future randomized controlled trials are needed to confirm this preliminary results.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | - Federico Barbariol
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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8
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Ma X, Li J, Zhou Q, Wang J. Serum lactate and the mortality of critically ill patients in the emergency department: A retrospective study. Exp Ther Med 2023; 26:371. [PMID: 37415838 PMCID: PMC10320652 DOI: 10.3892/etm.2023.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/05/2023] [Indexed: 07/08/2023] Open
Abstract
Serum lactate levels have been widely studied as a prognostic marker in critically ill patients, particularly those in the intensive care unit. However, it remains unknown whether the serum lactate levels affect the mortality rate of critically ill patients admitted to hospital. To investigate this hypothesis, the vital signs and blood gas analysis data of 1,393 critically ill patients who visited the Emergency Department of Affiliated Kunshan Hospital of Jiangsu University (Kunshan, China) between January and December 2021 were collected. Patients were divided into two groups, 30-day survival group and a 30-day death group, and logistic regression analysis was used to investigate the association between vital signs, laboratory results and mortality rates of critically ill patients. A total of 1,393 critically ill patients was enrolled in the present study, with a male-to-female ratio of 1.17:1.00, a mean age of 67.72±19.29 years and a mortality rate of 11.6%. The multivariate logistic regression analysis revealed that increased serum lactate levels were an independent risk factor for mortality rate of critically ill patients [Odds ratio (OR)=1.50, 95% confidence interval (95% CI): 1.40-1.62]. The critical cut-off value for the serum lactate levels was identified as 2.35 mmol/l. In addition, OR values of age, heart rate, systolic blood pressure, transcutaneous oxygen saturation (SpO2) and hemoglobin were 1.02, 1.01, 0.99, 0.96 and 0.99, respectively (95% CI: 1.01-1.04, 1.00-1.02, 0.98-0.99, 0.94-0.98 and 0.98-1.00, respectively). The logistic regression model was found to be of value in terms of identifying the mortality rate of patients and the area under the receiver operating characteristic curve was 0.894 (95% CI: 0.863-0.925; P<0.001). In conclusion, the present study showed that high serum lactate levels in critically ill patients upon admission to hospital are associated with higher 30-day mortality rate.
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Affiliation(s)
- Xiaoyu Ma
- The Second Clinical Medical School, Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Jianing Li
- The Second Clinical Medical School, Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Qiyang Zhou
- The First Clinical Medical School, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Juejin Wang
- Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
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9
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Lee H, Lee S, Kim H. Factors affecting the length of stay in the emergency department for critically Ill patients transferred to regional emergency medical center. Nurs Open 2022; 10:3220-3231. [PMID: 36575810 PMCID: PMC10077391 DOI: 10.1002/nop2.1573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/17/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022] Open
Abstract
AIM To identify the factors affecting Emergency Department Length of Stay for transferred critically ill patients. BACKGROUND The Length of Stay of the transferred patients is an important indicator of Emergency Department service quality; thus, understanding the factors affecting the Emergency Department Length of Stay of transferred critically ill patients is essential. METHODS Using the electronic medical records of 968 transferred critically ill Emergency Department patients of a tertiary hospital in Korea, prediction models for Emergency Department Length of Stay were built using various machine learning algorithms. RESULTS The logistic regression (AUROC 0.85) models showed the best performance, followed by random forest (AUROC 0.83) and Naive Bayes (AUROC 0.83). The logistic regression model indicated that fewer consultations, the highest acuity level, need for an emergency operation or angiography, need for ICU admission, severe emergency disease and fewer diagnoses were the statistically significant predictors for Emergency Department Length of Stay of 6 h or less. CONCLUSIONS The transferred critically ill patients analysed in this study who required immediate or specialized care tended to receive needed care on time at the study site. IMPLICATIONS FOR NURSING MANAGEMENT Understanding the factors affecting the Emergency Department Length of Stay of transferred critically ill patients is crucial for developing strategies to manage the nursing resource of Emergency Department successfully.
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Affiliation(s)
- Hyungbok Lee
- Emergency Nursing Department, Seoul National University Hospital, Seoul, Korea.,College of Nursing, Seoul National University, Seoul, Korea
| | - Sangrim Lee
- Emergency Nursing Department, Seoul National University Hospital, Seoul, Korea.,College of Nursing, Seoul National University, Seoul, Korea
| | - Hyeoneui Kim
- College of Nursing, Seoul National University, Seoul, Korea.,The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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10
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Vetrugno L, Anzellotti GM, Frontera R, Parinisi Z, Sessa B, Deana C, Maggiore SM. Severe Recurrent COVID-Associated Pulmonary Aspergillosis: A Challenging Case. Healthcare (Basel) 2022; 10. [PMID: 36554008 DOI: 10.3390/healthcare10122483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
We report a rare case of severe COVID-19-associated pulmonary aspergillosis presenting as invasive pulmonary aspergillosis and subsequently invasive tracheobronchial aspergillosis during hospitalization in a critically ill patient who developed a further Aspergillus infection after home discharge. He needed readmission to the ICU and mechanical ventilation. We therefore strongly encourage a high degree of attention to fungal complications, even after viral recovery and ICU discharge.
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Kishihara Y, Yasuda H, Moriya T, Kashiura M, Koike M, Kotani Y, Kondo N, Sekine K, Shime N, Morikane K, Abe T. A study of the risk factors for phlebitis in patients stratified using the acute physiology and chronic health evaluation II score and admitted to the intensive care unit: A post hoc analysis of the AMOR-VENUS study. Front Med (Lausanne) 2022; 9:965706. [PMID: 36544499 PMCID: PMC9760669 DOI: 10.3389/fmed.2022.965706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Peripheral intravascular catheters (PIVCs) are inserted in most patients admitted to the intensive care unit (ICU). Previous research has discussed various risk factors for phlebitis, which is one of the complications of PIVCs. However, previous studies have not investigated the risk factors based on the patient's severity of illness, such as the Acute Physiology and Chronic Health Evaluation (APACHE) II score. Different treatments can be used based on the relationship of risk factors to the illness severity to avoid phlebitis. Therefore, in this study, we investigate whether the risk factors for phlebitis vary depending on the APACHE II score. Materials and methods This study was a post hoc analysis of the AMOR-VENUS study involving 23 ICUs in Japan. We included patients with age ≥ 18 years and consecutive admissions to the ICU with PIVCs inserted during ICU admission. The primary outcome was phlebitis, and the objective was the identification of the risk factors evaluated by hazard ratio (HR) and 95% confidence interval (CI). The cut-off value of the APACHE II score was set as ≤15 (group 1), 16-25 (group 2), and ≥26 (group 3). Multivariable marginal Cox regression analysis was performed for each group using the presumed risk factors. Results A total of 1,251 patients and 3,267 PIVCs were analyzed. Multivariable marginal Cox regression analysis reveals that there were statistically significant differences among the following variables evaluated HR (95%CI): (i) in group 1, standardized drug administration measures (HR, 0.4 [0.17-0.9]; p = 0.03) and nicardipine administration (HR, 2.25 [1.35-3.75]; p < 0.01); (ii) in group 2, insertion in the upper arm using the forearm as a reference (HR, 0.41 [0.2-0.83]; p = 0.01), specified polyurethane catheter using polyurethane as a reference (HR, 0.56 [0.34-0.92]; p = 0.02), nicardipine (HR, 1.9 [1.16-3.12]; p = 0.01), and noradrenaline administration (HR, 3.0 [1.52-5.88]; p < 0.01); (iii) in group 3, noradrenaline administration (HR, 3.39 [1.14-10.1]; p = 0.03). Conclusion We found that phlebitis risk factors varied according to illness severity. By considering these different risk factors, different treatments may be provided to avoid phlebitis based on the patient's severity of illness.
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Affiliation(s)
- Yuki Kishihara
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan,Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan,*Correspondence: Hideto Yasuda,
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Midori Koike
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yuki Kotani
- Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
| | - Natsuki Kondo
- Department of Intensive Care Medicine, Chiba Emergency Medical Center, Chiba, Japan
| | - Kosuke Sekine
- Department of Medical Engineer, Kameda Medical Center, Chiba, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan
| | - Takayuki Abe
- Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan,School of Data Science, Yokohama City University, Kanagawa, Japan
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Kehagias D, Mulita F, Panagiotopoulos I, Lampropoulos C, Markopoulos G, Verras GI, Kehagias I. Primary aortoenteric fistula: is endovascular repair the prime option? A review of the literature. Kardiochir Torakochirurgia Pol 2022; 19:220-5. [PMID: 36643343 DOI: 10.5114/kitp.2022.122092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/15/2022] [Indexed: 01/03/2023]
Abstract
Primary aortoenteric fistula (PAEF) is a rare entity that demands high clinical suspicion and efficient management in a limited time. The evolution of interventional radiology established endovascular repair (EVAR) as an attractive option. The English literature was searched using the PubMed database with the terms "primary aortoenteric fistula", "primary aortoduodenal fistula" or "aortoduodenal fistula", and "endovascular repair" in different combinations. Studies and original articles that described the role and the outcomes of EVAR for primary aortoenteric fistula were included. Fourteen articles with a total of 15 patients with primary aortoenteric fistula who were managed with EVAR were included in our literature review. PAEF is a rare and lethal entity that everyone should be aware of. EVAR is a salvage option and a valuable weapon in our armamentarium. Is EVAR really a "bridge to surgery" or is it the birth pangs of a minimally invasive definite treatment of PAEF?
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Nakanishi N, Matsushima S, Tatsuno J, Liu K, Tamura T, Yonekura H, Yamamoto N, Unoki T, Kondo Y, Nakamura K. Impact of Energy and Protein Delivery to Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2022; 14. [PMID: 36432536 DOI: 10.3390/nu14224849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022] Open
Abstract
Optimal energy and protein delivery goals for critically ill patients remain unknown. The purpose of this systematic review and meta-analysis was to compare the impact of energy and protein delivery during the first 4 to 10 days of an ICU stay on physical impairments. We performed a systematic literature search of MEDLINE, CENTRAL, and ICHUSHI to identify randomized controlled trials (RCTs) that compared energy delivery at a cut-off of 20 kcal/kg/day or 70% of estimated energy expenditure or protein delivery at 1 g/kg/day achieved within 4 to 10 days after admission to the ICU. The primary outcome was activities of daily living (ADL). Secondary outcomes were physical functions, changes in muscle mass, quality of life, mortality, length of hospital stay, and adverse events. Fifteen RCTs on energy delivery and 14 on protein were included in the analysis. No significant differences were observed in any of the outcomes included for energy delivery. However, regarding protein delivery, there was a slight improvement in ADL (odds ratio 21.55, 95% confidence interval (CI) −1.30 to 44.40, p = 0.06) and significantly attenuated muscle loss (mean difference 0.47, 95% CI 0.24 to 0.71, p < 0.0001). Limited numbers of RCTs were available to analyze the effects of physical impairments. In contrast to energy delivery, protein delivery ≥1 g/kg/day achieved within 4 to 10 days after admission to the ICU significantly attenuated muscle loss and slightly improved ADL in critically ill patients. Further RCTs are needed to investigate their effects on physical impairments.
