scholarly journals Continuous versus intermittent infusion of cefotaxime in critically ill patients: a randomized controlled trial comparing plasma concentrations

2019 ◽  
Author(s):  
Heleen Aardema ◽  
Wouter Bult ◽  
Kai van Hateren ◽  
Willem Dieperink ◽  
Daan J Touw ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
Prolonged Treatment ◽  
Therapeutic Drug ◽  
Drug Concentrations ◽  
Pharmacodynamic Profile ◽  
Continuous Dosing ◽  
Critical Care Patients

Abstract Background In critical care patients, reaching optimal β-lactam concentrations poses challenges, as infections are caused more often by microorganisms associated with higher MICs, and critically ill patients typically have an unpredictable pharmacokinetic/pharmacodynamic profile. Conventional intermittent dosing frequently yields inadequate drug concentrations, while continuous dosing might result in better target attainment. Few studies address cefotaxime concentrations in this population. Objectives To assess total and unbound serum levels of cefotaxime and an active metabolite, desacetylcefotaxime, in critically ill patients treated with either continuously or intermittently dosed cefotaxime. Methods Adult critical care patients with indication for treatment with cefotaxime were randomized to treatment with either intermittent dosing (1 g every 6 h) or continuous dosing (4 g/24 h, after a loading dose of 1 g). We defined a preset target of reaching and maintaining a total cefotaxime concentration of 4 mg/L from 1 h after start of treatment. CCMO trial registration number NL50809.042.14, Clinicaltrials.gov NCT02560207. Results Twenty-nine and 30 patients, respectively, were included in the continuous dosing group and the intermittent dosing group. A total of 642 samples were available for analysis. In the continuous dosing arm, 89.3% met our preset target, compared with 50% in the intermittent dosing arm. Patients not reaching this target had a significantly higher creatinine clearance on the day of admission. Conclusions These results support the application of a continuous dosing strategy of β-lactams in critical care patients and the practice of therapeutic drug monitoring in a subset of patients with higher renal clearance and need for prolonged treatment for further optimization, where using total cefotaxime concentrations should suffice.

Efficacy of Epidural Analgesia for Pain Management of Critically Ill Patients and the Implications for Nursing Care

1991 ◽  
Vol 2 (4) ◽  
pp. 729-740 ◽  
Author(s):  
Jeanne F. Slack ◽  
Margaret Faut-Callahan
Keyword(s):  
Critical Care ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Critically Ill ◽  
Nursing Care ◽  
Critically Ill Patients ◽  
Continuous Epidural Analgesia ◽  
Analgesic Agents ◽  
Care Problems ◽  
Critical Care Patients

Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient’s recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care

Tracheostomy

2019 ◽  
pp. 850-854
Author(s):  
Saba Ghorab ◽  
David G. Lott
Keyword(s):  
United States ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

scholarly journals Impact of Enteral Nutrition Formulations Containing Dietary Fiber on Diarrhea Outcomes in Hospitalized Critical Care Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 842-842
Author(s):  
Kelly Cara ◽  
Andrew Beauchesne ◽  
Taylor Wallace ◽  
Mei Chung
Keyword(s):  
Systematic Review ◽  
Critical Care ◽  
Enteral Nutrition ◽  
Dietary Fiber ◽  
Critically Ill ◽  
Random Effects ◽  
Critically Ill Patients ◽  
Outcome Data ◽  
Meta Analyses ◽  
Critical Care Patients

