INTER-INDIVIDUAL VARIATION IN THEOPHYLLINE CLEARANCE IN CHILDREN

2016 ◽  
Vol 101 (9) ◽  
pp. e2.25-e2
Author(s):  
Mohammed Altamimi ◽  
Imti Choonara ◽  
Helen Sammons
Keyword(s):  
Critically Ill ◽  
Individual Variation ◽  
Critically Ill Patients ◽  
Plasma Clearance ◽  
Age Groups ◽  
Cochrane Library ◽  
Preterm Neonates ◽  
Term Neonates ◽  
The Mean ◽  
The Cochrane Library

BackgroundInter-individual variation in pharmacokinetics in children is an area where there has been little research. We wished to determine the extent of inter-individual variation in the clearance of theophylline in paediatric patients of different ages.MethodsA systematic literature review was performed using the following databases; Embase (1974 to January 2013), Medline (1946 to January 2013), CINAHL (1937 to January 2013), International Pharmaceutical Abstracts (1970 to January 2013) and the Cochrane Library. From the papers, the range in plasma clearance and the coefficient of variation (CV) in plasma clearance were determined.ResultsA total of 56 articles reporting on 1,315 patients met our inclusion criteria. Twenty six studies gave individual data. The majority of the studies were in critically ill patients. Inter-individual variation was a major problem in all age groups. The CV was 9–93% in preterm neonates, 20–97% in term neonates, 18–52% in infants, 2–72% in children and 4.5–43% in adolescents. The mean clearance was higher in children (0.85 to 2 ml/min/kg) than in neonates (0.24 to 0.6 ml/min/kg).ConclusionsLarge inter-individual variation was seen, especially in critically ill patients. Inter-individual variation was higher in neonates than children and adolescents.

scholarly journals Inter-individual variation in midazolam clearance in children

2014 ◽  
Vol 100 (1) ◽  
pp. 95-100 ◽  
Author(s):  
Mohammed I Altamimi ◽  
Helen Sammons ◽  
Imti Choonara
Keyword(s):  
Critically Ill ◽  
Individual Variation ◽  
Critically Ill Patients ◽  
Plasma Clearance ◽  
Full Range ◽  
Age Groups ◽  
Cochrane Library ◽  
Preterm Neonates ◽  
Term Neonates ◽  
Critically Ill Neonates

ObjectivesTo determine the extent of inter-individual variation in clearance of midazolam in children and establish which factors are responsible for this variation.MethodsA systematic literature review was performed to identify papers describing the clearance of midazolam in children. The following databases were searched: Medline, Embase, International Pharmaceutical Abstracts, CINAHL and Cochrane Library. From the papers, the range in plasma clearance and the coefficient of variation (CV) in plasma clearance were determined.Results25 articles were identified. Only 13 studies gave the full range of clearance values for individual patients. The CV was greater in critically ill patients (18%–170%) than non-critically ill patients (13%–54%). Inter-individual variation was a major problem in all age groups of critically ill patients. The CV was 72%–106% in preterm neonates, 18%–73% in term neonates, 31%–130% in infants, 21%–170% in children and 47%–150% in adolescents. The mean clearance was higher in children (1.1–16.7 mL/min/kg) than in neonates (0.78–2.5 mL/min/kg).ConclusionsLarge inter-individual variation was seen in midazolam clearance values in critically ill neonates, infants, children and adolescents.

Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Barry Burstein ◽  
Vidhu Anand ◽  
Bradley Ternus ◽  
Meir Tabi ◽  
Nandan S Anavekar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Power Output ◽  
Critically Ill Patients ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Power ◽  
The Mean ◽  
Cardiac Intensive Care

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.

scholarly journals Evaluation of bedbath in critically ill patients: impact of water temperature on the pulse oximetry variation

2010 ◽  
Vol 44 (4) ◽  
pp. 1039-1045 ◽  
Author(s):  
Aretha Pereira de Oliveira ◽  
Dalmo Valério Machado de Lima
Keyword(s):  
Water Temperature ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Age Groups ◽  
University Hospital ◽  
Convenience Sample ◽  
Level Ii ◽  
Before And After ◽  
Quasi Experimental ◽  
Water Temperature Data

This is a participant study, quasi-experimental, of a before and after type. A quantitative approach of biophysiological measures was used, represented by the saturation of oxygen measured by pulse oximeter (SpO2), and recorded on three occasions: before, during and after the bedbath in critically ill patients hospitalized at the ICU of a University Hospital in Brazil. Objective: to compare the SpO2 in various stages of the bath, with and without control of water temperature. Data collection was performed between December 2007 and April 2008 on a convenience sample consisting of 30 patients aged over 18 who had classification in TISS-28 from level II. Results show that water temperature control means a lower variation of SpO2 (p<0.05). No marked differences in variation of saturation between men and women or between age groups were established. In conclusion, heated and constant water temperature during the bedbath is able to minimize the fall of SpO2 that occurs while handling patients during procedures.