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Yan W, Li C, Song X, Zhou W, Chen Z. Prophylactic melatonin for delirium in critically ill patients: A systematic review and meta-analysis with trial sequential analysis. Medicine (Baltimore) 2022; 101:e31411. [PMID: 36316858 PMCID: PMC9622662 DOI: 10.1097/md.0000000000031411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Up to 80% of patients in the intensive care unit (ICU) suffer from delirium. Studies on the preventative use of melatonin in the ICU have produced mixed results. We performed a systematic review and meta-analysis to evaluate whether early administration of melatonin reduces the prevalence of delirium in critically ill patients. METHODS We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing melatonin or melatonin agonists to placebo in ICU setting. The population included adult patients in the ICU. The primary outcome was the prevalence of delirium. Secondary outcomes included duration of delirium, delirium-free day, serum melatonin concentration, need for sedation, duration of mechanical ventilation, hospital and ICU length of stay (LOS), all-cause mortality, sleep quality, and adverse events. Trial sequential analysis (TSA) was performed on the primary outcome to prevent the risk of random error and multiplicity phenomenon as a result of repeated significance testing across all the included trials. RESULTS Twelve trials with a total of 2538 patients were analyzed. When all trials were pooled, the incidence of delirium in ICU patients who received melatonin was significantly lower than in those who received placebo (risk ratio, 0.77; 95% confidence interval: 0.61-0.96; I2 = 56%). There were no significant differences in secondary outcomes including duration of delirium, duration of mechanical ventilation, ICU LOS, hospital LOS, and mortality. TSA indicated that Z-curve crossed the traditional boundary, but did not cross the monitoring boundary for benefit, which indicated that it is still inconclusive that melatonin affects the incidence of delirium. CONCLUSIONS This meta-analysis found that early administration of melatonin may result in a decreased delirium prevalence in critically ill patients. However, the sensitivity analysis of high-quality studies did not support this finding. In addition, TSA demonstrated that the result may have false-positive error. Therefore, this finding should be interpreted with caution. Further studies are needed to examine the effectiveness of prophylactic melatonin on the prevalence and duration of ICU delirium in the future.
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Affiliation(s)
- Wenqing Yan
- Medical Department of Nanchang University, Nanchang, Jiangxi, China
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
| | - Chen Li
- Department of Traumatology, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Xin Song
- Medical Department of Nanchang University, Nanchang, Jiangxi, China
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
| | - Wenqiang Zhou
- Medical Department of Nanchang University, Nanchang, Jiangxi, China
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
| | - Zhi Chen
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- * Correspondence: Zhi Chen, Department of Emergency, Jiangxi Provincial People’s Hospital, 92 Ai Guo Street, Nanchang, Jiangxi 330006, China (e-mail: )
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15
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Dairi MS, Aljabri MK, Bahakim AK, Aljabri AA, Alharbi TA, Alsehli AH, Alotaibi AT, Alsufyani AA, Alsairafi RA. Knowledge and Competence Towards Critical Care Concepts Among Final Year Medical Students and Interns: A Cross-Sectional Study. Adv Med Educ Pract 2022; 13:1091-1101. [PMID: 36157377 PMCID: PMC9507286 DOI: 10.2147/amep.s372119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Critical care knowledge constitutes an essential component in medicine. Unfortunately, ICU knowledge acquisition is limited in many medical schools. This study is intended to measure the knowledge background, gaps, and the confidence toward critical care concepts among final year medical students and interns at Umm Al-Qura University, Saudi Arabia. METHODS This was a cross-sectional study using a self-administered online questionnaire completed by final-year medical students and interns during January and February 2022. We collected data on demographics, academic year, critical care knowledge, competency, and satisfaction. RESULTS Two-hundred-twenty-one (221) responses were analyzed. The male gender was 54.3%. A small proportion (15.8%) identified the lowest acceptable oxygen saturation in a normal person. Around three-quarters of the participants did not feel competent about nasal airway suctioning and endotracheal tube suctioning (65.6% and 75.6%, respectively). Only 7.2% of the responder correctly identified the three most useful physiological observations pertinent to quick SOFA criteria. Regarding the training adequacy for identifying critically ill patients, 59.3% answered that they are inadequately trained. Regarding the satisfaction level of exposure to critical care, 54% of the sample responded that they need further improvement. CONCLUSION Undergraduate students and interns have limited knowledge and confidence in critical care medicine. Thus, we highly recommend an early institution of a dedicated critical care training module in the medical school curriculum.
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Affiliation(s)
- Mohammad S Dairi
- Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Moayad K Aljabri
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah K Bahakim
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdulkarim A Aljabri
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Tayil A Alharbi
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Anas H Alsehli
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Alwaleed T Alotaibi
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Rani A Alsairafi
- Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
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16
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Viaggi B, Cangialosi A, Langer M, Olivieri C, Gori A, Corona A, Finazzi S, Di Paolo A. Tissue Penetration of Antimicrobials in Intensive Care Unit Patients: A Systematic Review-Part II. Antibiotics (Basel) 2022; 11:antibiotics11091193. [PMID: 36139972 PMCID: PMC9495066 DOI: 10.3390/antibiotics11091193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
In patients that are admitted to intensive care units (ICUs), the clinical outcome of severe infections depends on several factors, as well as the early administration of chemotherapies and comorbidities. Antimicrobials may be used in off-label regimens to maximize the probability of therapeutic concentrations within infected tissues and to prevent the selection of resistant clones. Interestingly, the literature clearly shows that the rate of tissue penetration is variable among antibacterial drugs, and the correlation between plasma and tissue concentrations may be inconstant. The present review harvests data about tissue penetration of antibacterial drugs in ICU patients, limiting the search to those drugs that mainly act as protein synthesis inhibitors and disrupting DNA structure and function. As expected, fluoroquinolones, macrolides, linezolid, and tigecycline have an excellent diffusion into epithelial lining fluid. That high penetration is fundamental for the therapy of ventilator and healthcare-associated pneumonia. Some drugs also display a high penetration rate within cerebrospinal fluid, while other agents diffuse into the skin and soft tissues. Further studies are needed to improve our knowledge about drug tissue penetration, especially in the presence of factors that may affect drug pharmacokinetics.
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Affiliation(s)
- Bruno Viaggi
- Department of Anesthesiology, Neuro-Intensive Care Unit, Careggi University Hospital, 50139 Florence, Italy
- Associazione GiViTI, c/o Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Alice Cangialosi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Martin Langer
- Associazione GiViTI, c/o Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Carlo Olivieri
- Anesthesia and Intensive Care, Sant’Andrea Hospital, ASL VC, 13100 Vercelli, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alberto Corona
- ICU and Accident & Emergency Department, ASST Valcamonica, 25043 Breno, Italy
| | - Stefano Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 24020 Ranica, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Correspondence:
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Mao IC, Lin PR, Wu SH, Hsu HH, Hung PS, Kor CT. First 24-Hour Potassium Concentration and Variability and Association with Mortality in Patients Requiring Continuous Renal Replacement Therapy in Intensive Care Units: A Hospital-Based Retrospective Cohort Study. J Clin Med 2022; 11. [PMID: 35743452 DOI: 10.3390/jcm11123383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/06/2022] [Accepted: 06/11/2022] [Indexed: 02/04/2023] Open
Abstract
Serum potassium (K+) levels between 3.5 and 5.0 mmol/L are considered safe for patients. The optimal serum K+ level for critically ill patients with acute kidney injury undergoing continuous renal replacement therapy (CRRT) remains unclear. This retrospective study investigated the association between ICU mortality and K+ levels and their variability. Patients aged >20 years with a minimum of two serum K+ levels recorded during CRRT who were admitted to the ICU in a tertiary hospital in central Taiwan between January 01, 2010, and April 30, 2021 were eligible for inclusion. Patients were categorized into different groups based on their mean K+ levels: <3.0, 3.0 to <3.5, 3.5 to <4.0, 4.0 to <4.5, 4.5 to <5.0, and ≥5.0 mmol/L; K+ variability was divided by the quartiles of the average real variation. We analyzed the association between the particular groups and in-hospital mortality by using Cox proportional hazard models. We studied 1991 CRRT patients with 9891 serum K+ values recorded within 24 h after the initiation of CRRT. A J-shaped association was observed between serum K+ levels and mortality, and the lowest mortality was observed in the patients with mean K+ levels between 3.0 and 4.0 mmol/L. The risk of in-hospital death was significantly increased in those with the highest variability (HR and 95% CI = 1.61 [1.13−2.29] for 72 h mortality; 1.39 [1.06−1.82] for 28-day mortality; 1.43 [1.11−1.83] for 90-day mortality, and 1.31 [1.03−1.65] for in-hospital mortality, respectively). Patients receiving CRRT may benefit from a lower serum K+ level and its tighter control. During CRRT, progressively increased mortality was noted in the patients with increasing K+ variability. Thus, the careful and timely correction of dyskalemia among these patients is crucial.
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Sitaruno S, Santimaleeworagun W, Pattharachayakul S, DeBacker KC, Vattanavanit V, Binyala W, Pai MP. Comparison of Race and Non-Race Based Equations for Kidney Function Estimation in Critically Ill Thai Patients for Vancomycin Dosing. J Clin Pharmacol 2022; 62:1215-1226. [PMID: 35543614 PMCID: PMC9544596 DOI: 10.1002/jcph.2070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/02/2022] [Indexed: 11/12/2022]
Abstract
Empiric antibiotic dosing frequently relies on an estimate of kidney function based on age, serum creatinine (SCr), sex, and race (on occasion). New non-Race based estimated glomerular filtration rate (eGFR) equations have been published but their role to support dosing is not known. Here, we report on a population pharmacokinetic model of vancomycin that serves as a useful probe substrate of eGFR in critically ill Thai patients. Data were obtained from medical records during a 10-year period. A nonlinear mixed-effects modeling approach was conducted to estimate vancomycin parameters. Data from 208 critically ill patients (58.2% male and 36.0% septic shock) with 398 vancomycin concentrations were collected. Twenty-three covariates including 12 kidney function estimates were tested and ranked based on the model performance. The median [min, max] age, weight, and SCr was 69 [18, 97] years, 60.0 [27, 120] kg, and 1.53 [0.18, 7.15] mg/dL. The best base model was a one-compartment linear with zero-order input and proportional error model. A Thai specific eGFR equation not indexed to body surface area (BSA) model best predicted vancomycin clearance (CL). The typical value for volume of distribution and CL was 67.5 L and 1.22 L/h, respectively. A loading dose of 2000 mg followed by maintenance dose regimens based on eGFR is suggested. The Thai-GFR not indexed to BSA model best predicts vancomycin CL and dosing in the critically ill Thai population. A 5-10% absolute gain in the vancomycin probability of target attainment is expected with the use of this population specific GFR equation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sirima Sitaruno
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | | | - Sutthiporn Pattharachayakul
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kenneth C DeBacker
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Veerapong Vattanavanit
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Wanrada Binyala
- Pharmacy Department, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
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Herrera-Quintana L, Vázquez-Lorente H, Molina-López J, Gamarra-Morales Y, Planells E. Selenium Levels and Antioxidant Activity in Critically Ill Patients with Systemic Inflammatory Response Syndrome. Metabolites 2022; 12:metabo12040274. [PMID: 35448461 PMCID: PMC9025155 DOI: 10.3390/metabo12040274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
The Selenium (Se) status could be an important modifiable factor in critically ill patient outcomes due to the important role of this mineral in several functions. Although there are many clinical trials with Se interventions in the literature, the evidence is not sufficient to establish a common criterion regarding the Se status. Background and aims: An analysis was made of the evolution of selenium (Se) and antioxidant status in critically ill patients with Systemic Inflammatory Response Syndrome (SIRS) over 7 days of staying in the Intensive Care Unit (ICU). Methods: A prospective analytical study was carried out on 65 critically ill patients aged 31−77 years. A healthy control group of 56 volunteers from the same region was recruited to allow comparisons with reference normal values. The selenium levels in both the plasma and erythrocytes were analyzed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Glutathione Peroxidase (GPx) and Superoxide Dismutase (SOD) activity and the Total Antioxidant Capacity (TAC) were measured using kinetic colorimetric methods. Results: Low erythrocyte and plasma Se levels were found at ICU admission in comparison with the healthy reference group (p < 0.001), and the levels further decreased after one week (p < 0.001). Smaller changes in the plasma Se levels were associated with greater changes in the Sequential Organ Failure Assessment (SOFA) score (p < 0.05). The GPx activity in the critically ill was lower than in the control group (p < 0.05), with an inverse correlation to the severity scores at the baseline (p < 0.05) and reaching normal values after one week (p < 0.05). SOD activity was directly correlated to TAC (p = 0.03), with both parameters exhibiting a direct correlation to albumin (p < 0.05) after 7 days of ICU stay. Conclusions: A deficient Se status was observed at ICU admission and worsened further over follow-up regardless of the evolution of the patient severity and the antioxidant parameters. Adequate Se support from the start of admission could preserve and contribute to improve the Se-related outcomes and critical patient recovery during longer periods in the ICU.
