AN EVALUATION ON THE RELATIONSHIP BETWEEN VANCOMYCIN TROUGH CONCENTRATION AND MORTALITY IN CRITICALLY ILL PATIENTS: A MULTICENTER RETROSPECTIVE STUDY

Abstract Background: It remains unclear whether the mean vancomycin trough concentration (VTC) derived from the entire course of therapy is of potential benefit for critically ill patients. This study was conducted to explore the association between mean serum VTC and mortality in intensive care units (ICUs).Methods: 3,364 adult patients with two or more VTC records after receiving vancomycin therapy in the eICU Collaborative Research Database were included in this multicenter retrospective cohort study. Mean VTC was estimated using all measured VTCs and investigated as a continuous and categorical variable. Patients were categorized into four groups according to mean VTC: <10, 10–15, 15–20, and >20 mg/L. Multivariable logistic regression and subgroup analyses were performed to investigate the relationship of mean VTC with mortality.Results: After adjusting for a series of covariates, logistic regression analyses indicated that mean VTC, as a continuous variable, was positively correlated with ICU (odds ratio, 1.042, 95% confidence interval, [1.017–1.068]) and hospital (1.025 [1.004–1.046]) mortalities. As a categorical variable, mean VTC at 10–15 mg/L failed to reduce ICU mortality (1.512 [0.849–2.694]). Moreover, mean VTCs of 15–20 and >20 mg/L were significantly associated with higher ICU mortality (1.946 [1.106–3.424]; 2.314 [1.296–4.132]) than mean VTC <10 mg/L. Mean VTCs of 10–15, 15–20, and >20 mg/L were not associated with increased hospital mortality (1.154 [0.766–1.739]; 1.342 [0.896–2.011]; 1.496 [0.981–2.281]). Similar results were observed in different Acute Physiology and Chronic Health Evaluation IV score or creatinine clearance subgroups.Conclusions: Increasing mean VTC showed no benefit regarding ICU and hospital mortalities in critically ill patients. Our results suggested that continuous VTC monitoring might not guarantee vancomycin efficacy for ICU patients.

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The Relationship Between Prognostic Nutritional Index and All-Cause Mortality in Critically Ill Patients: A Retrospective Study

International Journal of General Medicine ◽

10.2147/ijgm.s318896 ◽

2021 ◽

Vol Volume 14 ◽

pp. 3619-3626

Author(s):

Yan Lu ◽

Chaoxiang Ren ◽

Jinwen Jiang

Keyword(s):

Retrospective Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Prognostic Nutritional Index ◽

Nutritional Index ◽

All Cause Mortality ◽

The Relationship

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Relationship Between Mean Vancomycin Trough Concentration and Mortality in Critically Ill Patients: A Multicenter Retrospective Study

Frontiers in Pharmacology ◽

10.3389/fphar.2021.690157 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yanli Hou ◽

Jiajia Ren ◽

Jiamei Li ◽

Xuting Jin ◽

Ya Gao ◽

...

Keyword(s):

Logistic Regression ◽

Hospital Mortality ◽

Critically Ill ◽

Trough Concentration ◽

Critically Ill Patients ◽

Continuous Variable ◽

Research Database ◽

Categorical Variable ◽

Vancomycin Trough ◽

Relationship Of

Background: It remains unclear whether the mean vancomycin trough concentration (VTC) derived from the entire course of therapy is of potential benefit for critically ill patients. This study was conducted to explore the association between mean serum VTC and mortality in intensive care units (ICUs).Methods: 3,603 adult patients with two or more VTC records after receiving vancomycin treatment in the eICU Collaborative Research Database were included in this multicenter retrospective cohort study. Mean VTC was estimated using all measured VTCs and investigated as a continuous and categorical variable. Patients were categorised into four groups according to mean VTC: <10, 10–15, 15–20, and >20 mg/L. Multivariable logistic regression and subgroup analyses were performed to investigate the relationship of mean VTC with mortality.Results: After adjusting for a series of covariates, logistic regression analyses indicated that mean VTC, as a continuous variable, was positively correlated with ICU (odds ratio, 1.038, 95% confidence interval, [1.014–1.063]) and hospital (1.025 [1.005–1.046]) mortalities. As a categorical variable, mean VTC of 10–15 mg/L was not associated with reduced ICU (1.705 [0.975–2.981]) and hospital (1.235 [0.829–1.841]) mortalities. Mean VTC of 15–20 mg/L was not correlated with a lower risk of hospital mortality (1.370 [0.924–2.029]). Moreover, mean VTCs of 15–20 and >20 mg/L were significantly associated with higher ICU mortality (1.924 [1.111–3.332]; 2.428 [1.385–4.258]), and mean VTC of >20 mg/L with higher hospital mortality (1.585 [1.053–2.387]) than mean VTC of <10 mg/L. Similar results were observed in patients with different Acute Physiology and Chronic Health Evaluation IV score, creatinine clearance, age, and body mass index subgroups.Conclusion: Mean VTC was not associated with reduced ICU/hospital related mortality. Our results suggested that VTC monitoring might not guarantee vancomycin efficacy for ICU patients.

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Klebsiella pneumoniae induced pyogenic liver abscess in critically ill patients: a retrospective study from a Chinese medical center, 1994-2015

10.26226/morressier.57c5383dd462b80296c9bad1 ◽

2016 ◽

Author(s):

Yun Qian

Keyword(s):

Retrospective Study ◽

Klebsiella Pneumoniae ◽

Critically Ill ◽

Liver Abscess ◽

Critically Ill Patients ◽

Medical Center ◽

Pyogenic Liver Abscess

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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