The ART of Antiretroviral Therapy in Critically Ill Patients With HIV

2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson
Keyword(s):  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critically Ill Patient ◽  
Intensive Care Setting ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

Anticonvulsants: Pharmacotberapeutic Issues in the Critically Ill Patient

1991 ◽  
Vol 2 (4) ◽  
pp. 639-656 ◽  
Author(s):  
Robert E. Dupuis ◽  
Jorge Miranda-Massari
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critical Care Setting ◽  
Critically Ill Patient ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Epilepsy Treatment

Critically ill patients often have or develop conditions that make them susceptible to seizures and epilepsy. Treatment frequently involves the use of anticonvulsants. In order to use these effectively, the critical care nurse must be aware of the indications and controversies surrounding their use, the pathophysiologic conditions that impact on the disposition, and appropriate dosing and monitoring of these agents in the critical care setting

scholarly journals Therapeutic Management of a Patient with Necrotizing Fasciitis Resulting in Quadrilateral Amputation and Critical Illness Myopathy in the Intensive Care Setting: A Case Report.

2021 ◽  
Author(s):  
Mallory Kargela ◽  
Annette Siebens
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Necrotizing Fasciitis ◽  
Care Setting ◽  
Assistive Device ◽  
Critical Illness Myopathy ◽  
Critically Ill Patient ◽  
Close Monitoring ◽  
Intensive Care Setting ◽  
Acute Setting

Purpose: The purpose of this case is to illustrate the best available evidence to provide early therapeutic intervention for a critically ill patient presenting with cardiovascular and pulmonary complications due to multi-system compromise. Case Description: A 19-year-old male was admitted to the hospital with the diagnosis of necrotizing fasciitis and necrotizing pneumonia. He experienced numerous additional medical complications ultimately leading to tracheostomy, delirium, critical illness myopathy, and quadrilateral amputation secondary to necrotizing fasciitis and critical limb ischemia following prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO). Outcomes: Patient was discharged to an outside rehabilitation hospital after 103 days in the acute setting (56 days in the ICU) and was able to tolerate 40 minutes sitting edge of bed with supervision, perform bed mobility with supervision, and propel a standard wheelchair up to 50 feet independently. At 10 months’ post-discharge from the acute setting, the patient was ambulating independently up to 150 feet without assistive device using bilateral lower extremity prosthetics, able to propel a lightweight wheelchair community distances, independent in all transfers, and returned to school and work. Discussion: These findings suggest that clinicians may want to consider examining and combining the best available evidence of multiple medical conditions to provide a well-rounded therapeutic approach including but not limited to, close monitoring of vitals and early mobilization, to managing complex patients in the intensive care setting.

scholarly journals Misfits: An ethnographic study of extremely fat patients in intensive care

2021 ◽  
Author(s):  
◽  
Caroline Hales
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Care Setting ◽  
Healthcare Delivery ◽  
Ethnographic Study ◽  
Care Staff ◽  
Intensive Care Setting ◽  
Emotional Labour ◽  
The Social ◽  
Care Practices

<p>Critically ill fat patients pose considerable healthcare delivery and resource utilisation challenges which are often exacerbated by the patients’ critical condition and types of interventional therapies used in the intensive care environment. Added to these difficulties of managing care is the social stigma that is attached to being fat. Intensive care staff not only have to attend to the specific needs of the critically ill body but also navigate, both personally and professionally, the social terrain of stigma when providing care to this patient population.  The purpose of this research was to explore the culture and influences within the intensive care setting in which doctors and nurses cared for fat patients. A focused ethnographic approach was adopted to elicit the specific knowledge and ‘situated’ experiences of caring for critically ill fat patients from the perspectives of intensive care staff. The setting for this study was an 18 bedded tertiary intensive care unit (ICU) in New Zealand. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. This study adopted an insider perspective throughout the research process as the study site was also my place of work. The dual tensions of the nurse and researcher position are reflexively explored through the thesis.  Key findings from this research reveal how fat patients were considered to be ‘misfits’ in the ICU as a result of not fitting the physical, medical, and social norms of intensive care practices. Staff managed their private perceptions of fatness during care situations through the use of emotional labour, behavioural regions, and face-work. Through the construction and presentation of the professional and private ‘face’, staff were able to establish positive social experiences for fat patients.  This study has brought new understandings of fatness; often percieved as the last socially accepted form of discrimination. Conceptualising fat patients as ‘misfits’ in the intensive care setting, reveals the performances of staff in managing the social awkwardness of fat stigma. The implications of this for healthcare is the provision of clinical services that are fit for purpose and a reconceptualisation of how staff use emotional labour in order to deliver non-discriminatory care to socially stigmatised fat patients.</p>

scholarly journals Chloride in intensive care units: a key electrolyte

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1930 ◽  
Author(s):  
Ghassan Bandak ◽  
Kianoush B. Kashani
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Chloride Content ◽  
Patient Admission ◽  
Critically Ill Patient ◽  
The Past ◽  
Arterial Blood ◽  
Clinical Investigations