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Affiliation(s)
- Lourdes Herrera-Quintana
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
| | - Héctor Vázquez-Lorente
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
| | - Jorge Molina-López
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
- Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain
- Correspondence: (J.M.-L.); (E.P.)
| | - Yenifer Gamarra-Morales
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
| | - Elena Planells
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
- Correspondence: (J.M.-L.); (E.P.)
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20
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Okubo K, Kato T, Shiko Y, Kawasaki Y, Inoda A, Koyama K. Two Cases of Liver Transplantation With a High Ionized Magnesium to Total Magnesium Ratio. Cureus 2022; 14:e23524. [PMID: 35494992 PMCID: PMC9038446 DOI: 10.7759/cureus.23524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/06/2022] Open
Abstract
Magnesium (Mg), an important cation, is involved in the activation of enzymes important for life support. The incidence of hypomagnesemia in critically ill patients admitted to the intensive care unit (ICU) is high and has been reported to be a factor in worsening prognosis. Ionized magnesium (iMg) is physiologically active, although total magnesium (tMg) is often used to evaluate the concentration of magnesium because of the limited availability of instruments that can measure iMg. However, the changes in tMg and iMg are not correlated in critically ill patients. We obtained considerable data on the simultaneous measurements of iMg and tMg in two patients with severe liver disease who underwent liver transplantation. In both patients, the iMg/tMg values were high, suggesting the influence of hypoalbuminemia associated with liver dysfunction. Mg correction using tMg as a guide may lead to overdose. Furthermore, when considering the data for each case, the correlation between iMg and tMg was very high, which suggested that the iMg/tMg ratio may be a value unique to each individual or disease. Investigating in a large-scale study the correlation between iMg levels and clinical symptoms and prognosis is necessary in the future.
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Affiliation(s)
- Kunihide Okubo
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Takao Kato
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, JPN.,Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, JPN.,Clinical Research Center, Chiba University Hospital, Chiba, JPN.,Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Ayako Inoda
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Kaoru Koyama
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
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21
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Deana C, Vetrugno L, Stefani F, Bassi F. Bronchoscopic suspect of Herpesvirus infection in critically ill COVID-19 patients: two case reports and brief literature review. Acta Biomed 2022; 92:e2021514. [PMID: 35045066 PMCID: PMC10523049 DOI: 10.23750/abm.v92is1.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 06/14/2023]
Abstract
Herpesviridae infection in COVID-19 patients has been reported, particularly muco-cutaneous lesions. Little is known about Herpesviridae lung infection in critically ill COVID-19 patients. Typical scattered lesions seen through fiberoptic bronchoscopy in these patients should raise the question as to whether to start empirically acyclovir treatment while a Herpesviridae diagnostics result becomes available.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care Unit 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
| | | | - Francesca Stefani
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine.
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine.
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22
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Lin XB, Hu XG, Xia YZ, Liu XM, Liang T, Chen X, Cai CJ. Voriconazole pharmacokinetics in a critically ill patient during extracorporeal membrane oxygenation. J Chemother 2021; 34:272-276. [PMID: 34904531 DOI: 10.1080/1120009x.2021.2014725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The pharmacokinetics (PK) of several drugs including antimicrobials might be highly altered during extracorporeal membrane oxygenation (ECMO) therapy. We present the change of voriconazole (VRC) PK during ECMO in a critically ill patient who received intravenous VRC at a maintenance dose of 200 mg every 12 h for empirical antifungal therapy. Two PK profiles were drawn before and after the initiation of ECMO therapy. Though the trough levels (both C0 and C12) with ECMO were slightly lower than that without ECMO (12.58 and 12.84 vs. 14.02 μg/mL), the peak levels and the area under the concentration-time curve from 0 h to 6 h (AUC0-6) were comparable (16.36 vs. 16.06 μg/mL and 90.78 vs. 91.45 μg·h/mL, respectively), indicating that VRC plasma exposure during ECMO therapy did not greatly decrease in our patient. The circuit factors including the type of membrane should be taken into account to further identify the effects of ECMO on the PK of VRC.
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Affiliation(s)
- Xiao-Bin Lin
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Guang Hu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan-Zhe Xia
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Man Liu
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tao Liang
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chang-Jie Cai
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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23
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Li Y, Kongsuwan W. Predictors of nurses' caring practice for critically ill patients in critical technological environments: A cross-sectional survey study. Belitung Nurs J 2021; 7:476-484. [PMID: 37497295 PMCID: PMC10367971 DOI: 10.33546/bnj.1794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/20/2021] [Accepted: 10/26/2021] [Indexed: 07/28/2023] Open
Abstract
Background Caring practice for critically ill patients refers to the actions/behaviors/performance of nurses while caring for critically ill adult patients in the intensive care unit (ICU). Although the caring practice is vital in ICUs and complex due to the multitude of available technologies, research on ICU nurses' caring practice and its predictive factors are lacking. Objective This study aimed to explore the level of nurses' caring practice for critically ill patients in critical technological environments in China and its predictors. Methods This was a cross-sectional online survey study with 218 ICU nurses in 29 tertiary hospitals of Guizhou province, China, from 1st to 30th April 2020. Data were collected by using e-questionnaires made in the Questionnaire Star program, including the Demographic Data Questionnaire (DDQ), Practice of Technological Competency as Caring in Nursing Instrument (P-TCCNI), Influence of Technology Questionnaire (ITQ), and Nurses' Professional Value Scale (NPVS). The questionnaires were content validated by three experts. Cronbach's alpha coefficient was 0.96 for the P-TCCNI, 0.70 for the ITQ, and 0.95 for the NPVS. Links to the questionnaires were distributed by research assistants to WeChat groups including target participants. Statistical Package for the Social Science (SPSS) program version 26 (IBM Corporation, Armonk, NY, USA) was used for data analysis. Descriptive and inferential statistics were used to analyze the data. Multiple linear regression analysis using stepwise solution analysis was performed to identify unique predictors of nurses' caring practice. Results The level of nurses' caring practice for critically ill patients was high (mean = 87.30, standard deviation = 13.73). The professional value was a significant predictor of nurses' caring practice (β = 0.41, p = 0.00). Conclusion ICU nurses exhibited a high level of caring practice. Professional value was a significant predictor of ICU nurses' caring practice. Nursing administrators should understand the current situation of caring practice in critical technological environments and design strategies to maintain and improve ICU nurses' professional value to increase the level of caring practice.
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Affiliation(s)
- Yinglan Li
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Waraporn Kongsuwan
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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24
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Lee DH, Kim HS, Park S, Kim HI, Lee SH, Kim YK. Population Pharmacokinetics of Meropenem in Critically Ill Korean Patients and Effects of Extracorporeal Membrane Oxygenation. Pharmaceutics 2021; 13:1861. [PMID: 34834278 DOI: 10.3390/pharmaceutics13111861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Limited studies have investigated population pharmacokinetic (PK) models and optimal dosage regimens of meropenem for critically ill adult patients using the probability of target attainment, including patients receiving extracorporeal membrane oxygenation (ECMO). A population PK analysis was conducted using non-linear mixed-effect modeling. Monte Carlo simulation was used to determine for how long the free drug concentration was above the minimum inhibitory concentration (MIC) at steady state conditions in patients with various degrees of renal function. Meropenem PK in critically ill patients was described using a two-compartment model, in which glomerular filtration rate was identified as a covariate for clearance. ECMO did not affect meropenem PK. The simulation results showed that the current meropenem dosing regimen would be sufficient for attaining 40%fT>MIC for Pseudomonas aeruginosa at MIC ≤ 4 mg/L. Prolonged infusion over 3 h or a high-dosage regimen of 2 g/8 h was needed for MIC > 2 mg/L or in patients with augmented renal clearance, for a target of 100%fT>MIC or 100%fT>4XMIC. Our study suggests that clinicians should consider prolonged infusion or a high-dosage regimen of meropenem, particularly when treating critically ill patients with augmented renal clearance or those infected with pathogens with decreased in vitro susceptibility, regardless of ECMO support.
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25
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Płaszewska-Żywko L, Sega A, Bukowa A, Wojnar-Gruszka K, Podstawa M, Kózka M. Risk Factors of Eye Complications in Patients Treated in the Intensive Care Unit. Int J Environ Res Public Health 2021; 18:11178. [PMID: 34769697 DOI: 10.3390/ijerph182111178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
In critically ill patients, normal eye protection mechanisms, such as tear production, blinking, and keeping the eye closed, are impaired. In addition, many other factors related to patients' severe condition and treatment contribute to ocular surface disease. Reducing risk factors and proper eye care can have a significant impact on incidences of eye complications and patient quality of life after discharge from the intensive care unit (ICU). The aim of the study was to determine risk factors for ocular complication, especially those related to nursing care. The study was conducted in the ICU of a university hospital. Methods for estimating and analyzing medical records were used. The patient's evaluation sheet covering 12 categories of risk factors for eye complications was worked out. The study group included 76 patients (34 patients with injuries and 42 without injuries). The Shapiro-Wilk test, the Spearman's rank correlation test, the Mann-Whitney U test and the Friedman's ANOVA test were used. The level of significance was set at α = 0.05. The most important risk factors for eye complications in the study group were: lagophthalmos (p < 0.001), sedation (p < 0.01), use of some cardiological drugs and antibiotics (p < 0.01), mechanical ventilation (p < 0.05), use of an open suctioning system (p < 0.01), presence of injuries (p < 0.01) including craniofacial trauma (p < 0.001), high level of care intensity (p < 0.01), failure to follow eye care protocol (p < 0.001), length of hospitalization at the ICU (p < 0.001), and the frequency of ophthalmological consultations (p < 0.001). There was no correlation between the incidence of these complications and the age and gender of the patients. The exposure of critically ill patients to eye complications was high. It is necessary to disseminate protocols and guidelines for eye care in ICU patients to reduce the risk factors.
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26
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Gaibani P, Gatti M, Rinaldi M, Crovara Pesce C, Lazzarotto T, Giannella M, Lombardo D, Amadesi S, Viale P, Pea F, Ambretti S. Suboptimal drug exposure leads to selection of different subpopulations of ceftazidime-avibactam-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in a critically ill patient. Int J Infect Dis 2021; 113:213-7. [PMID: 34656787 DOI: 10.1016/j.ijid.2021.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Ceftazidime-avibactam (CAZ-AVI) is a promising novel agent with activity against carbapenem-resistant Enterobacteriaceae. Here, we describe the dynamic evolution of a Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) infection in a critically ill patient treated with CAZ-AVI-tigecycline combination therapy. METHODS Whole-genome sequencing was performed on longitudinal intrapatient KPC-Kp strains isolated from different sites during CAZ-AVI treatment. The pharmacokinetic/pharmacodynamic (PK/PD) analysis was performed on the basis of therapeutic drug monitoring of ceftazidime. RESULTS The development of resistance due to mutations in the blaKPC gene was observed in KPC-Kp strains isolated from bronchoalveolar lavage and blood during CAZ-AVI treatment. PK/PD analysis demonstrated that during the first days of treatment CAZ- AVI blood exposure was suboptimal (steady-state concentration/minimum inhibitory concentration ratio 2.85). Of note, the low antibiotic pressure may have selected hybrid subpopulations harboring blaKPC-3 and T243M mutation in KPC-Kp isolated from bronchoalveolar lavage and D179Y mutation in those isolated from blood. CONCLUSION These results suggest the high adaptability of KPC to CAZ-AVI due to the rapid evolution of resistance and highlight the importance of identifying the optimal PK/PD target to prevent such an event from occurring again in a critically ill patient with pneumonia due to KPC-Kp.