Are ED-based violence intervention programmes effective in reducing revictimisation and perpetration in victims of violence? A systematic review

2020 ◽  
pp. emermed-2019-208970
Author(s):  
James Matthew Brice ◽  
Adrian A Boyle
Keyword(s):  
Literature Review ◽  
Outcome Measures ◽  
Community Violence ◽  
Age Groups ◽  
Cochrane Library ◽  
Violence Intervention ◽  
Violence Perpetration ◽  
Victims Of Violence ◽  
Randomised Controlled ◽  
The Cochrane Library

ObjectivesCommunity violence bears significant human and economic costs. Furthermore, victims requiring ED treatment are at a greater risk of violent reinjury, arrest due to perpetration and violent death. We aimed to evaluate the effectiveness of ED-based violence intervention programmes (EVIPs), which aim to reduce future violence involvement in these individuals.MethodsWe performed a systematic literature review searching MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, The Cochrane Library and Web of Science, in addition to hand-searching. Randomised controlled trials (RCTs) were included if they enrolled victims of community violence requiring ED treatment, evaluated interventions taking place in the ED and used violent revictimisation, arrests or intermediate outcome measures as endpoints. We included trials that had a Jadad score of 2 or above.Results297 records were identified, and 13 articles were included in our final qualitative analysis, representing 10 RCTs and 9 different EVIPs. The risk of selection bias was low; the risk of performance, detection and attrition bias was moderate. 9 out of 13 papers reported statistically significant improvements in one or more outcome measures related to violence, including violent reinjury and arrests due to violence perpetration.ConclusionThe results of this literature review show that EVIPs may be capable of reducing violent reinjury and arrests due to violence perpetration. Larger RCTs, taking place in different regions, in different age groups and using different techniques, are justified to determine which conditions may be required for success and whether EVIPs are generalisable.

Pharmacokinetics of Benzylpenicillin (Penicillin G) during Prolonged Intermittent Renal Replacement Therapy

Chemotherapy ◽  
2019 ◽  
Vol 64 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Vesa Cheng ◽  
Matthew Rawlins ◽  
Tim Chang ◽  
Emma Fox ◽  
John Dyer ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Penicillin G ◽  
Blood Samples ◽  
Staphylococcus Aureus Bacteremia ◽  
The Mean ◽  
Intermittent Renal Replacement Therapy

Prolonged intermittent renal replacement therapy (PIRRT) is an increasingly adopted method of renal replacement in critically ill patients. Like continuous renal replacement therapy, PIRRT can alter the pharmacokinetics (PK) of many drugs. In this setting, dosing data for antibiotics like benzylpenicillin are lacking. In order to enable clinicians to prescribe benzylpenicillin safely and effectively, knowledge of the effects of PIRRT on the plasma PK of benzylpenicillin is required. Herein, we describe the PK of benzylpenicillin in 2 critically ill patients on PIRRT for the treatment of penicillin-susceptible Staphylococcus aureus bacteremia complicated by infective endocarditis. Blood samples were taken for each patient taken over dosing periods during PIRRT and off PIRRT. Two-compartment PK models described significant differences in the mean clearance of benzylpenicillin with and without PIRRT (6.61 vs. 3.04 L/h respectively). We would suggest a benzylpenicillin dose of 1,800 mg (3 million units) every 6-h during PIRRT therapy as sufficient to attain PK/pharmacodynamic target.

In vivo Elimination of Clonidine by Continuous Venovenous Hemofiltration in Critically Ill Patients

2020 ◽  
Vol 49 (5) ◽  
pp. 622-626
Author(s):  
Huub L.A. van den Oever ◽  
Marieke Zeeman ◽  
Polina Nassikovker ◽  
Carmen Bles ◽  
Fred A.L. van Steveninck ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Continuous Venovenous Hemofiltration ◽  
Kidney Dysfunction ◽  
Sieving Coefficient ◽  
The Mean ◽  
Ventilated Patients

Background: Clonidine is an α2-agonist that is commonly used for sedation in the intensive care unit. When patients are on continuous venovenous hemofiltration (CVVH) in the presence of kidney dysfunction, the sieving coefficient of clonidine is required to estimate how much drug is removed by CVVH. In the present study, we measured the sieving coefficient of clonidine in critically ill, ventilated patients receiving CVVH. Methods: A total of 20 samples of plasma and ultrafiltrate of 3 patients on CVVH, using a standard 1.5 m2 polyacrylonitrile AN69 membrane, during continuous clonidine infusion were collected. After correction for the effect of predilution, we calculated the sieving coefficient for clonidine. Results: The mean sieving coefficient of clonidine was 0.52 (SD 0.097). Conclusion: Using a polyacrylonitrile AN69 membrane in a CVVH machine, the in vivo sieving coefficient of clonidine was 0.52.

