scholarly journals Impact of Loading Dose of Caspofungin in Pharmacokinetic-Pharmacodynamic Target Attainment for Severe Candidiasis Infections in Patients in Intensive Care Units: the CASPOLOAD Study

2020 ◽  
Vol 64 (12) ◽  
Author(s):  
Sébastien Bailly ◽  
Elodie Gautier-Veyret ◽  
Minh P. Lê ◽  
Lila Bouadma ◽  
Olivier Andremont ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
High Loading ◽  
Loading Dose ◽  
Target Attainment ◽  
Time Curve ◽  
Icu Patients ◽  
The Impact ◽  
To Receive ◽  
Improve Treatment Efficacy

ABSTRACT This study evaluated the impact of a high loading dose of caspofungin (CAS) on the pharmacokinetics of CAS and the pharmacokinetic-pharmacodynamic (PK-PD) target attainment in patients in intensive care units (ICU). ICU patients requiring CAS treatment were prospectively included to receive a 140-mg loading dose of CAS. Plasma CAS concentrations (0, 2, 3, 5, 7, and 24 h postinfusion) were determined to develop a two-compartmental population PK model. A Monte Carlo simulation was performed and the probabilities of target attainment (PTAs) were computed using previously published MICs. PK-PD targets were ratios of area under the concentration-time curve from 0 to 24 h (AUC0–24h) divided by the MIC (AUC0–24h/MIC) of 250, 450, and 865 and maximal concentration (Cmax) divided by the MIC (Cmax/MIC) of 5, 10, 15, and 20. Among 13 included patients, CAS clearance was 0.98 ± 0.13 liters/h and distribution volumes were V1 = 9.0 ± 1.2 liters and V2 = 11.9 ± 2.9 liters. Observed and simulated CAS AUC0–24h were 79.1 (IQR 55.2; 108.4) and 81.3 (IQR 63.8; 102.3) mg · h/liter during the first 24 h of therapy, which is comparable to values usually observed in ICU patients at day 3 or later. PTAs were >90% for MICs of 0.19 and 0.5 mg/liter, considering AUC/MIC = 250 and Cmax/MIC = 10 as PK-PD targets, respectively. Thus, a high loading dose of CAS (140 mg) increased CAS exposure in the first 24 h of therapy, allowing early achievement of PK-PD targets for most Candida strains. Such a strategy seems to improve treatment efficacy, though further studies are needed to assess the impact on clinical outcomes. (This study has been registered at ClinicalTrials.gov under identifier NCT02413892.)

Exploring the impact of 12-hour shifts on nurse fatigue in intensive care units

2019 ◽  
Vol 50 ◽  
pp. 151191 ◽  
Author(s):  
Fiona Yu ◽  
Deborah Somerville ◽  
Anna King
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Nurse Fatigue ◽  
The Impact

Communicating with parents in neonatal intensive care units: The impact on parental stress

2017 ◽  
Vol 100 (4) ◽  
pp. 710-719 ◽  
Author(s):  
Christian Enke ◽  
Andrés Oliva y Hausmann ◽  
Felix Miedaner ◽  
Bernhard Roth ◽  
Christiane Woopen
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Parental Stress ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
The Impact

scholarly journals Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study

2021 ◽  
Vol 8 ◽  
pp. 237437352110073
Author(s):  
Reza Norouzadeh ◽  
Mohammad Abbasinia ◽  
Zahra Tayebi ◽  
Ehsan Sharifipour ◽  
Alireza Koohpaei ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Health Care Providers ◽  
Spiritual Support ◽  
Care Providers ◽  
Structured Interviews ◽  
Icu Patients ◽  
Life Challenges ◽  
Care Models ◽  
The Face

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.

scholarly journals Estimating the Case Fatality Risk of COVID-19 using Cases from Outside China

2020 ◽  
Author(s):  
Nick Wilson ◽  
Amanda Kvalsvig ◽  
Lucy Telfar Barnard ◽  
Michael G Baker
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Meta Analysis ◽  
Case Fatality ◽  
Large Uncertainty ◽  
Icu Patients ◽  
Fatality Risk ◽  
Case Fatality Risk ◽  
Respiratory Conditions

AbstractThere is large uncertainty around the case fatality risk (CFR) for COVID-19 in China. Therefore, we considered symptomatic cases outside of China (countries/settings with 20+ cases) and the proportion who are in intensive care units (4.0%, 14/349 on 13 February 2020). Given what is known about CFRs for ICU patients with severe respiratory conditions from a meta-analysis, we estimated a CFR of 1.37% (95%CI: 0.57% to 3.22%) for COVID- 19 cases outside of China.

scholarly journals Colonization of central venous catheter in the intensive care units at the Institute of Cardiovascular Disease "Dedinje": One year study

2005 ◽  
Vol 52 (3) ◽  
pp. 33-37
Author(s):  
Ivana Cirkovic ◽  
Vera Mijac ◽  
Milena Svabic-Vlahovic ◽  
S. Dukic ◽  
I. Ilic ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Antimicrobial Agents ◽  
Microbial Colonization ◽  
Central Venous ◽  
Candida Spp ◽  
Icu Patients ◽  
Gram Negative ◽  
Microbiological Methods ◽  
Increased Risk

