Does crystalloid infusion rate really matter in critically ill patients?

2021 ◽  
pp. 100982
Author(s):  
Laurent Muller
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Crystalloid Infusion

scholarly journals Use of a Low-Molecular-Weight Heparinoid (Danaparoid Sodium) for Continuous Renal Replacement Therapy in Intensive Care Patients

2001 ◽  
Vol 7 (4) ◽  
pp. 300-304 ◽  
Author(s):  
Edelgard Lindhoff-Last ◽  
Christoph Betz ◽  
Rupen Bauersachs
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Efficient Treatment ◽  
Intensive Care Patients

The purpose of this study was to evaluate the efficacy and safety of danaparoid in the treatment of critically ill patients with acute renal failure and suspected heparin-induced thrombocytopenia (HIT) needing renal replacement therapy (RRT). We conducted a retrospective analysis of 13 consecutive intensive care patients with acute renal failure and suspected HIT who were treated with danaparoid for at least 3 days during RRT. In eight patients, continuous venovenous hemofiltration was performed. The mean infusion rate of danaparoid was 140 ± 86 U/hour. Filter exchange was necessary every 37.5 hours. In five patients, continuous venovenous hemodialysis was used. A bolus injection of 750 U danaparoid was followed by a mean infusion rate of 138 ± 122 U/hour. Filters were exchanged every 24 hours. In 7 of 13 patients, even a low mean infusion rate of 88 ± 35 U/hour was efficient. Mean anti-Xa (aXa) levels were approximately 0.4 ± 0.2 aXa U/mL. Persistent thrombocytopenia despite discontinuation of heparin treatment was observed in 9 of 13 patients, owing to disseminated intravascular coagulation (DIC). HIT was confirmed by an increase in platelet count and positive heparin-induced antibodies in 2 of 13 patients. No thromboembolic complications occurred, but major bleeding was observed in 6 of 13 patients, which could be explained by consumption of coagulation factors and platelets due to DIC in 5 of 6 patients. Nine of 13 patients died of multiorgan failure or sepsis, or both. In none of these patients was the fatal outcome related to danaparoid treatment. In critically ill patients with renal impairment and suspected HIT, a bralus injection of 750 U danaparoid followed by a mean infusion rate of 50 to 150 U/hour appears to be a safe and efficient treatment option when alternative anticoagutation is necessary.

Higher insulin infusion rate but not 24-h insulin consumption is associated with hypoglycemia in critically ill patients

2015 ◽  
Vol 110 (3) ◽  
pp. 322-327
Author(s):  
John J. Radosevich ◽  
Asad E. Patanwala ◽  
Paul D. Frey ◽  
Yong G. Lee ◽  
Holly Paddock ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Insulin Infusion ◽  
Insulin Infusion Rate

Remifentanil versus  Morphine Analgesia and Sedation for Mechanically Ventilated Critically Ill Patients

2004 ◽  
Vol 101 (3) ◽  
pp. 640-646 ◽  
Author(s):  
Ashraf A. Dahaba ◽  
Tanja Grabner ◽  
Peter H. Rehak ◽  
Werner F. List ◽  
Helfried Metzler
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Rapid Onset ◽  
Open Label ◽  
Morphine Group ◽  
Extubation Time ◽  
The Mean ◽  
Intent To Treat ◽  
Remifentanil Group

Background The rapid onset and offset of action of remifentanil could make it quickly adjustable to the required level of sedation in critically ill patients. The authors hypothesized that the efficacy of a remifentanil-based regimen was greater than that of a morphine-based regimen. Methods Forty intent-to-treat patients were randomly allocated to receive a blinded infusion of either remifentanil 0.15 microg x kg(-1) x min(-1) or morphine 0.75 microg x kg(-1) x min(-1). The opioid infusion was titrated, in the first intent, to achieve optimal sedation defined as Sedation Agitation scale of 4. A midazolam open-label infusion was started if additional sedation was required. Results The mean percentage hours of optimal sedation was significantly longer in the remifentanil group (78.3 +/- 6.2) than in the morphine group (66.5 +/- 8.5). This was achieved with less frequent infusion rate adjustments (0.34 +/- 0.25 changes/h) than in the morphine group (0.42 +/- 0.22 changes/h). The mean duration of mechanical ventilation and extubation time were significantly longer in the morphine group (18.1 +/- 3.4 h, 73 +/- 7 min) than in the remifentanil group (14.1 +/- 2.8 h, 17 +/- 6 min), respectively. Remifentanil mean infusion rate was 0.13 +/- 0.03 microg x kg(-1) x min(-1), whereas morphine mean infusion rate was 0.68 +/- 0.28 microg x kg(-1) x min(-1). More subjects in the morphine group (9 of 20) than in the remifentanil group (6 of 20) required midazolam. The incidence of adverse events was low and comparable across the two treatment groups. Conclusions A remifentanil-based regimen was more effective in the provision of optimal analgesia-sedation than a standard morphine-based regimen. The remifentanil-based regimen allowed a more rapid emergence from sedation and facilitated earlier extubation.

