scholarly journals Endoscopic retrograde cholangiopancreatography (ERCP) in critically ill patients is safe and effective when performed in the endoscopy suite

2020 ◽  
Vol 08 (09) ◽  
pp. E1165-E1172
Author(s):  
Domenico A. Farina ◽  
Srinadh Komanduri ◽  
A. Aziz Aadam ◽  
Rajesh N. Keswani
Keyword(s):  
Critically Ill ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bile Leak ◽  
Underlying Disease ◽  
Endoscopic Retrograde ◽  
Icu Patients ◽  
Cannulation Success Rate

Abstract Background and study aims Critically ill patients may require endoscopic retrograde cholangiopancreatography (ERCP) but performing ERCP in the intensive care unit (ICU) poses logistic and technical challenges. There are no data on ICU patients undergoing ERCP in the endoscopy suite. The primary aim of this study was to report outcomes, including safety, when ERCP in critically ill patients is performed in the endoscopy suite. Patients and methods We queried our institutional endoscopy database to identify all ICU patients who underwent ERCP at a single academic medical center from 04/01/2010 to 11/30/2017. Only patients admitted to an ICU prior to ERCP were included. Results Of 7,218 ERCPs performed during the study period, 260 ERCPs (3.6 %) were performed in 231 ICU patients (mean age 61y; 53 % male); nearly all ICU patient ERCPs (n = 258; 99 %) occurred in the endoscopy suite. ERCP indications included cholangitis (50 %), post-liver transplant cholestasis (15 %), and bile leak (10 %). All ERCPs were performed with anesthesiology, most with general anesthesia (60 %) and in the prone position (60 %). Most patients (73 %) had sepsis. Prior to ERCP, 17 % of patients required vasopressors; vasopressors were begun during ERCP in 4 %.The cannulation success rate was 95 % (94 % in native papillae). Adverse events occurred in 9 % (n = 23) of cases with post-ERCP pancreatitis most common. No patients died during or within 24 hours of ERCP. Mortality at 30 days was 16 %, all attributed to underlying disease. Conclusions When advanced ventilatory and hemodynamic support is available, critically ill patients can safely and effectively undergo ERCP in the endoscopy suite.

scholarly journals Pragmatic Disease-Focused Checklist for Use During Rounding on Critically Ill Patients With COVID-19

2021 ◽  
pp. e1-e5
Author(s):  
Somnath Bose ◽  
Akiva Leibowitz
Keyword(s):  
Critically Ill ◽  
Family Communication ◽  
Critically Ill Patients ◽  
Inflammatory Markers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Ventilation Strategies ◽  
Novel Coronavirus ◽  
Existing Structure

The sudden surge in cases of novel coronavirus disease 2019 (COVID-19) has presented unprecedented challenges in the care of critically ill patients with the disease. A disease-focused checklist was developed to supplement and streamline the existing structure of rounds during a time of significant resource constraint. A total of 51 critical care consultants across multiple specialties at a tertiary academic medical center were surveyed regarding their preference for a structured checklist. Among the respondents, 82% were in favor of a disease-focused checklist. Mechanical ventilation parameters, rescue ventilation strategies, sedation regimens, inflammatory markers specific to COVID-19, and family communication were the elements most commonly identified as being important for inclusion in such a checklist.

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 COVID-19-RELATED COAGULOPATHY IN CRITICALLY ILL PATIENTS: EXPERIENCE FROM AN ACADEMIC MEDICAL CENTER

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A1038-A1039
Author(s):  
Thejus Thayyil Jayakrishnan ◽  
Aaron Haag ◽  
Shane Mealy ◽  
Corbyn Minich ◽  
Abraham Attah ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Patients Experience

scholarly journals The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

2021 ◽  
pp. 106002802110173
Author(s):  
Corey J. Witenko ◽  
Audrey J. Littlefield ◽  
Sajjad Abedian ◽  
Anjile An ◽  
Philip S. Barie ◽  
...  
Keyword(s):  
New York ◽  
Acute Pancreatitis ◽  
Continuous Infusion ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Serum Triglyceride ◽  
Triglyceride Concentration ◽  
Optimal Monitoring