Objectives: The application of Central Venous Catheters (CVC) is associated with increased risk of microbial colonization and infection. The aim of present study was to assess the frequency of pathogens colonizing CVC and to determine their susceptibility pattern to various antimicrobial agents. Materials and methods: A total of 253 samples of CVC from intensive care units (ICU) patients were received for culture during 2003. All microorganisms were identified by standard microbiological methods and the susceptibility to antimicrobial agents was determined according to NCCLS recommendations. Results: A total of 184 (72.7%) cultures were positive and 223 pathogens were isolated. Coagulase negative staphylococci (CNS) were the dominant isolates (24.7%), followed by Enterobacter spp. (12.1%), Pseudomonas spp. (11.7%), Enterococcus spp. (9.9%), Klebsiella spp. (8.6%), Candida spp. (7.6%), Acinetobacter spp. (7.6%), other Gram negative nonfermentative bacilli (5.8%), Serratia spp. (4.5%), Staphylococcus aureus (2.6%), Proteus mirabilis (2.2%), E. coli (1.8%) and Citrobacter spp. (0.9%). Meropenem (84.5%) and vancomycin (100%) remain the most effective antimicrobial agents against Gram negative and Gram positive bacteria, respectively. Conclusion: Gram negative bacilli and CNS are the commonest microorganisms colonizing CVC from ICU patients. The increasing resistance of the bacteria to antimicrobial agents is the major problem in spite of restricted policy of using antimicrobial agents in ICU.

The rate and impact of substance misuse in psychiatric intensive care units (PICUs) in the UK

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Hattie Catherine Ann Moyes ◽  
Lana MacNaboe ◽  
Kate Townsend
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Substance Misuse ◽  
Well Being ◽  
Training Programme ◽  
Content Type ◽  
National Quality ◽  
Improvement Programme ◽  
The Uk ◽  
The Impact

Purpose This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs. Design/methodology/approach The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients. Findings The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed. Research limitations/implications The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs. Practical implications This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes. Originality/value This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units

2007 ◽  
Vol 16 (6) ◽  
pp. 589-598 ◽  
Author(s):  
Mark A. Malesker ◽  
Pamela A. Foral ◽  
Ann C. McPhillips ◽  
Keith J. Christensen ◽  
Julie A. Chang ◽  
...  
Keyword(s):  
Intensive Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Intensive Care Units ◽  
Tight Glycemic Control ◽  
Third Party ◽  
Full Time ◽  
Motion Data ◽  
Time Motion ◽  
The Impact

Background The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. Objectives To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. Methods Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. Results Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. Conclusions Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.

scholarly journals Selection of an instrument to evaluate the organizational environment of nurses working in intensive care: an integrative review

2014 ◽  
Vol 3 (6) ◽  
pp. 143
Author(s):  
Brett Abbenbroek ◽  
Christine Duffield ◽  
Doug Elliott
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Outcome Measures ◽  
Organizational Structures ◽  
Survey Instrument ◽  
Integrative Review ◽  
Organizational Environment ◽  
Intensive Care Nurses ◽  
Survey Instruments ◽  
The Impact

Objective: To determine an appropriate survey instrument to evaluate the impact of organizational structures on the work environment of intensive care nurses. Background: Internationally the demand for intensive care is increasing. Solely increasing bed capacity is not sustainable. Large capacity multi-specialty Intensive Care Units are emerging as the preferred organizational model with benefits resulting from optimizing operational synergies and economies of scale. The impact of this organizational transition on intensive care nurses is not well understood. An appropriate survey instrument for intensive care nurses is required. Design: Integrative literature review. Data Sources: CINAHL, PubMed, EMBASE and OVID Nursing databases searched for studies published between 2005 and 2013. Review methods: An integrative review and quality assessment of the studies was undertaken to select nurse outcome measures associated with organizational structures across a range of acute and critical care settings. Congruence between nurse outcome measures and nurse survey instruments tested in the literature was assessed to select instruments for further psychometric evaluation. Results: Thirty-one cross sectional quantitative studies, from fourteen countries, were reviewed. Twenty one nurse outcome measures associated with organizational factors were identified and a total of twenty five survey instruments used in the studies reviewed. Assessment of congruence and psychometric properties determined that a combination of two instruments is required to comprehensively assess the organizational environment of nurses working in intensive care units. Conclusion: The environment of nurses working in intensive care is effectively evaluated with an instrument that combines subscales from the Practice Environment Scale-Nurse Work Index and Maslach’s Burnout Inventory. 

scholarly journals Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Alberto García-Salido ◽  
◽  
Juan Carlos de Carlos Vicente ◽  
Sylvia Belda Hofheinz ◽  
Joan Balcells Ramírez ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Gastrointestinal Symptoms ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Vasoactive Drugs ◽  
Pediatric Intensive Care Units ◽  
Neutrophil Lymphocyte Ratio ◽  
Inflammatory Syndrome ◽  
To Receive

Abstract Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

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