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27
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Danielis M, Castellano A, Mattiussi E, Palese A. Nursing-Sensitive Outcomes among Patients Cared for in Paediatric Intensive Care Units: A Scoping Review. Int J Environ Res Public Health 2021; 18:9507. [PMID: 34574430 DOI: 10.3390/ijerph18189507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/04/2022]
Abstract
Measuring the effectiveness of nursing interventions in intensive care units has been established as a priority. However, little is reported about the paediatric population. The aims of this study were (a) to map the state of the art of the science in the field of nursing-sensitive outcomes (NSOs) in paediatric intensive care units (PICUs) and (b) to identify all reported NSOs documented to date in PICUs by also describing their metrics. A scoping review was conducted by following the framework proposed by Arksey and O’Malley. Fifty-eight articles were included. Publications were mainly authored in the United States and Canada (n = 28, 48.3%), and the majority (n = 30, 51.7%) had an observational design. A total of 46 NSOs were documented. The most reported were related to the clinical (n = 83), followed by safety (n = 41) and functional (n = 18) domains. Regarding their metrics, the majority of NSOs were measured in their occurrence using quantitative single measures, and a few validated tools were used to a lesser extent. No NSOs were reported in the perceptual domain. Nursing care of critically ill children encompasses three levels: improvement in clinical performance, as measured by clinical outcomes; assurance of patient care safety, as measured by safety outcomes; and promotion of fundamental care needs, as measured by functional outcomes. Perceptual outcomes deserve to be explored.
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28
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Deng T, Liu M, Pan L, Jiang K, Li Y. A comparison of arterial blood glucose and peripheral blood glucose levels in critically ill patients: measurements using the arterial blood gas analyzer and the rapid glucose meter. Ann Palliat Med 2021; 10:3179-3184. [PMID: 33849103 DOI: 10.21037/apm-21-354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study explored the differences, correlation, and consistency between blood glucose levels measured using an arterial blood gas analyzer and a rapid blood glucose meter in critically ill patients. METHODS A total of 73 critically ill patients admitted to the Department of Critical Care Medicine, from October to December 2016 were enrolled in this study. The patient's arterial blood glucose was measured by arterial blood gas analyzer, while peripheral blood glucose was measured by a rapid blood glucose meter (via the non-infusion limb). The correlation between indicators was analyzed using the linear regression model. Bland-Altman was performed to evaluate the agreement of the two methods for measuring blood glucose. P<0.05 was considered statistically significant. RESULTS The blood glucose values measured using the arterial blood gas analyzer was significantly different from the values obtained using the rapid blood glucose meter (P=0.000). Regression analysis showed that R2 was 0.857 and β was 0.324 (P=0.000). Bland-Altman plot analysis showed that arterial blood glucose values obtained using the arterial blood gas analyzer were higher than the peripheral blood glucose values obtained using the rapid blood glucose meter on the non-infused limb, with 2.74% of dots lying outside the 95% limit of agreement and the maximum absolute value (2.30 mmol/L) of blood glucose difference within the limit of agreement. The blood glucose levels measured using the two different methods showed good agreement. CONCLUSIONS The difference in blood glucose values measured using the two different measurement methods was statistically significant, but the maximum absolute value (2.30 mmol/L) of blood glucose difference within the limit of agreement, which is acceptable in the clinical setting. In clinical care, it is not necessary to repeat a measure of the patient's capillary blood glucose (CBG) using the rapid blood glucose meter after the blood glucose levels have been measured with the arterial blood gas analyzer, thereby reducing the associated pain and inconvenience for the patients.
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Affiliation(s)
- Ting Deng
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mengjiao Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Lu Pan
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kai Jiang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Li
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
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29
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Tomasa-Irriguible TM, Sabater-Riera J, Pérez-Carrasco M, Ortiz-Ballujera P, Díaz-Buendía Y, Navas-Pérez A, Betbesé-Roig A, Rodríguez-López M, Ibarz-Vilamayor M, Olmo-Isasmendi A, Oliva-Zelaya I, Rovira-Anglès C, Cano-Hernández S, Vendrell-Torra E, Catalan-Ibars RM, Miralbés-Torner M, González de Molina J, Xirgu-Cortacans J, Marcos-Neira P. Augmented renal clearance. An unnoticed relevant event. Sci Prog 2021; 104:368504211018580. [PMID: 34078190 PMCID: PMC10359677 DOI: 10.1177/00368504211018580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Augmented renal clearance (ARC) is a phenomenon that can lead to a therapeutic failure of those drugs of renal clearance. The purpose of the study was to ascertain the prevalence of ARC in the critically ill patient, to study the glomerular filtration rate (GFR) throughout the follow-up and analyze the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimation formula and measured GFR. Observational, prospective, multicenter study. ARC was defined as a creatinine clearance greater than 130 ml/min/1.73 m2. Eighteen hospitals were recruited. GFR measurements carried out twice weekly during a 2-month follow-up period. A total of 561 patients were included. ARC was found to have a non-negligible prevalence of 30%. More even, up to 10.7% already had ARC at intensive care unit (ICU) admission. No specific pattern of GFR was found during the follow-up. Patients in the ARC group were younger 56.5 (53.5-58.5) versus 66 (63.5-68.5) years than in the non-ARC group, p < 0.001. ICU mortality was lower in the ARC group, 6.9% versus 14.5%, p = 0.003. There was no concordance between the estimation of GFR by the CKD-EPI formula and GFR calculated from the 4-h urine. ARC is found in up to 30% of ICU patients, so renal removal drugs could be under dosed by up to 30%. And ARC is already detected on admission in 10%. It is a dynamic phenomenon without an established pattern that usually occurs in younger patients that can last for several weeks. And the CKD-EPI formula does not work to estimate the real creatinine clearance of these patients.
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Affiliation(s)
| | | | | | | | | | - Ana Navas-Pérez
- Intensive Care Department, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | | | | | | - Aitor Olmo-Isasmendi
- Intensive Care Department, General de Catalunya Hospital, Sant Cugat del Vallès, Spain
| | | | | | - Silvia Cano-Hernández
- Intensive Care Department, Fundació Althaia Xarxa Assistencial Universitària, Manresa, Spain
| | | | | | | | | | | | - Pilar Marcos-Neira
- Intensive Care Department, Germans Trias i Pujol Hospital, Barcelona, Spain
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Yan C, Zhang X, Gao C, Wilfong E, Casey J, France D, Gong Y, Patel M, Malin B, Chen Y. Collaboration Structures in COVID-19 Critical Care: Retrospective Network Analysis Study. JMIR Hum Factors 2021; 8:e25724. [PMID: 33621187 PMCID: PMC7942392 DOI: 10.2196/25724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/12/2021] [Accepted: 02/22/2021] [Indexed: 01/26/2023] Open
Abstract
Background Few intensive care unit (ICU) staffing studies have examined the collaboration structures of health care workers (HCWs). Knowledge about how HCWs are connected to the care of critically ill patients with COVID-19 is important for characterizing the relationships among team structures, care quality, and patient safety. Objective We aimed to discover differences in the teamwork structures of COVID-19 critical care by comparing HCW collaborations in the management of critically ill patients with and without COVID-19. Methods In this retrospective study, we used network analysis methods to analyze the electronic health records (EHRs) of 76 critically ill patients (with COVID-19: n=38; without COVID-19: n=38) who were admitted to a large academic medical center, and to learn about HCW collaboration. We used the EHRs of adult patients who were admitted to the COVID-19 ICU at the Vanderbilt University Medical Center (Nashville, Tennessee, United States) between March 17, 2020, and May 31, 2020. We matched each patient according to age, gender, and their length of stay. Patients without COVID-19 were admitted to the medical ICU between December 1, 2019, and February 29, 2020. We used two sociometrics—eigencentrality and betweenness—to quantify HCWs’ statuses in networks. Eigencentrality characterizes the degree to which an HCW is a core person in collaboration structures. Betweenness centrality refers to whether an HCW lies on the path of other HCWs who are not directly connected. This sociometric was used to characterize HCWs’ broad skill sets. We measured patient staffing intensity in terms of the number of HCWs who interacted with patients’ EHRs. We assessed the statistical differences in the core and betweenness statuses of HCWs and the patient staffing intensities of COVID-19 and non–COVID-19 critical care, by using Mann-Whitney U tests and reporting 95% CIs. Results HCWs in COVID-19 critical care were more likely to frequently work with each other (eigencentrality: median 0.096) than those in non–COVID-19 critical care (eigencentrality: median 0.057; P<.001). Internal medicine physicians in COVID-19 critical care had higher core statuses than those in non–COVID-19 critical care (P=.001). Nurse practitioners in COVID-19 care had higher betweenness statuses than those in non–COVID-19 care (P<.001). Compared to HCWs in non–COVID-19 settings, the EHRs of critically ill patients with COVID-19 were used by a larger number of internal medicine nurse practitioners (P<.001), cardiovascular nurses (P<.001), and surgical ICU nurses (P=.002) and a smaller number of resident physicians (P<.001). Conclusions Network analysis methodologies and data on EHR use provide a novel method for learning about differences in collaboration structures between COVID-19 and non–COVID-19 critical care. Health care organizations can use this information to learn about the novel changes that the COVID-19 pandemic has imposed on collaboration structures in urgent care.
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Affiliation(s)
- Chao Yan
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Xinmeng Zhang
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Cheng Gao
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Erin Wilfong
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jonathan Casey
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Yang Gong
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mayur Patel
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.,Geriatric Research and Education Clinical Center, Veteran Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bradley Malin
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - You Chen
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Zhong M, Xu W, Qiu Y, Li L, Qu H, Chen E. Association of Changes in Acute Gastrointestinal Injury Grade with Prognosis in Critically Ill Patients: A Prospective, Single-Center, Observational Study. J Multidiscip Healthc 2021; 14:279-286. [PMID: 33574672 PMCID: PMC7872930 DOI: 10.2147/jmdh.s291883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the association between the change of acute gastrointestinal injury (AGI) grade and the outcome in critically ill patients. Methods This was a prospectively observational study. All patients admitted in the ICU from October 2013 to June 2015, with the duration of ICU > 72 h and age >18 years, were enrolled in this study. The AGI grade and gastrointestinal symptoms were evaluated during ICU stay following the 2012 ESICM recommendation. The ICU mortality, duration of ICU stay, mechanical ventilation (MV) use, vasoactive drug use, and continuous renal replacement therapy of patients were recorded accordingly. Results A total of 320 patients were included, and 265 of them were diagnosed with AGI. The overall ICU mortality was 11.88%, while it was 13.58% in patients with AGI. In logistic regression analyses, the decreasing trend of AGI grade was identified as a protective factor for ICU death (odds ratio (OR), 0.484; 95% confidence interval (CI), 0.26–0.90), while the max AGI grade was a risk factor (OR, 3.464; 95% CI, 2.71–8.47) for ICU death. Conclusion The changes of AGI grades in critically ill patients were associated with their clinical outcomes. The ICU-acquired AGI patients associated with longer ICU stay days.
