Continuous Infusion Versus Intermittent Infusion Vancomycin in a Regional Burn Center Intensive Care Unit

Burns ◽  
2021 ◽  
Author(s):  
Cory J. Schlobohm ◽  
Elizabeth Zhu ◽  
Jeremiah J. Duby
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Intermittent Infusion ◽  
Burn Center

scholarly journals Influence of Vancomycin on Renal Function in Critically Ill Patients after Cardiac Surgery

2009 ◽  
Vol 111 (2) ◽  
pp. 356-365 ◽  
Author(s):  
Doris Hutschala ◽  
Christian Kinstner ◽  
Keso Skhirdladze ◽  
Florian Thalhammer ◽  
Markus Müller ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Treatment Group ◽  
Continuous Infusion ◽  
Critically Ill Patients ◽  
Intermittent Infusion ◽  
Continuous Treatment ◽  
Intermittent Treatment

Background Vancomycin is frequently used in clinical practice to treat severe wound and systemic infections caused by Gram-positive bacteria after cardiac surgery. The drug is excreted almost entirely by glomerular filtration and might exhibit nephrotoxic side effects. This study compared the nephrotoxic impact of vancomycin during continuous versus intermittent administration. Methods The authors analyzed 149 patients admitted to the intensive care unit during a 5-yr period. All patients were treated at the intensive care unit after elective open heart surgery. Thirty patients received a dosage of 1325 +/- 603 mg/d vancomycin (range 300-3400 mg/d) by intermittent infusion, and 119 patients received a mean dosage of 1935 +/- 688 mg/d (range 352-3411 mg/d) by continuous infusion. Results Nephrotoxicity occurred in 11 patients (36.7%) in the intermittent treatment group and in 33 patients (27.7%) in the continuous treatment group (P = 0.3; 95% CI = 0.283). Continuous veno-venous hemofiltration after vancomycin administration was required for 9 patients (9 of 30; 30%) in the intermittent treatment group and for 28 (28 of 119; 23.5%) in the continuous treatment group (P = 0.053; 95% CI = 0.256). A change of one unit (1 mg/l) in vancomycin serum concentration (DeltaVancoC) induced an average change of 0.04 mg/dl in creatinine (DeltaCrea) in the intermittent treatment group versus 0.006 mg/dl in the continuous treatment group (P < 0.001). Conclusions The data show that both the intermittent and also the continuous application modality of vancomycin are associated with deterioration of renal function in critically ill patients after cardiac surgery. However, continuous infusion showed the tendency to be less nephrotoxic than the intermittent infusion of vancomycin.

Evaluation of Continuous Infusion Vancomycin Administration in a Critically Ill Trauma Population

2018 ◽  
Vol 35 (6) ◽  
pp. 570-575 ◽  
Author(s):  
Brittany D. Bissell ◽  
Gina Riggi ◽  
Christopher Morrison
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Cost Savings ◽  
Intermittent Infusion ◽  
Potential Cost ◽  
Blood Samples ◽  
Trauma Population ◽  
Patient Groups ◽  
Infusion Protocol

Vancomycin is a first-line antibiotic for empiric treatment of gram-positive infections in the trauma intensive care unit. When dosed intermittently, difficulties arise from trough collection and drug monitoring. The objective of this study was to evaluate time to goal vancomycin levels comparing a continuous infusion protocol when compared to standard intermittent infusion dosing. This was a retrospective cohort of patients admitted to the trauma intensive care unit between July 2011 and July 2015 receiving vancomycin for at least 48 hours. In this cohort of 150 patients, continuous infusion vancomycin had a decreased time to goal vancomycin level (2.5 vs 3.8 days, P ≤ .05) with a higher incidence of target attainment (60% vs 40%, P ≤ .05). This reflected in a decrease in average number of blood samples per patient (1 vs 3, P ≤ .05) and shorter duration of therapy (3.8 vs 6.8 days, P ≤ .05). Patients receiving continuous infusion vancomycin also experienced less nephrotoxicity (21% vs 43%, P ≤ .05). Patients in the intermittent infusion group had more missed levels and doses, with only 1 in every 3 patients receiving all intended doses on time. Vancomycin continuous infusion resulted in a decrease in time to goal therapeutic vancomycin levels, number of blood samples required, and therapy duration. Larger trials are needed to validate these outcomes in broad patient groups and to validate the clinical implication and potential cost savings of these results.