Effectiveness and Safety of Magnesium Replacement in Critically Ill Patients Admitted to the Medical Intensive Care Unit in an Academic Medical Center: A Retrospective, Cohort Study

2017 ◽  
Vol 34 (11-12) ◽  
pp. 967-972 ◽  
Author(s):  
Drayton A. Hammond ◽  
Jelena Stojakovic ◽  
Niranjan Kathe ◽  
Julie Tran ◽  
Oktawia A. Clem ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Medical Intensive Care Unit ◽  
Serum Magnesium ◽  
Magnesium Concentration ◽  
Serum Magnesium Concentration ◽  
Medical Intensive Care

Background: “Rules of thumb” for the replacement of electrolytes, including magnesium, in critical care settings are used, despite minimal empirical validation of their ability to achieve a target serum concentration. This study’s purpose was to evaluate the effectiveness and safety surrounding magnesium replacement in medically, critically ill patients with mild-to-moderate hypomagnesemia. Methods: This was a single-center, retrospective, observational evaluation of episodes of intravenous magnesium replacement ordered for patients with mild-to-moderate hypomagnesemia (1.0-1.9 mEq/L) admitted to a medical intensive care unit from May 2014 to April 2016. The primary effectiveness outcome, achievement of target serum magnesium concentration (≥2 mEq/L) compared to expected achievement using a “rule of thumb” estimation that 1 g intravenous magnesium sulfate raises the magnesium concentration 0.15 mEq/L, was tested using 1-sample z test. Logistic regression analysis was conducted to assess the effect of infusion rate on target achievement. Results: Of 152 days on which magnesium replacements were provided for 72 patients, a follow-up serum magnesium concentration was checked within 24 hours in 89 (58.6%) episodes. Of these 89 episodes, serum magnesium concentration reached target in only 49 (59.8%) episodes compared to an expected 89 (100%; P < .0001). There was no significant association between infusion rate and achievement of the target serum magnesium concentration (odds ratio: 0.962, 95% confidence interval: 0.411-2.256). Conclusions: Medically, critically ill patients who received nonprotocolized magnesium replacement achieved the target serum magnesium concentration less frequently than the “rule of thumb” estimation predicted.

scholarly journals Does enteral nutrition infusion rate impact on the gastric residual volume of critically Ill Patients?

2020 ◽  
Vol 12 (2) ◽  
pp. 78-82
Author(s):  
Poliana Guiomar de Almeida Brasiel ◽  
Adriana Soares Torres Melo ◽  
Aline Silva de Aguiar ◽  
Sheila Cristina Potente Dutra Luquetti
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Residual Volume ◽  
Gastric Residual Volume

scholarly journals Application of FASTHUG-MAIDENS mnemonic and evaluation of its impact in pharmaceutical intervention in an adult intensive care unit

2021 ◽  
Vol 12 (1) ◽  
pp. 566
Author(s):  
Íkaro M. LIMA ◽  
Samira B. VIDIGAL ◽  
Nathália M. LIMA ◽  
Daniel A. CARVALHO ◽  
Elton J. SANTOS ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Clinical Evaluation ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Medical Prescription ◽  
Adult Intensive Care Unit ◽  
Clinical Pharmacists ◽  
Pharmaceutical Interventions

Objective: To evaluate the impact of the application of the FASTHUG-MAIDENS mnemonic by clinical pharmacists to optimize critically ill patients’ pharmacotherapy. Methods: Cross-sectional study performed on an adult intensive care unit of an University Hospital, between august and november 2019, where 155 patients were followed by three clinical pharmacists during hospital stay. Patients who stayed less than 24 hours in the hospital or whose stay was during weekends or holidays were excluded. The interventions were performed together with a multidisciplinary team using FASTHUG-MAIDENS, as well as technical analysis of medical prescription and patients’ clinical evaluation. The clinical evaluation included analysis of laboratory tests, nursing records and medical prescription, all registered in an institutional spreadsheet. The pharmaceutical interventions were registered in the pharmaceutical section of both physic and electronic medical records, and the data were later evaluated, classified, and submitted to descriptive analytical analysis. Results: 1.145 pharmaceutical interventions were performed, with an acceptance rate of 99,3%. The number of pharmaceutical interventions were increased by 104,4% with the application of the FASTHUG-MAIDENS mnemonic, compared to the period before the research. The main interventions performed were: inclusion of a drug (25,2%), exclusion of a drug (17,9%), dose adjustment (12,2%), change of the administration timetable to avoid intravenous incompatibility (11,4%), inclusion of infusion rate (7,3%), dilution adequacy (5,8%), inclusion of reconstitution (3,5%), microbiological culture request (3,4%), drug interaction monitoring (2,7%), adequacy of infusion rate (2,6%) and others (7,4%).Pharmaceutical interventions showed clinical (96,9%), preventive (99,3%) and economic (21,6%) impact. Conclusion: The application of the FASTHUG-MAIDENS mnemonic extended the pharmaceutical care to critically ill patients, enabling an accurate evaluation of the pharmacotherapy, clinically impacting critical patient care and reducing errors and adverse drug events.

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