Abstract Objectives The objective is to conduct a systematic review on the safety of using enteral nutrition formulations containing dietary fiber in hospitalized critical care patients. Methods This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Version 6.1,2020). Searches were implemented in four databases on 4/20/20. Results were limited to English language studies conducted in humans. Any clinical study design or case study measuring adverse events (e.g., diarrhea and mortality) or health outcomes (as defined in each study) associated with enteral nutrition interventions containing dietary fiber in adult critically ill patients was considered. Random effects meta-analyses were conducted on outcomes assessed by three or more included studies. Results Altogether, 18 articles were included, and 11 randomized controlled trials assessed diarrhea outcomes (i.e., diarrhea score and number or frequency of events). Six studies used the Hart and Dobb (1988) diarrhea score, and random effects meta-analyses showed the mean diarrhea scores were lower for fiber compared to non-fiber groups (n = 4, pooled mean difference: −2.78, 95% confidence interval: −4.10, −1.47). Five of seven reported group comparisons showed fewer diarrhea events for fiber compared with non-fiber groups, although the overall difference was not statistically significant (n = 7, pooled risk ratio: 0.68, 95% CI: 0.45, 1.02). For three studies using other or unspecified scoring methods, pooled results showed significantly fewer diarrhea events in the fiber groups compared to non-fiber groups (n = 3, pooled RR: 0.42, 95% CI: 0.20, 0.89). Studies reported no difference in incidence of mortality due to fiber interventions (n = 7, pooled RR: 0.99, 95% CI: 0.66, 1.48). Risk of bias for diarrhea outcomes was high due to missing outcome data, and there was some concern for bias due to randomization, measurement of the outcome, and selection of reported results. Conclusions Enteral nutrition formulas with fiber may help reduce incidence and severity of diarrhea in critically ill patients without increasing incidence of mortality. As these results are subject to bias, more high-quality studies are needed to verify this conclusion. Funding Sources This study was supported by funding from an unrestricted educational grant from Nestle Health Sciences.

scholarly journals Effects of synbiotic supplementation on energy and macronutrients homeostasis and muscle wasting of critical care patients: study protocol and a review of previous studies

2019 ◽  
Author(s):  
Najmeh Seifi ◽  
Mohammad Safarian ◽  
Mohsen Nematy ◽  
Reza Rezvani ◽  
Majid Khadem-Rezaian ◽  
...  
Keyword(s):  
Critical Care ◽  
Gut Microbiota ◽  
Critically Ill ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Muscle Wasting ◽  
Control Group ◽  
Clinical Prognosis ◽  
Synbiotic Supplementation ◽  
Critical Care Patients

Abstract Background: Among critically ill patients, regardless of the heterogeneity of disease state, an extreme and persistent dysbiosis occurs. Dysbiosis in critically ill patients may make them prone to hospital-acquired infections, sepsis, multi-organ failure (MOF), energy homeostasis disturbance, muscle wasting, and cachexia. Modulation of gut microbiota through synbiotics can be considered as a potential treatment for muscle wasting and macronutrients homeostasis disturbances. Methods: This is a prospective, single center, double-blind; a parallel randomized controlled trial that aimed to evaluate the effects of synbiotic supplementation on energy and macronutrient ‎homeostasis and muscle wasting in critical care patients.‎ All eligible patients (20 subjects in each group) will receive standard hospital gavage as enteral nutrition through a nasogastric tube (NGT) in the 24-48h after admission. In the intervention group, patients will receive Lactocare (ZistTakhmir) capsules 500 mg every 12h for 14 days. Patients in the control group will receive a placebo capsule which contains only the sterile maize starch and is similar to synbiotic capsules. The synbiotic and placebo capsules will be given through nasogastric tube, separately from gavage, after feeding. Discussion: Gut microbiota modulation through synbiotics is proposed to improve clinical prognosis and reduce infectious complications, ventilator dependency and ICU stay by improving energy and macronutrient homeostasis and reducing muscle protein catabolism. Trials registration: The trial protocol has been approved in Iranian Registry of Clinical Trials at 2019-03-17. The registration reference is IRCT20190227042857N1.

scholarly journals Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 177
Author(s):  
Sharon Lechtig-Wasserman ◽  
Hans Liebisch-Rey ◽  
Nicolas Diaz-Pinilla ◽  
Jhosep Blanco ◽  
Yuli-Viviana Fuentes-Barreiro ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Antimicrobial Resistance ◽  
Critically Ill ◽  
Drug Monitoring ◽  
Critically Ill Patients ◽  
Clinical Cure ◽  
Standard Care ◽  
Plasma Concentrations ◽  
Therapeutic Drug ◽  
Secondary Outcomes