scholarly journals Comparison between nurses' and families' opinion about priorities of immediate patient's family needs

2018 ◽  
Vol 9 (1) ◽  
pp. 113
Author(s):  
Intessar Mohamed Ahmad
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Time Frame ◽  
Medical Institute ◽  
Family Needs ◽  
The Family ◽  
The Mean ◽  
Individual Needs ◽  
Strongly Agree

Background and objective: Acute critical illness represents a crisis not just for the individual patient however conjointly for the members of the family. Moreover, the admission of the patient represents a sudden crisis allowing no time for its preparation. The responsibilities of critical care nurses extend beyond the patients in the intensive care unit (ICU) to incorporate the members of the family of these patients. Nurses are a primary resource for members of family of ICU patients and they are in a perfect position to assist patients’ members of the family in an applicable approach. For this reason, recognition of these needs by nursing personnel is very important for applying of holistic nursing care. The aims of this study were 1) Ranking the immediate needs of members of family of critically ill patients and nurses. 2) Comparing between nurses, and families, opinion regarding priorities of immediate patient's family needs using Critical Care Family Needs Inventory (CCFNI).Methods: This descriptive study was conducted at the general ICUs of Damanhour Medical Institute which has 15 beds, Damanhour chest hospital which has 7 beds and Itay Elbaroad General Hospital which has 11 beds. The three units have a total of 100 nurses. A questionnaire was used for data collection. It consisted of part one which comprised patient's condition whose families were studied participants, biosocial knowledge related to the members of family and part two which included CCFNI tool. The adapted CCFNI was translated into colloquial Arabic. Participant members of family were individually interviewed by the researcher. Members of family were required to answer each statement with strongly agree, agree, neutral, do not agree and strongly do not agree. The interview took approximately 45 to 60 minutes to be completed, and all interviews took place within the 72 hours' time frame of each patient's admission to the critical care unit. The nurses were approached and given the questionnaires to be filled in by themselves during handover, tea or lunch break.Results: Generally, families ranked their knowledge, proximity and comfort needs higher in importance than the nurses. Also, the knowledge and assurance needs were ranked above the needs for support, comfort, and proximity by our participating nurses and members of family. Moreover, the mean scores of knowledge, proximity, support and comfort needs for members of family were significantly higher than these for nurses. Out of 35 needs of the members of family in the CCFNI, there were no significant differences between the mean scores of the nurses and those of the members of family in 10 individual needs. Results show that the nurses were correct in 10 out of 35 members of family’ individual needs. The remaining mean scores from 25 individual needs showed significant differences between the nurses and actual family needs. Results show that did not meet all the specific family needs during the care of the critically ill patients. Results show that members of family scored significantly higher than nurses on 20 statements while, the nurses scored significantly higher than members of family on only 5 of the statements.Conclusions: Families considered that knowledge then assurance was the most important needs. While nurses considered that assurance then knowledge were the most important needs which indicate that nurses underestimated the needs of the family and family need may be inaccurately evaluated by heath care team and almost unmet. Furthermore, Members of family in this study considered the needs that bring comfort and support as less in priority needs.

A New Noninvasive Method to Measure Blood Pressure 

1999 ◽  
Vol 91 (3) ◽  
pp. 686-686 ◽  
Author(s):  
Kumar Belani ◽  
Makoto Ozaki ◽  
James Hynson ◽  
Thomas Hartmann ◽  
Hugo Reyford ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Critically Ill ◽  
Radial Artery ◽  
Pulse Rate ◽  
Critically Ill Patients ◽  
Arterial Catheter ◽  
Arterial Waveform ◽  
Measure Blood Pressure ◽  
The Mean ◽  
Radial Artery Catheter