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Affiliation(s)
- Ming Zhong
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Wen Xu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yuzhen Qiu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lei Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
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Jandee S, Wetwittayakhlang P, Boonsri P. Efficacy of prucalopride in critically ill patients with paralytic ileus: A pilot randomized double-blind placebo-controlled trial. J Gastroenterol Hepatol 2021; 36:362-366. [PMID: 32483847 DOI: 10.1111/jgh.15127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIM Paralytic ileus is a common intestinal dysfunction in critically ill patients, which results in complications and poor hospital outcomes. There are still no established effective medications, except correcting the primary causes and prokinetics trial, which have limited efficacy and potential adverse events. This study aims to evaluate the efficacy of prucalopride on paralytic ileus in critically ill patients. METHODS A randomized, double-blind, placebo-controlled trial of five consecutive days treatment periods was conducted. Critically ill patients with paralytic ileus were included. The primary endpoint was the improvement of bowel dilatation on plain abdominal radiography. The secondary endpoint was the change of abdominal circumference. RESULTS Twenty patients were consecutively enrolled in the study. There was no significant difference in baseline characteristics of patients. The common causes of hospitalization were infection and respiratory problems. The maximum large bowel diameters dramatically decreased in prucalopride group and reached maximum point on the third day after intervention when compared with placebo (-2.1 [± 1.8] vs 0.3 [± 1.5] cm, P = 0.01). The maximum small bowel diameters were noticeably less decreased and were not significantly different when compared with placebo. The abdominal circumferences notably decreased and significantly diverged from placebo on the third day. CONCLUSIONS Prucalopride was an effective enterokinetic agent to improve non-severe inflammatory/ischemic bowel conditions related paralytic ileus in critically ill patients. Its effect was predominant on large intestine but could not be well demonstrated on small bowel in this study. Future study or concomitant other prokinetics for upper gut motility should be further evaluated.
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Affiliation(s)
- Sawangpong Jandee
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Panu Wetwittayakhlang
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pattira Boonsri
- Diagnostic Radiology Unit, Division of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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McIntyre M, Chimunda T, Koppa M, Dalton N, Reinders H, Doeltgen S. Risk Factors for Postextubation Dysphagia: A Systematic Review and Meta-analysis. Laryngoscope 2020; 132:364-374. [PMID: 33320371 DOI: 10.1002/lary.29311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify, describe, and where possible meaningfully synthesize the reported risk factors for postextubation dysphagia (PED) in critically ill patients. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic search of peer-reviewed and grey literature was conducted in common scientific databases to identify previously evaluated risk factors of PED. Data extraction and risk of bias assessment used a double-blind approach. Random effects models were used for the meta-analyses. Meta-analyses were conducted where sufficient study numbers allowed after accounting for statistical and clinical heterogeneity. RESULTS Twenty-five studies were included, which investigated a total of 150 potential risk factors. Of these, 63 risk factors were previously identified by at least one study each as significantly increasing the risk of PED. After accounting for clinical and statistical heterogeneity, only two risk factors were suitable for meta-analysis, gender, and duration of intubation. In separate meta-analyses, neither gender (RR 1.00 [0.71, 1.43], I2 = 0%) nor duration of intubation (RR 1.54 [-0.40, 3.49], I2 = 0%) were significant predictors of PED. CONCLUSIONS A large number of risk factors for PED have been reported in the literature. However, significant variability in swallowing assessment methods, patient populations, timing of assessment, and duration of intubation prevented meaningful meta-analyses for the majority of these risk factors. Where meta-analysis was possible, gender and duration of intubation were not identified as risk factors for PED. We discuss future directions in clinical and research contexts. Laryngoscope, 2020.
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Affiliation(s)
- Melanie McIntyre
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Department of Speech Pathology, Bendigo Health, Bendigo, Victoria, Australia
| | - Timothy Chimunda
- Division of Critical Care, Bendigo Health, Bendigo, Victoria, Australia.,Department of Intensive Care Medicine, Goulburn Valley Health, Shepparton, Victoria, Australia.,Department of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Mayank Koppa
- School of Rural Health, Monash University, Melbourne, Victoria, Australia
| | - Nathan Dalton
- School of Rural Health, Monash University, Melbourne, Victoria, Australia
| | - Hannah Reinders
- Department of Speech Pathology, Bendigo Health, Bendigo, Victoria, Australia
| | - Sebastian Doeltgen
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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Ozsurekci Y, Aykac K, Er AG, Halacli B, Arasli M, Oygar PD, Gürlevik S, Cura Yayla BC, Karakaya J, Alp A, Topeli A, Cengiz AB, Akova M, Ceyhan M. Predictive value of cytokine/chemokine responses for the disease severity and management in children and adult cases with COVID-19. J Med Virol 2020; 93:2828-2837. [PMID: 33225509 PMCID: PMC7753701 DOI: 10.1002/jmv.26683] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023]
Abstract
The disease course of children with coronavirus disease 2019 (COVID‐19) seems milder as compared with adults, however, actual reason of the pathogenesis still remains unclear. There is a growing interest on possible relationship between pathogenicity or disease severity and biomarkers including cytokines or chemokines. We wondered whether these biomarkers could be used for the prediction of the prognosis of COVID‐19 and improving our understanding on the variations between pediatric and adult cases with COVID‐19. The acute phase serum levels of 25 cytokines and chemokines in the serum samples from 60 COVID‐19 pediatric (n = 30) and adult cases (n = 30) including 20 severe or critically ill, 25 moderate and 15 mild patients and 30 healthy pediatric (n = 15) and adult (n = 15) volunteers were measured using commercially available fluorescent bead immunoassay and analyzed in combination with clinical data. Interferon gamma‐induced protein 10 (IP‐10) and macrophage inflammatory protein (MIP)−3β levels were significantly higher in patient cohort including pediatric and adult cases with COVID‐19 when compared with all healthy volunteers (p ≤ .001 in each) and whereas IP‐10 levels were significantly higher in both pediatric and adult cases with severe disease course, MIP‐3β were significantly lower in healthy controls. Additionally, IP‐10 is an independent predictor for disease severity, particularly in children and interleukin‐6 seems a relatively good predictor for disease severity in adults. IP‐10 and MIP‐3β seem good research candidates to understand severity of COVID‐19 in both pediatric and adult population and to investigate possible pathophysiological mechanism of COVID‐19.
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Affiliation(s)
- Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kubra Aykac
- Department of Pediatric Infectious Diseases, University of Health Science Ankara Training and Research Hospital, Ankara, Turkey
| | - Ahmet Gorkem Er
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcin Halacli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Arasli
- Department of Immunology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Pembe Derin Oygar
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sibel Gürlevik
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Ceylan Cura Yayla
- Department of Pediatric Infectious Diseases, University of Health Science Ankara Training and Research Hospital, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alparslan Alp
- Department of Microbiology and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Bülent Cengiz
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ceyhan
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Agudelo-Ochoa GM, Valdés-Duque BE, Giraldo-Giraldo NA, Jaillier-Ramírez AM, Giraldo-Villa A, Acevedo-Castaño I, Yepes-Molina MA, Barbosa-Barbosa J, Benítez-Paéz A. Gut microbiota profiles in critically ill patients, potential biomarkers and risk variables for sepsis. Gut Microbes 2020; 12:1707610. [PMID: 31924126 PMCID: PMC7524144 DOI: 10.1080/19490976.2019.1707610] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Critically ill patients are physiologically unstable and recent studies indicate that the intestinal microbiota could be involved in the health decline of such patients during ICU stays. This study aims to assess the intestinal microbiota in critically ill patients with and without sepsis and to determine its impact on outcome variables, such as medical complications, ICU stay time, and mortality. A multi-center study was conducted with a total of 250 peri-rectal swabs obtained from 155 patients upon admission and during ICU stays. Intestinal microbiota was assessed by sequencing the V3-V4 hypervariable regions of the 16S rRNA gene. Linear mixed models were used to integrate microbiota data with more than 40 clinical and demographic variables to detect covariates and minimize the effect of confounding factors. We found that the microbiota of ICU patients with sepsis has an increased abundance of microbes tightly associated with inflammation, such as Parabacteroides, Fusobacterium and Bilophila species. Female sex and aging would represent an increased risk for sepsis possibly because of some of their microbiota features. We also evidenced a remarkable loss of microbial diversity, during the ICU stay. Concomitantly, we detected that the abundance of pathogenic species, such as Enterococcus spp., was differentially increased in sepsis patients who died, indicating these species as potential biomarkers for monitoring during ICU stay. We concluded that particular intestinal microbiota signatures could predict sepsis development in ICU patients. We propose potential biomarkers for evaluation in the clinical management of ICU patients.
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Affiliation(s)
- Gloria M. Agudelo-Ochoa
- Food and Human Nutrition Research Group, Universidad de Antioquia (UdeA), Medellín, Colombia,Gloria M. Agudelo-Ochoa Carrera, 75 No. 65-87, Medellín, Colombia
| | - Beatriz E. Valdés-Duque
- Biosciences Research Group, Institución Universitaria Colegio Mayor de Antioquia, Medellín, Colombia
| | | | | | | | | | | | | | - Alfonso Benítez-Paéz
- Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology. Spanish National Research Council (IATA-CSIC), Paterna-Valencia, Spain,CONTACT Alfonso Benítez-Paéz C/Catedràtic Agustín Escardino Benlloch, 7. 46980 Paterna, Valencia, Spain
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Abstract
Background: Clinical trialists and clinicians have used a number of sleep quality measures to determine the outcomes of interventions to improve sleep and ameliorate the neurobehavioral consequences of sleep deprivation in critically ill patients, but findings have not always been consistent. To elucidate the source of these consistencies, an important consideration is responsiveness of existing sleep measures. The purpose of an evaluative measure is to describe a construct of interest in a specific population, and to measure the extent of change in the construct over time. This systematic literature review identified measures of sleep quality in critically ill adults hospitalized in the Intensive Care Unit (ICU), and assessed their measurement properties, strengths and weaknesses, clinical usefulness, and responsiveness. We also recommended modifications, including new technology, that may improve clinical usefulness and responsiveness of the measures in research and practice. Methods: CINAHAL, PubMed/Medline, and Cochrane Library were searched from January 1, 2000 to February 1, 2020 to identify studies that evaluated sleep quality in critically ill patients. Results: Sixty-two studies using polysomnography (PSG) and other electroencephalogram-based methods, actigraphy, clinician observation, or patient perception using questionnaires were identified and evaluated. Key recommendations are: standard criteria are needed for scoring PSG in ICU patients who often have atypical brain waves; studies are too few, samples sizes too small, and study duration too short for recommendations on electroencephalogram-based measures and actigraphy; use the Sleep Observation Tool for clinician observation of sleep; and use the Richards Campbell Sleep Questionnaire to measure patient perception of sleep. Conclusions: Measuring the impact of interventions to prevent sleep deprivation requires reliable and valid sleep measures, and investigators have made good progress developing, testing, and applying these measures in the ICU. We recommend future large, multi-site intervention studies that measure multiple dimensions of sleep, and provide additional evidence on instrument reliability, validity, feasibility and responsiveness. We also encourage testing new technologies to augment existing measures to improve their feasibility and accuracy.