Drug monitoring is one strategy of antibiotic stewardship to face antimicrobial resistance. This strategy could have a determinant role in critically ill patients treated with carbapenems to overcome pharmacokinetic variability, reduce the risk of subtherapeutic dosage or toxicity, and reduce the risks inherent to treatment. However, the effectiveness of therapeutic drug monitoring (TDM) is unknown. This paper aims to identify TDM effectiveness in critically ill patients treated with carbapenems. English and ClinicalTrials.gov databases were searched to identify relevant studies evaluating carbapenem TDM. Randomized controlled trials (RCTs) and comparative cohort studies were selected for inclusion if they compared carbapenem TDM to standard care in adult critically ill or sepsis/septic shock patients. The primary outcome was mortality. Secondary outcomes included morbidity, clinical cure, microbiological eradication, antimicrobial resistance, drug-related side effects, and achievement of target plasma concentrations. Overall, performing carbapenem TDM was not associated with a decrease in mortality. However, it could be evidence for a relationship with clinical cure as well as target attainment. Some studies found favorable outcomes related to clinical and microbiological responses, such as lower procalcitonin levels at the end of the monitored therapy compared to standard care. For the primary and secondary outcomes analyzed, strong evidence was not identified, which could be due to the size, risk of bias, and design of selected studies.

scholarly journals Effects of synbiotic supplementation on energy and macronutrients homeostasis and muscle wasting of critical care patients: study protocol and a review of previous studies

2019 ◽  
Author(s):  
Najmeh Seifi ◽  
Mohammad Safarian ◽  
Mohsen Nematy ◽  
Reza Rezvani ◽  
Majid Khadem-Rezaian ◽  
...  
Keyword(s):  
Critical Care ◽  
Gut Microbiota ◽  
Critically Ill ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Muscle Wasting ◽  
Control Group ◽  
Clinical Prognosis ◽  
Synbiotic Supplementation ◽  
Critical Care Patients

Abstract Background Among critically ill patients, regardless of the heterogeneity of disease state, an extreme and persistent dysbiosis occurs. Dysbiosis in critically ill patients may make them prone to hospital-acquired infections, sepsis, multi-organ failure (MOF), energy homeostasis disturbance, muscle wasting, and cachexia. Modulation of gut microbiota through synbiotics can be considered as a potential treatment for muscle wasting and macronutrients homeostasis disturbances.Methods This is a prospective, single center, double-blind; a parallel randomized controlled trial that aimed to evaluate the effects of synbiotic supplementation on energy and macronutrient ‎homeostasis and muscle wasting in critical care patients.‎ All eligible patients (20 subjects in each group) will receive standard hospital gavage as enteral nutrition through a nasogastric tube (NGT) in the 24-48h after admission. In the intervention group, patients will receive Lactocare (ZistTakhmir) capsules 500 mg every 12h for 14 days. Patients in the control group will receive a placebo capsule which contains only the sterile maize starch and is similar to synbiotic capsules. The synbiotic and placebo capsules will be given through nasogastric tube, separately from gavage, after feeding.Discussion Gut microbiota modulation through synbiotics is proposed to improve clinical prognosis and reduce infectious complications, ventilator dependency and ICU stay by improving energy and macronutrient homeostasis and reducing muscle protein catabolism.Trials registration The trial protocol has been approved in Iranian Registry of Clinical Trials at 2019-03-17. The registration reference is IRCT20190227042857N1.

How Safe Are Intramuscular Injections?

1994 ◽  
Vol 5 (2) ◽  
pp. 207-215 ◽  
Author(s):  
Pauline C. Beecroft ◽  
Sylvia R. Kongelbeck
Keyword(s):  
Critical Care ◽  
Adverse Effects ◽  
Critically Ill ◽  
Case History ◽  
Critically Ill Patients ◽  
Intramuscular Route ◽  
Intramuscular Injections ◽  
Critical Care Patients

The authors present an overview of adverse effects associated with intramuscular injections and factors contributing to these effects. Guidelines for both general and critical care patients are proposed after evaluating available research and case history literature. Recommendations include re-evaluating the appropriateness of the intramuscular route for administration of drugs to critical care patients. Avoidance of this route for most critically ill patients is suggested

scholarly journals The provision of central venous access, transfer of critically ill patients and advanced airway management.: Are advanced critical care practitioners safe and effective?

