scholarly journals Safety and Efficacy of Antiviral Therapy for Prevention of Cytomegalovirus Reactivation in Immunocompetent Critically Ill Patients

2017 ◽  
Vol 177 (6) ◽  
pp. 774 ◽  
Author(s):  
Nicholas J. Cowley ◽  
Andrew Owen ◽  
Sarah C. Shiels ◽  
Joanne Millar ◽  
Rebecca Woolley ◽  
...  
Keyword(s):  
Antiviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Safety And Efficacy ◽  
Cytomegalovirus Reactivation

Evaluation of the Safety and Efficacy of Metformin Use in Hospitalized, Non–Critically Ill Patients

2020 ◽  
Vol 36 (3) ◽  
pp. 102-109
Author(s):  
Tahnia Alauddin ◽  
Sarah E. Petite
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Safety And Efficacy ◽  
Antihyperglycemic Therapy ◽  
Heart Failure Diagnosis

Background: Contraindications and precautions to metformin have limited inpatient use, and limited evidence exists evaluating metformin in hospitalized patients. Objective: This study aimed to determine the safety and efficacy of inpatient metformin use. Methods: This study was an observational, retrospective, cohort study at an academic medical center between June 1, 2016, and May 31, 2018. Hospitalized adults with type 2 diabetes mellitus receiving at least 1 metformin dose were included. The primary endpoint was to identify hospitalized patients using metformin with at least 1 contraindication or precautionary warning against use. Secondary endpoints included assessing metformin efficacy with glycemic control, characterizing adverse outcomes of inpatient metformin, and comparing the efficacy of metformin-containing regimens. Results: Two hundred patients were included. There were 126 incidences of potentially unsafe use identified in 111 patients (55.5%). The most common reasons were age ≥65 years (47%), heart failure diagnosis (7.5%), and metformin within 48 hours of contrast (6%). Metformin was contraindicated in 2 patients (1%) with an estimated glomerular filtration rate ≤30 mL/min/1.73 m2. The overall median daily blood glucose was 146 mg/dL (interquartile range [IQR] = 122-181). Patients were divided into 3 groups: metformin monotherapy, metformin plus oral antihyperglycemic therapy, and metformin plus insulin. The median daily blood glucoses were 129 mg/dL (IQR = 110-152), 154 mg/dL (IQR = 133-178), and 174 mg/dL (IQR = 142-203; P < .001), respectively. Two patients (1%) developed acute kidney injury, and no patients developed lactic acidosis. Conclusions: Metformin was associated with goal glycemic levels in hospitalized patients with no adverse outcomes. These results suggest the potential for metformin use in hospitalized, non–critically ill patients.

scholarly journals Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Philippe Lachance ◽  
Justin Chen ◽  
Robin Featherstone ◽  
Wendy I Sligl
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Resource Utilization ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Health Resource ◽  
Health Resource Utilization ◽  
Cytomegalovirus Reactivation ◽  
Cmv Reactivation

Abstract Background The aim of our systematic review was to investigate the association between cytomegalovirus (CMV) reactivation and outcomes in immunocompetent critically ill patients. Methods We searched electronic databases and gray literature for original studies and abstracts published between 1990 and October 2016. The review was limited to studies including critically ill immunocompetent patients. Cytomegalovirus reactivation was defined as positive polymerase chain reaction, pp65 antigenemia, or viral culture from blood or bronchoalveolar lavage. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT), and nosocomial infections. Health resource utilization outcomes included intensive care unit and hospital lengths of stay. Results Twenty-two studies were included. In our primary analysis, CMV reactivation was associated with increased ICU mortality (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.87–3.47), overall mortality (OR, 2.02; 95% CI, 1.60–2.56), duration of mechanical ventilation (mean difference 6.60 days; 95% CI, 3.09–10.12), nosocomial infections (OR, 3.20; 95% CI, 2.05–4.98), need for RRT (OR, 2.37; 95% CI, 1.31–4.31), and ICU length of stay (mean difference 8.18 days; 95% CI, 6.14–10.22). In addition, numerous sensitivity analyses were performed. Conclusions In this meta-analysis, CMV reactivation was associated with worse clinical outcomes and greater health resource utilization in critically ill patients. However, it remains unclear whether CMV reactivation plays a causal role or if it is a surrogate for more severe illness.

The Safety and Efficacy of Bedside Tracheotomy

1993 ◽  
Vol 109 (4) ◽  
pp. 707-711 ◽  
Author(s):  
Neal D. Futran ◽  
Paul O. Dutcher ◽  
Jay K. Roberts
Keyword(s):  
Intensive Care ◽  
Head And Neck ◽  
Operating Room ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Life Support ◽  
Safety And Efficacy ◽  
Patients Âgés ◽  
Perioperative Bleeding ◽  
The University

Many institutions require that tracheotomies be performed in the operating room. Movement of critically ill patients dependent on multiple life support systems is technically difficult, labor intensive, and potentially dangerous for the patients. Between 1983 and 1992, 1088 tracheotomies were performed on patients ages 1 week to 94 years at the University of Rochester affiliated hospitals on critically ill patients as isolated procedures. The procedure was performed in the Intensive Care Units (ICU) on 996 patients, (92.9%), whereas 92 patients (7.1%) had tracheotomies in the operating room (OR1). An additional 346 tracheotomies took place in the operating room in conjunction with other head and neck procedures (OR2). Incidence of perioperative bleeding (within 48 hours) was 2.3% in the ICU group, 2.1% in the ORI group, and 2.0% in the OR2 group. Incidence of stomal infection was also similar among the three groups at 1.8%, 2.1%, and 1.5%, respectively. Tube dislodgement in all groups was a complication. No statistical differences were noted among the three groups (ICU, OR1, OR2) at the p < 0.01 level. Criteria for performing the tracheotomy in the ICU are delineated and discussed.

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