Clinical Pharmacology in Aged Intensive Care Unit Patients

1993 ◽  
Vol 8 (6) ◽  
pp. 289-297
Author(s):  
Edward T. Zawada ◽  
John L. Boice
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medical Technology ◽  
The Elderly ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Population Demographics ◽  
Drug Dosing ◽  
Care Services ◽  
Age Related

Elderly patients are presenting themselves for advanced critical care services in ever-increasing numbers due to changing population demographics coupled with advances in medical technology and pharmacology. Medical management of the elderly in critical care settings is complicated by pre-existing multisystem chronic disease, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics. Three principles in the management of the elderly in an intensive care unit (ICU) setting are discussed: (1) the protection of renal function from common nephrotic drugs; (2) the necessity of altered drug dosing due to changes in pharmacokinetics and pharmacodynamics; and (3) the necessity of avoiding polypharmacy. Strategies for the prevention of acute renal failure in ICU contrast studies are described. A review of pharmacodynamics and pharmacokinetics in the elderly is presented with examples of commonly seen ICU medication problems.

scholarly journals A study of medication errors during the prescription stage in the pediatric critical care services of a secondary-tertiary level public hospital

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lorena Michele Brennan-Bourdon ◽  
Alan O. Vázquez-Alvarez ◽  
Jahaira Gallegos-Llamas ◽  
Manuel Koninckx-Cañada ◽  
José Luis Marco-Garbayo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medication Errors ◽  
Public Hospital ◽  
Care Practice ◽  
Tertiary Level ◽  
Skin Reactions ◽  
Pediatric Critical Care ◽  
Care Services

Abstract Background Medication Errors (MEs) are considered the most common type of error in pediatric critical care services. Moreover, the ME rate in pediatric patients is up to three times higher than the rate for adults. Nevertheless, information in pediatric population is still limited, particularly in emergency/critical care practice. The purpose of this study was to describe and analyze MEs in the pediatric critical care services during the prescription stage in a Mexican secondary-tertiary level public hospital. Methods A cross-sectional study to detect MEs was performed in all pediatric critical care services [pediatric emergency care (PEC), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and neonatal intermediate care unit (NIMCU)] of a public teaching hospital. A pharmacist identified MEs by direct observation as the error detection method and MEs were classified according to the updated classification for medication errors by the Ruíz-Jarabo 2000 working group. Thereafter, these were subclassified in clinically relevant MEs. Results In 2347 prescriptions from 301 patients from all critical care services, a total of 1252 potential MEs (72%) were identified, and of these 379 were considered as clinically relevant due to their potential harm. The area with the highest number of MEs was PICU (n = 867). The ME rate was > 50% in all pediatric critical care services and PICU had the highest ME/patient index (13.1). The most frequent MEs were use of abbreviations (50.9%) and wrong speed rate of administration (11.4%), and only 11.7% of the total drugs were considered as ideal medication orders. Conclusion Clinically relevant medication errors can range from mild skin reactions to severe conditions that place the patient’s life at risk. The role of pharmacists through the detection and timely intervention during the prescription and other stages of the medication use process can improve drug safety in pediatric critical care services.

scholarly journals A California Hospital’s Response to COVID-19: From a Ripple to a Tsunami Warning

2020 ◽  
Vol 40 (6) ◽  
pp. e1-e16
Author(s):  
Mary Kay Bader ◽  
Annabelle Braun ◽  
Cherie Fox ◽  
Lauren Dwinell ◽  
Jennifer Cord ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Task Force ◽  
The United States ◽  
Tsunami Warning ◽  
Care Services ◽  
Evidence Review ◽  
Excellent Care

Background The outbreak of coronavirus disease 2019 (COVID-19) rippled across the world from Wuhan, China, to the shores of the United States within a few months. Hospitals and intensive care units were suddenly faced with a “tsunami” warning requiring instantaneous implementation and escalation of disaster plans. Evidence Review An evidence-based question was developed and an extensive review of the literature was completed, resulting in a structured plan for the intensive care units to manage a surge of patients critically ill with COVID-19 in March 2020. Twenty-five sources of evidence focusing on pandemic intensive care unit and COVID-19 management laid the foundation for the team to navigate the crisis. Implementation The Critical Care Services task force adopted recommendations from the CHEST consensus statement on surge capacity principles and other sources, which served as the framework for the organized response. The 4 S’s became the focus: space, staff, supplies, and systems. Development of algorithms, workflows, and new processes related to treating patients, staffing shortages, and limited supplies. New intensive care unit staffing solutions were adopted. Evaluation Using a framework based on the literature reviewed, the Critical Care Services task force controlled the surge of patients with COVID-19 in March through May 2020. Patients received excellent care, and the mortality rate was 0.008%. The intensive care unit team had the needed respiratory and general supplies but had to continually adapt to shortages of personal protective equipment, cleaning products, and some medications. Sustainability The intensive care unit pandemic response plan has been established and the team is prepared for the next wave of COVID-19.