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Affiliation(s)
- Kathy C Richards
- University of Texas at Austin School of Nursing, Austin, TX, United States
| | - Yan-Yan Wang
- University of Texas at Austin School of Nursing, Austin, TX, United States.,West China Hospital, Sichuan University, Chengdu, China
| | - Jeehye Jun
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Lichuan Ye
- School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
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Sato T, Ohbe H, Fujita M, Kushimoto S. Clinical characteristics and prediction of the asymptomatic phenotype of pneumatosis intestinalis in critically ill patients: a retrospective observational study. Acute Med Surg 2020; 7:e556. [PMID: 32995016 PMCID: PMC7507103 DOI: 10.1002/ams2.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/11/2020] [Accepted: 07/20/2020] [Indexed: 11/07/2022] Open
Abstract
Aim The differences in clinical characteristics between benign asymptomatic and symptomatic pneumatosis intestinalis (PI) remain unknown. This study aimed to reveal the clinical characteristics of PI in critically ill patients. Methods This was a retrospective observational study undertaken between 2013 and 2017 in a single facility. Patients with PI were enrolled. Pneumatosis intestinalis was diagnosed using computed tomography, and clinical data were collected. Pathologic PI refers to PI with bowel ischemia. Asymptomatic PI refers to PI with a benign etiology. Results There were 17 patients with pathologic PI and 31 with asymptomatic PI. Pathologic PI was detected at day 4 of hospital stay, and asymptomatic PI was detected at day 30 of hospital stay (P < 0.01). The symptoms that were different between pathologic and asymptomatic PI were acute diarrhea (18% and 65%, P = 0.01), C‐reactive protein level elevation (9.9 and 2.1 mg/dL, P = 0.01), and systemic inflammatory reaction syndrome (100% and 13%, P < 0.01). Computed tomography findings showed a difference in the occurrence of ascites collection (94% versus 23%, P < 0.01) and PI of the ascending colon (47% versus 80%, P = 0.02). Hospital mortality of pathologic PI was 88%, whereas all patients with benign PI survived. The positive likelihood ratio of acute diarrhea with PI of the ascending colon to diagnose benign PI was 7.33 (1.11–48.5). Conclusions Pneumatosis intestinalis of the ascending colon that occurs in the post‐intensive care phase with a poor inflammatory reaction, acute diarrhea, and no ascites collection could be benign. In other cases, bowel ischemia should be promptly ruled out.
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Affiliation(s)
- Takeaki Sato
- Department of Emergency and Critical Care Medicine Tohoku University Hospital Sendai Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics The University of Tokyo Sendai Japan
| | - Motoo Fujita
- Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan
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Heck T, Ludwig M, Frizzo M, Rasia-Filho A, Homem de Bittencourt PI. Suppressed anti-inflammatory heat shock response in high-risk COVID-19 patients: lessons from basic research (inclusive bats), light on conceivable therapies. Clin Sci (Lond) 2020; 134:1991-2017. [PMID: 32749472 PMCID: PMC7403894 DOI: 10.1042/cs20200596] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/05/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
The major risk factors to fatal outcome in COVID-19 patients, i.e., elderliness and pre-existing metabolic and cardiovascular diseases (CVD), share in common the characteristic of being chronic degenerative diseases of inflammatory nature associated with defective heat shock response (HSR). The molecular components of the HSR, the principal metabolic pathway leading to the physiological resolution of inflammation, is an anti-inflammatory biochemical pathway that involves molecular chaperones of the heat shock protein (HSP) family during homeostasis-threatening stressful situations (e.g., thermal, oxidative and metabolic stresses). The entry of SARS coronaviruses in target cells, on the other hand, aggravates the already-jeopardized HSR of this specific group of patients. In addition, cellular counterattack against virus involves interferon (IFN)-mediated inflammatory responses. Therefore, individuals with impaired HSR cannot resolve virus-induced inflammatory burst physiologically, being susceptible to exacerbated forms of inflammation, which leads to a fatal "cytokine storm". Interestingly, some species of bats that are natural reservoirs of zoonotic viruses, including SARS-CoV-2, possess an IFN-based antiviral inflammatory response perpetually activated but do not show any sign of disease or cytokine storm. This is possible because bats present a constitutive HSR that is by far (hundreds of times) more intense and rapid than that of human, being associated with a high core temperature. Similarly in humans, fever is a physiological inducer of HSR while antipyretics, which block the initial phase of inflammation, impair the resolution phase of inflammation through the HSR. These findings offer a rationale for the reevaluation of patient care and fever reduction in SARS, including COVID-19.
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Affiliation(s)
- Thiago Gomes Heck
- Research Group in Physiology, Department of Life Sciences, Regional University of Northwestern Rio Grande do Sul State (UNIJUI), Ijuí, RS, 98700-000 Brazil
- Postgraduate Program in Integral Attention to Health (PPGAIS), Regional University of Northwestern Rio Grande do Sul State (UNIJUI), Ijuí, RS, 98700-000 Brazil
| | - Mirna Stela Ludwig
- Research Group in Physiology, Department of Life Sciences, Regional University of Northwestern Rio Grande do Sul State (UNIJUI), Ijuí, RS, 98700-000 Brazil
- Postgraduate Program in Integral Attention to Health (PPGAIS), Regional University of Northwestern Rio Grande do Sul State (UNIJUI), Ijuí, RS, 98700-000 Brazil
| | - Matias Nunes Frizzo
- Research Group in Physiology, Department of Life Sciences, Regional University of Northwestern Rio Grande do Sul State (UNIJUI), Ijuí, RS, 98700-000 Brazil
- Postgraduate Program in Integral Attention to Health (PPGAIS), Regional University of Northwestern Rio Grande do Sul State (UNIJUI), Ijuí, RS, 98700-000 Brazil
| | - Alberto Antonio Rasia-Filho
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Graduate Program in Biosciences, Porto Alegre, RS, 90050-170 Brazil
| | - Paulo Ivo Homem de Bittencourt
- Laboratory of Cellular Physiology, Department of Physiology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90050-170 Brazil
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Abstract
INTRODUCTION Since the coronavirus disease 2019 (COVID-19) outbreak in Wuhan in late 2019, controversy on the use of corticosteroids for COVID-19 has obtained increasing attention. We present 1 critically ill patient who had a rapid therapeutic response to moderate-dose corticosteroids. PATIENT CONCERNS A 53-year-old critically ill woman from Wuhan suffered with COVID-19. DIAGNOSIS The chest computed tomography scan was suggestive of COVID-19. The diagnosis was confirmed by a real-time reverse transcription polymerase chain reaction test for SARS-CoV-2. The critically ill status was characterized by worsening dyspnea, progressing bilateral lung consolidation, and poor oxygenation (SiO2/FiO2:110 mm Hg). INTERVENTIONS The patient was treated with a moderate dose of intravenous corticosteroids and high-flow nasal cannula oxygen therapy. OUTCOMES After the initiation of corticosteroids, the patient rapidly improved over the following 6 days. Serial chest computed tomography scans showed good absorption of the consolidations. The patient was discharged on Day 17 of hospitalization without obvious adverse effects. CONCLUSIONS Early use of moderate-dose corticosteroids over a short period may enhance recovery from COVID-19 in critically ill patients.
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Affiliation(s)
- Kaige Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu
| | - Fen Tan
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Respiratory Disease Research Institute of Hunan Province, Changsha
| | - Rui Zhou
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Respiratory Disease Research Institute of Hunan Province, Changsha
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu
| | - Zhong Ni
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu
| | - Jiasheng Liu
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fengming Luo
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu
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Li H, Li M, Yan J, Gao L, Zhou L, Wang Y, Li Q, Wang J, Chen T, Wang T, Zheng J, Qiang W, Zhang Y, Shi Q. Voriconazole therapeutic drug monitoring in critically ill patients improves efficacy and safety of antifungal therapy. Basic Clin Pharmacol Toxicol 2020; 127:495-504. [PMID: 32639669 DOI: 10.1111/bcpt.13465] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
Since voriconazole plasma trough concentration (VPC) is related to its efficacy and adverse events, therapeutic drug monitoring (TDM) is recommended to perform. However, there is no report about the data of voriconazole TDM in critically ill patients in China. This retrospective study was performed to determine whether voriconazole TDM was associated with treatment response and/or voriconazole adverse events in critically ill patients, and to identify the potential risk factors associated with VPC. A total of 216 critically ill patients were included. Patients were divided into two groups: those underwent voriconazole TDM (TDM group, n = 125) or did not undergo TDM (non-TDM group, n = 91). The clinical response and adverse events were recorded and compared. Furthermore, in TDM group, multivariate logistic regression analysis was performed to identify the possible risk factors resulting in the variability in initial VPC. The complete response in the TDM group was significantly higher than that in the non-TDM group (P = .012). The incidence of adverse events strongly associated with voriconazole in the non-TDM group was significantly higher than that in the TDM group (19.8% vs 9.6%; P = .033). The factors, including age (OR 0.934, 95% CI: 0.906-0.964), male (OR 5.929, 95% CI: 1.524-23.062), serum albumin level (OR 1.122, 95% CI: 1.020-1.234), diarrhoea (OR 4.953, 95% CI: 1.495-16.411) and non-intravenous administration (OR 4.763, 95% CI: 1.576-14.39), exerted the greatest effects on subtherapeutic VPC (VPC < 1.5 mg/L) in multivariate analysis. Intravenous administration (OR 7.657, 95% CI: 1.957-29.968) was a significant predictor of supratherapeutic VPC (VPC > 4.0 mg/L). TDM can result in a favourable clinical efficacy and a lower incidence of adverse events strongly associated with voriconazole in critically ill patients. Subtherapeutic VPC was closely related to younger age, male, hyperalbuminaemia, diarrhoea and non-intravenous administration, and intravenous administration was a significant predictor of supratherapeutic VPC.
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Affiliation(s)
- Hao Li
- Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mo Li
- Department of Statistical Sciences and Operation Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Jinqi Yan
- Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lan Gao
- Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linjing Zhou
- Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang Wang
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Li
- Department of Neurosurgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin Wang
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tianjun Chen
- Department of Respiratory Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Taotao Wang
- Department of Pharmacy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jie Zheng
- Department of Clinical Research Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Wei Qiang
- Department of Endocrinology, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yongjian Zhang
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qindong Shi
- Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Valdés-Duque BE, Giraldo-Giraldo NA, Jaillier-Ramírez AM, Giraldo-Villa A, Acevedo-Castaño I, Yepes-Molina MA, Barbosa-Barbosa J, Barrera-Causil CJ, Agudelo-Ochoa GM. Stool Short-Chain Fatty Acids in Critically Ill Patients with Sepsis. J Am Coll Nutr 2020; 39:706-712. [PMID: 32163012 DOI: 10.1080/07315724.2020.1727379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: To determine the concentration of stool short-chain fatty acids (SCFAs) in critically ill patients with sepsis and to compare the results between the critically ill patient and the control group.Methods: This descriptive, multicenter, observational study was conducted in five health institutions. Over a 6-month study period, critically ill patients with sepsis who were admitted to the intensive care unit (ICU) and met the inclusion criteria were enrolled, and a control, paired by age and sex, was recruited for each patient. A spontaneous stool sample was collected from each participant and a gas chromatograph coupled to a mass spectrometer (Agilent 7890/MSD 5975 C) was used to measure the concentrations SCFAs.Results: The final sample included 44 patients and 45 controls. There were no differences in the age and sex distributions between the groups (p > 0.05). According to body mass index (BMI), undernutrition was more prevalent among critically ill patients, and BMI in control subjects was most frequently classified as overweight (p = 0.024). Propionic acid, acetic acid, butyric acid, and isobutyric acid concentrations were significantly lower in the critically ill patient group than in the control group (p = 0.000). No association with outcome variables (complications, ICU stay, and discharge condition) was found in the patients, and patients diagnosed with infection on ICU admission showed significant decreases in butyric and isobutyric acid concentrations with respect to other diagnostic criteria (p < 0.05).Conclusions: The results confirm significantly lower concentrations of stool SCFAs in critically ill patients with sepsis than in control subjects. Due to its role in intestinal integrity, barrier function, and anti-inflammatory effect, maintaining the concentration of SCFAs may be important in the ICU care protocols of the critical patient.