Over the past few years, chloride has joined the league of essential electrolytes for critically ill patients. Dyschloremia can occur secondary to various etiologic factors before and during patient admission in the intensive care unit. Some cases are disease-related; others, treatment-related. Chloride abnormalities were shown in animal models to have adverse effects on arterial blood pressure, renal blood flow, and inflammatory markers, which have led to several clinical investigations. Hyperchloremia was studied in several settings and correlated to different outcomes, including death and acute kidney injury. Baseline hypochloremia, to a much lesser extent, has been studied and associated with similar outcomes. The chloride content of resuscitation fluids was also a subject of clinical research. In this review, we describe the effect of dyschloremia on outcomes in critically ill patients. We review the major studies assessing the chloride content of resuscitation fluids in the critically ill patient.

Results of a Multicenter Feasibility Study of an Automated Bedside Glucose Monitoring System in the Burn Intensive Care Setting

2019 ◽  
Vol 41 (3) ◽  
pp. 535-538
Author(s):  
Craig T Elder ◽  
Tera Thigpin ◽  
Rachel Karlnoski ◽  
David Smith ◽  
David Mozingo ◽  
...  
Keyword(s):  
Intensive Care ◽  
Blood Glucose ◽  
Critically Ill ◽  
Care Setting ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Serum Glucose ◽  
Burn Patients ◽  
Intensive Care Setting ◽  
Continuous Glucose Monitor

Abstract Intensive blood glucose regimens required for tight glycemic control in critically ill burn patients carry risk of hypoglycemia and are ultimately limited by the frequency of which serum glucose measurements can be feasibly monitored. Continuous inline glucose monitoring has the potential to significantly increase the frequency of serum glucose measurement. The objective of this study was to assess the accuracy of a continuous glucose monitor with inline capability (Optiscanner) in the burn intensive care setting. A multicenter, observational study was conducted at two academic burn centers. One hundred and six paired blood samples were collected from 10 patients and measured on the Optiscanner and the Yellow Springs Instrument. Values were plotted on a Clarke Error Grid and mean absolute relative difference calculated. Treatment was guided by existing hospital protocols using separately obtained values. 97.2% of results obtained from Optiscanner were within 25% of corresponding Yellow Springs Instrument values and 100% were within 30%. Mean absolute relative difference was calculated at 9.6%. Our findings suggest that a continuous glucose monitor with inline capability provides accurate blood glucose measurements among critically ill burn patients.

scholarly journals The role of urea-induced osmotic diuresis and hypernatremia in a critically ill patient: case report and literature review

2020 ◽  
Vol 42 (1) ◽  
pp. 106-112 ◽  
Author(s):  
Jesiree Iglésias Quadros Distenhreft ◽  
Júlia Guasti Pinto Vianna ◽  
Gabriela S. Scopel ◽  
Jayme Mendonça Ramos ◽  
Antonio Carlos Seguro ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Setting ◽  
Free Water ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
Clinical Approach ◽  
Intensive Care Setting ◽  
Osmotic Diuresis ◽  
Free Water Clearance

Abstract Hypernatremia is a common electrolyte problem at the intensive care setting, with a prevalence that can reach up to 25%. It is associated with a longer hospital stay and is an independent risk factor for mortality. We report a case of hypernatremia of multifactorial origin in the intensive care setting, emphasizing the role of osmotic diuresis due to excessive urea generation, an underdiagnosed and a not well-known cause of hypernatremia. This scenario may occur in patients using high doses of corticosteroids, with gastrointestinal bleeding, under diets and hyperprotein supplements, and with hypercatabolism, especially during the recovery phase of renal injury. Through the present teaching case, we discuss a clinical approach to the diagnosis of urea-induced osmotic diuresis and hypernatremia, highlighting the utility of the electrolyte-free water clearance concept in understanding the development of hypernatremia.

Circulation and circulatory support in the critically ill

2020 ◽  
pp. 3881-3891
Author(s):  
Michael R. Pinsky
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Assessment ◽  
Circulatory Support ◽  
Critically Ill Patient ◽  
Haemodynamic Monitoring ◽  
Vast Array ◽  
Bedside Echocardiography ◽  
Diagnostic Approaches

Cardiovascular dysfunction is common in critically ill patients and is the primary cause of death in a vast array of illnesses. The prompt identification and diagnosis of its probable cause, coupled to appropriate resuscitation and (when possible) specific treatments, are cornerstones of intensive care medicine. Cardiovascular performance can be assessed clinically at the bedside and through haemodynamic monitoring, and with therapeutic or other proactive interventions. Rapid assessment of shocked patients by bedside echocardiography is increasingly used in those institutions where equipment and expertise are available. Diagnostic approaches or therapies based on data derived from invasive haemodynamic monitoring in the critically ill patient assume that specific patterns of derangement reflect specific disease processes, which will respond to appropriate intervention.

Sign in / Sign up

Export Citation Format

Share Document