Background Blood pressure (BP) monitoring with arterial waveform display requires an arterial cannula. We evaluated a new noninvasive device, Vasotrac (Medwave, Arden Hills, MN) that provides BP measurements approximately every 12-15 beats and displays pulse rate and a calibrated arterial waveform for each BP measurement. Methods Surgical and critically ill patients (n = 80) served as subjects for the study. BPs, pulse waveforms, and pulse rates measured via a radial artery catheter were compared with those obtained by the Vasotrac from the opposite radial artery. Data were analyzed to determine agreement between the two systems of measurement. Results Blood pressure measured noninvasively by the Vasotrac demonstrated excellent correlation (P&lt;0.01) with BP measured via a radial arterial catheter (systolic r2 = 0.93; diastolic r2 = 0.89; mean r2 = 0.95). Differences in BP measured by the Vasotrac versus the radial arterial catheter were small. The mean+/-SD bias and precision were as follows: systolic BP 0.02+/-5.4 mm Hg and 3.9+/-3.7 mm Hg; diastolic BP -0.39+/-3.9 mm Hg and 2.7+/-2.8 mm Hg; mean BP -0.21+/-3.0 mm Hg and 2.1+/-2.2 mm Hg compared with radial artery measurements. The Vasotrac pulse rates were almost identical to those measured directly (r2 = 0.95). The Vasotrac BP waveform resembled those directly obtained radial artery pulsatile waveforms. Conclusions In surgical and critically ill patients, the Vasotrac measured BP, pulse rate, and displayed radial artery waveform, which was similar to direct radial arterial measurements. It should be a suitable device to measure BP frequently in a noninvasive fashion.

scholarly journals The Diagnostic Concordance of Whole Slide Imaging and Light Microscopy: A Systematic Review

2016 ◽  
Vol 141 (1) ◽  
pp. 151-161 ◽  
Author(s):  
Edward Goacher ◽  
Rebecca Randell ◽  
Bethany Williams ◽  
Darren Treanor
Keyword(s):  
Systematic Review ◽  
Light Microscopy ◽  
Primary Diagnosis ◽  
Cochrane Library ◽  
Whole Slide Imaging ◽  
Tissue Samples ◽  
The Mean ◽  
Diagnostic Concordance ◽  
High Level ◽  
The Cochrane Library

Context.—Light microscopy (LM) is considered the reference standard for diagnosis in pathology. Whole slide imaging (WSI) generates digital images of cellular and tissue samples and offers multiple advantages compared with LM. Currently, WSI is not widely used for primary diagnosis. The lack of evidence regarding concordance between diagnoses rendered by WSI and LM is a significant barrier to both regulatory approval and uptake. Objective.—To examine the published literature on the concordance of pathologic diagnoses rendered by WSI compared with those rendered by LM. Data Sources.—We conducted a systematic review of studies assessing the concordance of pathologic diagnoses rendered by WSI and LM. Studies were identified following a systematic search of Medline (Medline Industries, Mundelein, Illinois), Medline in progress (Medline Industries), EMBASE (Elsevier, Amsterdam, the Netherlands), and the Cochrane Library (Wiley, London, England), between 1999 and March 2015. Conclusions.—Thirty-eight studies were included in the review. The mean diagnostic concordance of WSI and LM, weighted by the number of cases per study, was 92.4%. The weighted mean κ coefficient between WSI and LM was 0.75, signifying substantial agreement. Of the 30 studies quoting percentage concordance, 18 (60%) showed a concordance of 90% or greater, of which 10 (33%) showed a concordance of 95% or greater. This review found evidence to support a high level of diagnostic concordance. However, there were few studies, many were small, and they varied in quality, suggesting that further validation studies are still needed.

scholarly journals The Role of Mean Platelet Volume as a Predictor of Mortality in Critically Ill Patients: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Pattraporn Tajarernmuang ◽  
Arintaya Phrommintikul ◽  
Atikun Limsukon ◽  
Chaicharn Pothirat ◽  
Kaweesak Chittawatanarat
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Mean Platelet Volume ◽  
Meta Analysis ◽  
Small Sample ◽  
Mean Difference ◽  
Platelet Volume ◽  
Significant Difference ◽  
The Mean

Background. An increase in the mean platelet volume (MPV) has been proposed as a novel prognostic indicator in critically ill patients.Objective. We conducted a systematic review and meta-analysis to determine whether there is an association between MPV and mortality in critically ill patients.Methods. We did electronic search in Medline, Scopus, and Embase up to November 2015.Results. Eleven observational studies, involving 3724 patients, were included. The values of initial MPV in nonsurvivors and survivors were not different, with the mean difference with 95% confident interval (95% CI) being 0.17 (95% CI: −0.04, 0.38;p=0.112). However, after small sample studies were excluded in sensitivity analysis, the pooling mean difference of MPV was 0.32 (95% CI: 0.04, 0.60;p=0.03). In addition, the MPV was observed to be significantly higher in nonsurvivor groups after the third day of admission. On the subgroup analysis, although patient types (sepsis or mixed ICU) and study type (prospective or retrospective study) did not show any significant difference between groups, the difference of MPV was significantly difference on the unit which had mortality up to 30%.Conclusions. Initial values of MPV might not be used as a prognostic marker of mortality in critically ill patients. Subsequent values of MPV after the 3rd day and the lower mortality rate unit might be useful. However, the heterogeneity between studies is high.

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