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Affiliation(s)
- Beatriz E Valdés-Duque
- Bioscience Research Group, Institución Universitaria Colegio Mayor de Antioquia - IUCMA, Medellín, Antioquia, Colombia
| | - Nubia A Giraldo-Giraldo
- Food and Human Nutrition Research Group, Universidad de Antioquia - UdeA, Medellín, Antioquia, Colombia
| | - Ana M Jaillier-Ramírez
- Departamento de nutrición, Hospital Universitario San Vicente Fundación Rionegro, Rionegro, Antioquia, Colombia
| | - Adriana Giraldo-Villa
- Departamento de nutrición clínica, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
| | - Irene Acevedo-Castaño
- Departamento de nutrición y dietética, Hospital General, Medellín, Antioquia, Colombia
| | - Mónica A Yepes-Molina
- Departamento de nutrición y dietética, Hospital Universitario San Vicente Fundación Medellín, Medellín, Antioquia, Colombia
| | - Janeth Barbosa-Barbosa
- Departamento de nutrición, área de soporte nutricional, Clínica Las Américas, Medellín, Antioquia, Colombia
| | - Carlos J Barrera-Causil
- Research Group in Teaching and Modeling in Applied Exact Sciences, Instituto Tecnológico Metropolitano - ITM, Medellín, Antioquia, Colombia
| | - Gloria M Agudelo-Ochoa
- Food and Human Nutrition Research Group, Universidad de Antioquia - UdeA, Medellín, Antioquia, Colombia
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Moron R, Galvez J, Colmenero M, Anderson P, Cabeza J, Rodriguez-Cabezas ME. The Importance of the Microbiome in Critically Ill Patients: Role of Nutrition. Nutrients 2019; 11:E3002. [PMID: 31817895 PMCID: PMC6950228 DOI: 10.3390/nu11123002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022] Open
Abstract
Critically ill patients have an alteration in the microbiome in which it becomes a disease-promoting pathobiome. It is characterized by lower bacterial diversity, loss of commensal phyla, like Firmicutes and Bacteroidetes, and a domination of pathogens belonging to the Proteobacteria phylum. Although these alterations are multicausal, many of the treatments administered to these patients, like antibiotics, play a significant role. Critically ill patients also have a hyperpermeable gut barrier and dysregulation of the inflammatory response that favor the development of the pathobiome, translocation of pathogens, and facilitate the emergence of sepsis. In order to restore the homeostasis of the microbiome, several nutritional strategies have been evaluated with the aim to improve the management of critically ill patients. Importantly, enteral nutrition has proven to be more efficient in promoting the homeostasis of the gut microbiome compared to parenteral nutrition. Several nutritional therapies, including prebiotics, probiotics, synbiotics, and fecal microbiota transplantation, are currently being used, showing variable results, possibly due to the unevenness of clinical trial conditions and the fact that the beneficial effects of probiotics are specific to particular species or even strains. Thus, it is of great importance to better understand the mechanisms by which nutrition and supplement therapies can heal the microbiome in critically ill patients in order to finally implement them in clinical practice with optimal safety and efficacy.
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Affiliation(s)
- Rocio Moron
- Servicio Farmacia Hospitalaria, Hospital Universitario Clínico San Cecilio, 18016-Granada, Spain; (R.M.); (J.C.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain; (M.C.); (P.A.); (M.E.R.-C.)
| | - Julio Galvez
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain; (M.C.); (P.A.); (M.E.R.-C.)
- Department of Pharmacology, CIBER-ehd, Center of Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
| | - Manuel Colmenero
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain; (M.C.); (P.A.); (M.E.R.-C.)
- Servicio de Medicina Intensiva, Hospital Universitaro Clinico San Cecilio, 18016 Granada, Spain
| | - Per Anderson
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain; (M.C.); (P.A.); (M.E.R.-C.)
- Servicio de Análisis Clínicos e Inmunologia, UGC Laboratorio Clínico, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - José Cabeza
- Servicio Farmacia Hospitalaria, Hospital Universitario Clínico San Cecilio, 18016-Granada, Spain; (R.M.); (J.C.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain; (M.C.); (P.A.); (M.E.R.-C.)
| | - Maria Elena Rodriguez-Cabezas
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain; (M.C.); (P.A.); (M.E.R.-C.)
- Department of Pharmacology, CIBER-ehd, Center of Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
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Li H, Gao L, Zhou L, Wang Y, Li Q, Wang J, Chen T, Zhang Y, Wang T, Shi Q. Optimal teicoplanin loading regimen to rapidly achieve target trough plasma concentration in critically ill patients. Basic Clin Pharmacol Toxicol 2019; 126:277-288. [PMID: 31608579 DOI: 10.1111/bcpt.13338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022]
Abstract
Teicoplanin is used for the treatment of Methicillin-resistant Staphylococcus aureus infection. It has been demonstrated that conventional loading regimen was insufficient for teicoplanin to achieve target trough plasma concentration (Cmin > 10 mg/L). Therefore, a Chinese expert group recommended an optimal loading dose regimen of teicoplanin to treat severe Gram-positive infection. However, there was no report about the teicoplanin concentration, and the safety and efficacy of teicoplanin therapy in Chinese patients since the consensus was published. The objective of this study was to compare the teicoplanin Cmin and clinical response in critically ill Chinese patients after the administration of conventional or optimal loading regimen, and to reveal the potential factors that may affect teicoplanin Cmin in addition to loading regimen. Fifty-five patients were retrospectively divided into two groups based on teicoplanin loading regimen: (a) CD group (conventional loading dose group, n = 18, loading dose was 400 mg); (b) OD group (optimal loading dose group, n = 37, loading dose was 800 mg). Initially, three loading doses were administered every 12 hours, while the fourth loading dose was injected 24 hours after the third dose. The maintenance dose was 400 mg (CD group) or 800 mg (OD group), respectively. The mean teicoplanin Cmin on day 2 and day 4 in the OD group was significantly higher than those in the CD group, which were 14.75 ± 5.93 mg/L vs 8.26 ± 4.87 mg/L (P < .001) and 14.90 ± 5.20 mg/L vs 9.13 ± 4.75 mg/L (P = .019), respectively. The percentages of patients in the OD group achieving the target teicoplanin Cmin on day 2 and day 4 were also significantly higher than those in the CD group, which were 83.7% vs 33.3% (P < .001) and 82.4% vs 28.6% (P = .0013), respectively. Furthermore, multivariate linear regression analysis showed that body-weight exerted significant effect on teicoplanin Cmin in the OD group. The percentage of favourable clinical response in the OD group was significantly higher than that in the CD group (83.8% vs 55.6%, P = .025). There was no difference between teicoplanin adverse effects in the two groups. The study demonstrated that the optimal loading dose regimen of teicoplanin can rapidly reach target Cmin , and result in a good clinical efficacy and low adverse effect in critically ill Chinese patients.
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Affiliation(s)
- Hao Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lan Gao
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linjing Zhou
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin Wang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tianjun Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yongjian Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Taotao Wang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qindong Shi
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Havel C, Selim J, Besnier E, Gouin P, Veber B, Clavier T. Impact of an Intensive Care Information System on the Length of Stay of Surgical Intensive Care Unit Patients: Observational Study. JMIR Perioper Med 2019; 2:e14501. [PMID: 33393935 PMCID: PMC7709852 DOI: 10.2196/14501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/27/2019] [Accepted: 07/22/2019] [Indexed: 11/18/2022] Open
Abstract
Background The implementation of computerized monitoring and prescription systems in intensive care has proven to be reliable in reducing the rate of medical error and increasing patient care time. They also showed a benefit in reducing the length of stay in the intensive care unit (ICU). However, this benefit has been poorly studied, with conflicting results. Objective This study aimed to show the impact of computerization on the length of stay in ICUs. Methods This was a before-after retrospective observational study. All patients admitted in the surgical ICU at the Rouen University Hospital were included, from June 1, 2015, to June 1, 2016, for the before period and from August 1, 2016, to August 1, 2017, for the after period. The data were extracted from the hospitalization report and included the following: epidemiological data (age, sex, weight, height, and body mass index), reason for ICU admission, severity score at admission, length of stay and mortality in ICU, mortality in hospital, use of life support during the stay, and ICU readmission during the same hospital stay. The consumption of antibiotics, biological analyses, and the number of chest x-rays during the stay were also analyzed. Results A total of 1600 patients were included: 839 in the before period and 761 in the after period. Only the severity score Simplified Acute Physiology Score II was significantly higher in the postcomputerization period (38 [SD 20] vs 40 [SD 21]; P<.05). There was no significant difference in terms of length of stay in ICU, mortality, or readmission during the stay. There was a significant increase in the volume of prescribed biological analyses (5416 [5192-5956] biological exams prescribed in the period before Intellispace Critical Care and Anesthesia [ICCA] vs 6374 [6013-6986] biological exams prescribed in the period after ICCA; P=.002), with an increase in the total cost of biological analyses, to the detriment of hematological and biochemical blood tests. There was also a trend toward reduction in the average number of chest x-rays, but this was not significant (0.55 [SD 0.39] chest x-rays per day per patient before computerization vs 0.51 [SD 0.37] chest x-rays per day per patient after computerization; P=.05). On the other hand, there was a decrease in antibiotic prescribing in terms of cost per patient after the implementation of computerization (€149.50 [$164 USD] per patient before computerization vs €105.40 [$155 USD] per patient after computerization). Conclusions Implementation of an intensive care information system at the Rouen University Hospital in June 2016 did not have an impact on reducing the length of stay.
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Affiliation(s)
- Camille Havel
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Jean Selim
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
| | - Emmanuel Besnier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
| | - Philippe Gouin
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Thomas Clavier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
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Hu B, Sun R, Wu A, Ni Y, Liu J, Guo F, Ying L, Ge G, Ding A, Shi Y, Liu C, Xu L, Jiang R, Lu J, Lin R, Zhu Y, Wu W, Xie B. Prognostic Value of Prolonged Feeding Intolerance in Predicting All-Cause Mortality in Critically Ill Patients: A Multicenter, Prospective, Observational Study. JPEN J Parenter Enteral Nutr 2019; 44:855-865. [PMID: 31429970 DOI: 10.1002/jpen.1693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/27/2019] [Accepted: 07/17/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The 2012 European Society of Intensive Care Medicine (ESICM) guidelines provided a clear definition of feeding intolerance (FI). The study aimed to investigate the association between FI based on the current ESICM definition and clinical outcome and to further explore the effect of the duration of FI on mortality. METHODS Adult patients from 14 general intensive care units (ICUs) with an expected ICU stay ≥24 hours were prospectively studied. Based on FI duration in the first week of admission to the ICU, FI was categorized as 7-day persistent feeding tolerance (FT), delayed FT, delayed FI, and 7-day persistent FI. The primary outcomes were 28-day and 60-day all-cause mortality. RESULTS Of 499 patients, the prevalence of 3-day and 7-day persistent FI was 39.2% (n = 196) and 25.4% (n = 106), respectively. The patients with 3-day FT had lower risk of 28-day and 60-day mortality rates and higher prevalence in ventilator weaning and vasoactive medication on the seventh day of ICU admission than those with 3-day FI. Three-day FI remained an independent predictor for 60-day mortality. In a subgroup analysis including 418 patients with 7-day survival, compared with those with 7-day persistent FT, the odds ratios of 60-day mortality were 1.67, 1.97, and 2.62 in the patients with delayed FT, delayed FI, and 7-day persistent FI, respectively. CONCLUSION FI was associated with increased mortality and longer duration of mechanical ventilation and vasoactive support. Prolonged or relapsing FI represented an incremental risk of adverse outcomes in critically ill patients.