Background: Propofol is commonly used to achieve ventilator synchrony in critically ill patients with coronavirus disease 2019 (COVID-19), yet its safety in this patient population is unknown. Objective: To evaluate the safety, in particular the incidence of hypertriglyceridemia, of continuous infusion propofol in patients with COVID-19. Methods: This was a retrospective study at 1 academic medical center and 1 affiliated teaching hospital in New York City. Adult, critically ill patients with COVID-19 who received continuous infusion propofol were included. Patients who received propofol for <12 hours, were transferred from an outside hospital while on mechanical ventilation, or did not have a triglyceride concentration obtained during the infusion were excluded. Results: A total of 252 patients were included. Hypertriglyceridemia (serum triglyceride concentration ≥ 400 mg/dL) occurred in 38.9% of patients after a median cumulative dose of 4307 mg (interquartile range [IQR], 2448-9431 mg). The median time to triglyceride elevation was 3.8 days (IQR, 1.9-9.1 days). In the multivariable regression analysis, obese patients had a significantly greater odds of hypertriglyceridemia (odds ratio = 1.87; 95% CI = 1.10, 3.21). There was no occurrence of acute pancreatitis. The incidence of possible propofol-related infusion syndrome was 3.2%. Conclusion and Relevance: Hypertriglyceridemia occurred frequently in patients with COVID-19 who received propofol but did not lead to acute pancreatitis. Elevated triglyceride concentrations occurred more often and at lower cumulative doses than previously reported in patients without COVID-19. Application of these data may aid in optimal monitoring for serious adverse effects of propofol in patients with COVID-19.

scholarly journals Emergency endoscopic retrograde cholangiopancreatography in critically ill patients is a safe and effective procedure

2012 ◽  
Vol 4 (2) ◽  
pp. 138-142 ◽  
Author(s):  
Venkata Pawan Kumar Lekharaju ◽  
Javaid Iqbal ◽  
Omar Noorullah ◽  
Naveen Polavarapu ◽  
Shyam Menon ◽  
...  
Keyword(s):  
Critically Ill ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Critically Ill Patients ◽  
Effective Procedure ◽  
Endoscopic Retrograde

Association of Phosphate Containing Solutions with Incident Hypophosphatemia in Critically Ill Patients Requiring Continuous Renal Replacement Therapy

2021 ◽  
pp. 1-8
Author(s):  
Melissa L. Thompson Bastin ◽  
Paul M. Adams ◽  
Sethabhisha Nerusu ◽  
Peter E. Morris ◽  
Kirby P. Mayer ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Fold Increase ◽  
Academic Medical ◽  
Phosphate Supplementation

<b><i>Background:</i></b> Hypophosphatemia in critically ill patients is a common electrolyte disturbance associated with a myriad of adverse effects. Critically ill patients requiring continuous renal replacement therapy (CRRT) are at high risk of hypophosphatemia and often require phosphate supplementation during therapy. The aim of this study was to evaluate the association of phosphate versus non-phosphate containing CRRT solutions with incident hypophosphatemia in critically ill patients requiring CRRT. <b><i>Materials and Methods:</i></b> This is a single-center, retrospective, cohort study at a tertiary academic medical center of 1,396 adult patients requiring CRRT during their intensive care unit stay comprising 7,529 (phosphate containing) and 4,821 (non-phosphate containing) cumulative days of CRRT. Multivariable logistic regression was used to model the primary outcome of hypophosphatemia during CRRT according to exposure to phosphate versus non-phosphate containing CRRT solutions. <b><i>Results:</i></b> Incident hypophosphatemia during CRRT, serum phosphate &#x3c;2.5 mg/dL or 0.81 mmol/L, was significantly higher in the non-phosphate versus phosphate containing solution group: 304/489 (62%) versus 175/853 (21%) (<i>p</i> &#x3c; 0.001). Cumulative phosphate supplementation was also significantly higher in the non-phosphate versus phosphate containing solution group: 79 (IQR: 0–320) versus 0 (0–16) mmol (<i>p</i> &#x3c; 0.001). Non-phosphate solutions were associated with an 8-fold increase in the incidence of hypophosphatemia (adjusted OR 8.05; 95% CI 5.77, 11.26; <i>p</i> &#x3c; 0.001). <b><i>Discussion/Conclusions:</i></b> The use of phosphate containing CRRT solutions was independently associated with reduced risk of incident hypophosphatemia and decreased phosphate supplementation during CRRT. Interventional studies to confirm these findings are needed.

Accuracy of Height Measurement in the Inpatient Setting

2021 ◽  
Vol 30 (1) ◽  
pp. 77-79
Author(s):  
Peter A. Kahn ◽  
Malgorzata Cartiera ◽  
Walter Lindop ◽  
Robert L. Fogerty
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Inpatient Setting ◽  
Height Measurement ◽  
Academic Medical

Accurate height measurement is critical for accurate dosing of medications, mechanical ventilation, and nutritional calculations. Prior research has identified inaccuracies with self-reported height, and height is notably important to measure accurately in critically ill patients. In this study, conducted in a large tertiary academic medical center, medical records rarely indicated the method of height measurement, and there were statistically significant variations in measured height across admissions.

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