Hospital Length of Stay Among Patients Receiving Intermittent Versus Prolonged Piperacillin/Tazobactam Infusion in the Intensive Care Units

2017 ◽  
Vol 33 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Jeannie D. Chan ◽  
Timothy H. Dellit ◽  
John B. Lynch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Randomized Trials ◽  
Average Duration ◽  
Intermittent Infusion ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Inclusion Criteria ◽  
Prolonged Infusion

Objectives: We sought to evaluate clinical outcomes of intensive care unit (ICU) patients following a hospital-wide initiative of prolonged piperacillin/tazobactam (PIP/TAZ) infusion. Methods: Retrospective observational study of patients >18 years old who was hospitalized in the ICU receiving PIP/TAZ for >72 hours during the preimplementation (June 1, 2010 to May 31, 2011) and postimplementation (July 7, 2011 to June 30, 2014) periods. Results: There were 124 and 429 patients who met inclusion criteria with average age of 54.3 and 56.9 years, and average duration of PIP/TAZ therapy was 6.1 ± 2.8 days and 5.9 ± 3.4 days in the pre- and postimplementation period, respectively. Intensive care unit and hospital length of stay (LOS) following initiation of PIP/TAZ were 8.0 ± 8.4 days versus 6.4 ± 6.8 days and 26.3 ± 22.8 days versus 20.4 ± 16.1 days among patients in the pre- and postimplementation periods, respectively. Compared to patients who received intermittent PIP/TAZ infusion, the adjusted difference in ICU and hospital LOS was 0.6 ± 0.8 days (95% confidence interval [CI]: −0.9 to 2.1 days) and 5.6 ± 2.1 days (95% CI: 1.4 - 9.7 days) shorter among patients who received prolonged PIP/TAZ infusion. At hospital discharge, 19 (15.3%) intermittent infusion and 74 (17.2%) prolonged infusion recipients had died. In comparison to intermittent infusion recipients, the adjusted odds ratio for mortality was 1.17 (95% CI: 0.65-2.1) with prolonged infusion. Conclusion: Our study demonstrated a reduction in hospital LOS with prolonged PIP/TAZ infusion among critically ill patients. Randomized trials are needed to further validate these findings.

Continuous infusion of haloperidol and delerium in intensive care unit

1996 ◽  
Vol 6 ◽  
pp. 133
Author(s):  
A. Aït-ameur ◽  
J.M. Doise ◽  
A. Leuret-Barondeau ◽  
L. Piroth ◽  
H. Aube ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion

1308: Impact of Ketamine Versus Fentanyl Continuous Infusion in a Surgical-Trauma Intensive Care Unit

2020 ◽  
Vol 49 (1) ◽  
pp. 660-660
Author(s):  
Yogitha Pazhani ◽  
Jennifer Roth ◽  
Vivek Kataria ◽  
Adrian Ramos ◽  
Jennifer Mooney ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Surgical Trauma

scholarly journals Cerebrospinal Fluid Penetration and Pharmacokinetics of Vancomycin Administered by Continuous Infusion to Mechanically Ventilated Patients in an Intensive Care Unit

2000 ◽  
Vol 44 (5) ◽  
pp. 1356-1358 ◽  
Author(s):  
Jacques Albanèse ◽  
Marc Léone ◽  
Bernard Bruguerolle ◽  
Marie-Laure Ayem ◽  
Bruno Lacarelle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cerebrospinal Fluid ◽  
Intensive Care ◽  
Continuous Infusion ◽  
The Other ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Csf Penetration ◽  
Group Serum ◽  
Ventilated Patients

ABSTRACT Cerebrospinal fluid (CSF) penetration and the pharmacokinetics of vancomycin were studied after continuous infusion (50 to 60 mg/kg of body weight/day after a loading dose of 15 mg/kg) in 13 mechanically ventilated patients hospitalized in an intensive care unit. Seven patients were treated for a sensitive bacterial meningitis and the other six patients, who had a severe concomitant neurologic disease with intracranial hypertension, were treated for various infections. Vancomycin CSF penetration was significantly higher (P< 0.05) in the meningitis group (serum/CSF ratio, 48%) than in the other group (serum/CSF ratio, 18%). Vancomycin pharmacokinetic parameters did not differ from those obtained with conventional dosing. No adverse effect was observed, in particular with regard to renal function.

The Future of Intensive Care Unit Sedation: A Report of Continuous Infusion Ketamine as an Alternative Sedative Agent

2016 ◽  
Vol 30 (5) ◽  
pp. 576-581 ◽  
Author(s):  
Scott T. Benken ◽  
Alexandra Goncharenko
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Ventilator Weaning ◽  
Long Term Effects ◽  
Alternative Agent ◽  
Epidural Hemorrhage ◽  
Icu Sedation

This report describes a patient case utilizing a nontraditional sedative, continuous infusion ketamine, as an alternative agent for intensive care unit (ICU) sedation. A 27-year-old female presented for neurosurgical management of a coup contrecoup injury, left temporal fracture, epidural hemorrhage (EDH), and temporal contusion leading to sustained mechanical ventilation. The patient experienced profound agitation during mechanical ventilation and developed adverse effects with all traditional sedatives: benzodiazepines, dexmedetomidine, opioids, and propofol. Ketamine was titrated to effect and eliminated the need for other agents. This led to successful ventilator weaning, extubation, and transition of care. Given the unique side effect profile of ketamine, it is imperative that information is disseminated on potential utilization of this agent. More information is needed regarding dosing, monitoring, and long-term effects of utilizing ketamine as a continuous ICU sedative, but given the analgesia, anesthesia, and cardiopulmonary stability, future utilization of this medication for this indication seems promising.

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