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Affiliation(s)
- Bangchuan Hu
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Renhua Sun
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Aiping Wu
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Yin Ni
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Jingquan Liu
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Feng Guo
- ICU, Sir Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China
| | - Lijun Ying
- ICU, Shaoxing People's Hospital, Shaoxing, P. R. China
| | - Guoping Ge
- ICU, Jinhua People's Hospital, Jinhua, P. R. China
| | - Aijun Ding
- ICU, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P. R. China
| | - Yunchao Shi
- ICU, The First Hospital of Jiaxing, Jiaxing, P. R. China
| | - Changwen Liu
- ICU, Hangzhou First People's Hospital, Hangzhou, P. R. China
| | - Lei Xu
- ICU, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, P. R. China
| | - Ronglin Jiang
- ICU, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P. R. China
| | - Jun Lu
- ICU, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P. R. China
| | - Ronghai Lin
- ICU, Taizhou Hospital of Zhejiang Province, Linhai, P. R. China
| | - Yannan Zhu
- ICU, Zhuji People's Hospital of Zhejiang Province, Shaoxing, P. R. China
| | - Weidong Wu
- ICU, The Central Hospital of Lishui City, Lishui, P. R. China
| | - Bo Xie
- ICU, Huzhou Central Hospital, Huzhou, P. R. China
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Mehralian HA, Moghaddasi J, Rafiei H. The prevalence of potentially beneficial and harmful drug-drug interactions in intensive care units. Drug Metab Pers Ther 2019; 34:dmpt-2018-0034. [PMID: 30903758 DOI: 10.1515/dmpt-2018-0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/29/2019] [Indexed: 12/11/2022]
Abstract
Background The present study was conducted with the aim of investigating the prevalence of potentially beneficial and harmful drug-drug interactions (DDIs) in intensive care units (ICUs). Methods The present cross-sectional prospective study was conducted in two ICUs in Shahr-e Kord city, Iran. The study sample was consisted of 300 patients. The Drug Interaction Facts reference text book [Tatro DS. Drug interaction facts. St Louis, MO: Walters Kluwer Health, 2010.] was used to determine the type and the frequency of the DDIs. Results The participants consisted of 189 patients men and 111 women. The mean age of patients was 44.2 ± 24.6 years. Totally, 60.5% of patients had at least one drug-drug interaction in their profile. The total number of DDIs found was 663 (the mean of the total number of drug-drug interactions was 2.4 interactions per patient). Of all the 663 interactions, 574 were harmful and others were beneficial. In terms of starting time, 98 of the potential interactions were rapid and 565 of them were delayed. In terms of severity, 511 of the potential interactions were moderate. Some of the drugs in the patients' medical records including phenytoin, dopamine, ranitidine, corticosteroid, dopamine, heparin, midazolam, aspirin, magnesium, calcium gluconate, and antibiotics, the type of ventilation, the type of nutrition and the duration of hospital stay were among the factors that were associated with high risk of potential DDIs (p < 0.05). Conclusions The prevalence of potentially beneficial and harmful DDIs, especially harmful drug-drug interactions, is high in ICUs and it is necessary to reduce these interactions by implementing appropriate programs and interventions.
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Affiliation(s)
- Hossein Ali Mehralian
- Community Oriented Nursing and Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Jafar Moghaddasi
- Community Oriented Nursing and Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hossein Rafiei
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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Paydar S, Moein-Vaziri N, Dehghankhalili M, Abdolrahimzaeh H, Bolandparvaz S, Abbasi HR. Jejunostomy with Enteroenterostomy for Enteral Nutrition in Critically Ill Trauma Patients. A Novel Technique. Cureus 2018; 10:e3431. [PMID: 30546978 PMCID: PMC6289558 DOI: 10.7759/cureus.3431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The aim of the current study was to report the surgical outcome and complications of jejunostomy with enteroenterostomy for enteral nutrition (EN) in critically ill trauma patients with prolonged nasogastric (NG) nutrition. Methods This cross-sectional study was carried out in a level I trauma center in Shiraz, southern Iran during a one-year period from 2016 to 2017. We included a total number of 30 patients with severe trauma admitted to the intensive care unit (ICU) with more than three months NG nutrition and bowel atrophy. We performed a novel jejunostomy with an enteroenterostomy procedure for providing a route for enteral nutrition in all 30 patients. The rate of complications, such as dislodgement, clogging, obstruction, leakage, mucosal bleeding, and infection, were recorded and reported. We also recorded the hospital and ICU length of stay (LOS). Results We included a total number of 30 patients with a mean age of 35.64 ± 8.91 years, and there were 23 (76.6%) men and seven (23.4%) women among the patients. Overall, 14 (46.6%) patients experienced complications related to the jejunostomy with enteroenterostomy. The most common complication was nausea and vomiting (33.3%) and distention (33.3%), followed by surgical site infection (30.0%). The mean ICU LOS and hospital LOS was found to be 16.8 ± 3.7 and 24.3 ± 4.1 days, respectively. The overall mortality rate was 17 (56.6%), which was secondary to the primary injury and was not related to the procedure. Conclusion Jejunostomy with enteroenterostomy is a safe and feasible method for providing a route for EN in critically ill trauma patients with prolonged NG nutrition and bowel atrophy.
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Affiliation(s)
- Shahram Paydar
- General Surgery, Shiraz University of Medical Sciences, Shiraz, IRN
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48
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Panahi Y, Dehcheshmeh HS, Mojtahedzadeh M, Joneidi-Jafari N, Johnston TP, Sahebkar A. Analgesic and sedative agents used in the intensive care unit: A review. J Cell Biochem 2018; 119:8684-8693. [PMID: 30076655 DOI: 10.1002/jcb.27141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/18/2018] [Indexed: 11/10/2022]
Abstract
Pain is a common experience for most patients in the intensive care unit (ICU). In the current study, the advantages and disadvantages of analgesic and sedative drugs used in the ICU are reviewed. An ideal sedative and analgesic agent should have features such as rapid onset of action, rapid recovery after discontinuation, predictability, minimal accumulation of the agent and metabolites in the body, and lack of toxicity. None of the sedative and analgesic agents have all of these desired characteristics; nevertheless, clinicians must be familiar with these classes of drugs to optimize pharmacotherapy and ensure as few side-effects as possible for ICU patients.
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Affiliation(s)
- Yunes Panahi
- Pharmacotherapy Department, School of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Mojtaba Mojtahedzadeh
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Thomas P Johnston
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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49
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Kaska M, Havel E, Selke-Krulichova I, Safranek P, Bezouska J, Martinkova J. Covariate determinants of effective dosing regimens for time-dependent beta-lactam antibiotics for critically ill patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:219-226. [PMID: 29582860 DOI: 10.5507/bp.2018.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/21/2018] [Indexed: 11/23/2022] Open
Abstract
AIMS Critically ill patients undergoing aggressive fluid resuscitation and treated empirically with hydrosoluble time-dependent beta-lactam antibiotics are at risk for sub-therapeutic plasma concentrations. The aim of this study was to assess the impact of two covariates - creatinine clearance (Clcr) and cumulative fluid balance (CFB) on pharmacokinetics/pharmacodynamics (PK/PD) target attainment within a week of treatment with meropenem (ME) or piperacillin/tazobactam (PIP/TZB). METHODS In this prospective observational pharmacokinetic (PK) study, 18 critically ill patients admitted to a surgical Intensive Care Unit (ICU) were enrolled. The primary PK/PD target was free antibiotic concentrations above MIC at 100% of the dosing interval (100%fT>MIC) to obtain maximum bactericidal activity. Drug concentration was measured using liquid chromatography-tandem mass spectrometry. RESULTS The treatment of both 8 septic patients with IV extended ME dosing 2 g/3 h q8 h and 10 polytraumatized patients with IV intermittent PIP/TZB dosing 4.0/0.5 g q8 h was monitored. 8/18 patients (44%) manifested augmented renal clearence (ARC) where Clcr ≥130 mL/min/1.73 m2. Maximum changes were reported on days 2-3: the median positive CFB followed by the large median volume of distribution: Vdme=70.3 L (41.9-101.5), Vdpip = 46.8 L (39.7-60.0). 100%fTme>MIC was achieved in all patients on ME (aged ≥60 years), and only in two patients (non-ARC, aged ≥65 years) out of 10 on PIP/TZB. A mixed model analysis revealed positive relationship of CFBpip with Vdpip (P=0.021). CONCLUSION Assuming that the positive correlation between CFB and Vd exists for piperacillin in the setting of the pathological state, then CFB should predict Vdpip across subjects at each and every time point.
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Affiliation(s)
- Milan Kaska
- Department of Surgery, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic.,Academic Department of Surgery, Faculty of Medicine in Hradec Kralove, Charles University and Department of Surgery, University Hospital, Sokolska 581, 50005 Hradec Kralove, Czech Republic
| | - Eduard Havel
- Department of Surgery, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic.,Academic Department of Surgery, Faculty of Medicine in Hradec Kralove, Charles University and Department of Surgery, University Hospital, Sokolska 581, 50005 Hradec Kralove, Czech Republic
| | - Iva Selke-Krulichova
- Academic Department of Surgery, Faculty of Medicine in Hradec Kralove, Charles University and Department of Surgery, University Hospital, Sokolska 581, 50005 Hradec Kralove, Czech Republic
| | - Petr Safranek
- Department of Surgery, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
| | - Jan Bezouska
- Academic Department of Surgery, Faculty of Medicine in Hradec Kralove, Charles University and Department of Surgery, University Hospital, Sokolska 581, 50005 Hradec Kralove, Czech Republic
| | - Jirina Martinkova
- Department of Surgery, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
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50
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Bano S, Qadeer A, Akhtar A, Ata Ur-Rehman HM, Munawar K, Hussain SW, Khan MT, Zafar R. Measurement of Internal Jugular Vein and Common Carotid Artery Diameter Ratio by Ultrasound to Estimate Central Venous Pressure. Cureus 2018; 10:e2277. [PMID: 30949421 PMCID: PMC6440552 DOI: 10.7759/cureus.2277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective The objective of this study is to find a correlation between internal jugular vein (IJV) and common carotid artery (CCA) diameter ratio and central venous pressure (CVP) measurement and find a cut-off value for the IJV/CCA ratio to predict low CVP i.e. < 10 cm H20, for estimating the volume status in critically ill patients. Methods This prospective cross-sectional study was conducted at the critical care department of Shifa International Hospital, Islamabad, from July to December 2017. A sample of 49 patients ≥ 18 years with intrathoracic central venous catheters (CVCs) who underwent bedside sonographic assessments of IJV and CCA diameter were included in this study using convenient sampling. The IJV/CCA diameter ratio was calculated and correlated with CVP and the predictive value of the IJV/CCA diameter ratio to predict CVP < 10 cm H2O was explored by calculating the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and positive and negative predictive values. Results A total of 49 patients, 30 males (61.2%) and 19 females (38.8%) with a mean age of 56.00±16.11 years were included in the study. The mean CVP was 8.98±2.37cm H2O in ventilated (51%) and 10.7± 6.01 cm H2O in non-ventilated (49%) patients. The mean IJV/CCA diameter ratio was 1.60±0.55 at expiration and 1.41±0.56 at inspiration. There was a significant correlation between the IJV/CCA diameter ratio and CVP at expiration (r=0.401, p=0.004). The correlation between IJV/CCA and CVP was significant in non-ventilated patients at expiration (r=0.439, p=0.032). The area under the ROC curve for the IJV/CCA diameter ratio for predicting CVP < 10 cm H2O was 0.684 (p=0.028). The predictive value of the IJV/CCA diameter ratio for CVP < 10 cm H20 at the cutoff value of < 2 was insignificant. A new cut-off < 1.75 was taken for the IJV/CCA diameter ratio from the coordinates of the ROC curve. The sensitivity, specificity, PPV, and NPV of an IJV/CCA diameter ratio of < 1.75 for predicting a CVP < 10 cm H20 were 84.62%, 52.17%, 66.67%, and 75.00%, respectively. Conclusion The assessment of volume status by the IJV/CCA diameter ratio with a sonographic device may be a useful noninvasive alternative for a central venous catheterization with a cut-off < 1.75.
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Affiliation(s)
- Sheher Bano
- Internal Medicine, Shifa International Hospital, Islamabad, PAK
| | - Aayesha Qadeer
- Critical Care, Shifa International Hospital, Islamabad, PAK
| | - Aftab Akhtar
- Internal Medicine, Shifa International Hospital, Islamabad, PAK
| | | | - Kamran Munawar
- Internal Medicine, Shifa College of Medicine, Islamabad, PAK
| | | | | | - Rizwan Zafar
- Department of Internal Medicine, Shifa International Hospital, Islamabad, PAK
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