2018 ◽  
Vol 20 (3) ◽  
pp. 248-254 ◽  
Author(s):  
Gavin Denton ◽  
Lindsay Green ◽  
Marion Palmer ◽  
Anita Jones ◽  
Sarah Quinton ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Central Venous Catheterisation ◽  
The United Kingdom ◽  
Advanced Airway ◽  
Critical Care Patients

Advanced critical care practitioners are a new and growing component of the critical care multidisciplinary team in the United Kingdom. This audit considers the safety profile of advanced critical care practitioners in the provision of central venous catheterisation and transfer of ventilated critical care patients without direct supervision and supervised drug assisted intubation of critically ill patients. The audit showed that advanced critical care practitioners can perform central venous cannulation, transfer of critically ill ventilated patients and intubation with parity to published UK literature.

scholarly journals Pharmacokinetic Analysis of Meropenem and Piperacillin in Critically-Ill Patients Requiring Continuous Ven-Venous Hemodiafiltration

2015 ◽  
Vol 6 (2) ◽  
Author(s):  
Brandon Ferlas ◽  
Kristina Nelson ◽  
Milind Junghare ◽  
Kimberly Boeser
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Pharmacokinetic Analysis ◽  
Therapeutic Drug ◽  
Complex Nature ◽  
Original Research ◽  
Beta Lactam ◽  
Post Dose ◽  
Drug Concentrations ◽  
Trough Concentrations

Background: Literature has demonstrated proper antibiotic selection and prompt initiation of antibiotics are associated with lower morbidity and mortality. Septic patients have altered pharmacokinetics and often require continuous renal replacement therapy which contributes to altered drug clearance and metabolism. The current study evaluates the pharmacokinetics of meropenem and piperacillin/tazobactam in critically-ill patients requiring continuous veno-venous hemodiafiltration. Purpose: This observational, prospective, single-center, nonrandomized study evaluated the pharmacokinetics of meropenem and piperacillin/tazobactam in critically-ill patients requiring continuous veno-venous hemodiafiltration. Methods: Plasma drug concentrations were determined via high-performance liquid chromatography using three post-dose blood samples after steady-state antimicrobial agent administration. Results: Meropenem peak drug concentrations ranged from 35.9 to 61 mcg/mL, while trough concentrations ranged from 3.9 to 16.7 mcg/mL. Piperacillin peak drug concentrations ranged from 240 to 331.8 mcg/mL, while trough concentrations ranged from 152.7 to 194.9 mcg/mL. Both drugs examined displayed peak concentrations relatively consistent with those expected from the literature, but observed trough concentrations for meropenem and piperacillin were uniformly high. Conclusions: Intravenous doses of meropenem and piperacillin result in peak drug concentrations similar to those previously reported and trough concentrations significantly greater than those in the literature. While concentrations above an organism’s MIC are desirable given the time-dependent nature of these beta-lactam antibiotics, decreased renal clearance of patients maintained on CVVHDF therapy while receiving higher doses of antimicrobials creates a situation in which drug accumulation and toxicity may occur. Given the complex nature of ICU patient care, increased pharmacovigilance and therapeutic drug monitoring are necessary in this unique population.   Type: Original Research

scholarly journals Diarrhoea in critical care patients: focus on special issues

2013 ◽  
pp. 4-11
Author(s):  
Maurizio Ventrucci ◽  
Paolo Pozzato
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Epidemiological Data ◽  
Elderly Subjects ◽  
Oral Medications ◽  
Antibiotic Drugs ◽  
Therapeutic Measures ◽  
Critical Care Patients ◽  
Clostridium Difficile Associated Diarrhoea

BACKGROUND Diarrhoea is common in critically ill patients, especially in elderly subjects during antibiotic therapy and enteral feeding. The management of diarrhoea includes generous hydration, compensation for the loss of electrolytes, antidiarrhoeal oral medications, and antibiotic drugs in infections related diarrhoea. AIM OF THE STUDY The purpose of this review is to provide an update on particular types of diarrhoea in critically ill patients. Epidemiological data will be discussed, with special emphasis on Clostridium difficile-associated diarrhoea. The possible therapeutic measures will be presented.

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