scholarly journals View. The Dutch Critical Care Triage Guideline on Covid-19: Not Necessarily Discriminatory

2020 ◽  
Vol 27 (5) ◽  
pp. 495-498
Author(s):  
André den Exter
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Selection Criterion ◽  
The Elderly ◽  
Medical Doctors ◽  
Age Limit ◽  
National Emergency

Abstract Recently, the Dutch Medical Doctors Association (Federatie Medisch Specialisten en de Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst) drafted the ‘Covid-19 triage guideline ICU admission’ that has age cut-offs that deprioritise or exclude the elderly. Such an age limit for intensive care unit (ICU) admission in case of a national emergency seems discriminatory, and thus, is it inappropriate to use, or not? The question is whether age in itself can be considered as an acceptable selection criterion.

Characteristics of Nonpharmacological Interventions for Pain Management in the ICU: A Scoping Review

2019 ◽  
Vol 30 (4) ◽  
pp. 388-397 ◽  
Author(s):  
Geraldine Martorella
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Management ◽  
Pain Relief ◽  
Scoping Review ◽  
Elderly Women ◽  
The Elderly ◽  
Self Report ◽  
Pharmacological Interventions

Pain relief in the intensive care unit (ICU) is of particular concern since patients are exposed to multiple painful stimuli associated with care procedures. Considering the adverse effects of pharmacological approaches, particularly in vulnerable populations such as the elderly, the use of non-pharmacological interventions has recently been recommended in the context of critical care. The main goal of this scoping review was to systematically map the research done on non-pharmacological interventions for pain management in ICU adults and describe the characteristics of these interventions. A wide variety of non-pharmacological interventions have been tested, with music and massage therapies being the most frequently used. An interesting new trend is the use of combined or bundle interventions. Lastly, it was observed that these interventions have not been studied in specific subgroups, such as the elderly, women, and patients unable to self-report.

Barriers to Addressing the Spiritual and Religious Needs of Patients and Families in the Intensive Care Unit: A Qualitative Study of Critical Care Physicians

2020 ◽  
pp. 104990912097090
Author(s):  
Christian K. Alch ◽  
Christina L. Wright ◽  
Kristin M. Collier ◽  
Philip J. Choi
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Spiritual Care ◽  
Spiritual Needs ◽  
Care Providers ◽  
Structured Interviews ◽  
Care Services ◽  
Qualitative Research Design ◽  
Data Saturation

Objectives: Though critical care physicians feel responsible to address spiritual and religious needs with patients and families, and feel comfortable in doing so, they rarely address these needs in practice. We seek to explore this discrepancy through a qualitative interview process among physicians in the intensive care unit (ICU). Methods: A qualitative research design was constructed using semi-structured interviews among 11 volunteer critical care physicians at a single institution in the Midwest. The physicians discussed barriers to addressing spiritual and religious needs in the ICU. A code book of themes was created and developed through a regular and iterative process involving 4 investigators. Data saturation was reached as no new themes emerged. Results: Physicians reported feeling uncomfortable in addressing the spiritual needs of patients with different religious views. Physicians reported time limitations, and prioritized biomedical needs over spiritual needs. Many physicians delegate these conversations to more experienced spiritual care providers. Physicians cited uncertainty into how to access spiritual care services when they were desired. Additionally, physicians reported a lack of reminders to meet these needs, mentioning frequently the ICU bundle as one example. Conclusions: Barriers were identified among critical care physicians as to why spiritual and religious needs are rarely addressed. This may help inform institutions on how to better meet these needs in practice.

scholarly journals The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care?

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Michael Beil ◽  
Hans Flaatten ◽  
Bertrand Guidet ◽  
Sigal Sviri ◽  
Christian Jung ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Chronic Conditions ◽  
Fine Tuning ◽  
Demographic Ageing ◽  
Care Services ◽  
Research And Innovation ◽  
The World ◽  
Support Decision Making

AbstractThere is ongoing demographic ageing and increasing longevity of the population, with previously devastating and often-fatal diseases now transformed into chronic conditions. This is turning multi-morbidity into a major challenge in the world of critical care. After many years of research and innovation, mainly in geriatric care, the concept of multi-morbidity now requires fine-tuning to support decision-making for patients along their whole trajectory in healthcare, including in the intensive care unit (ICU). This article will discuss current challenges and present approaches to adapt critical care services to the needs of these patients.

scholarly journals Equity of access to critical care services in Scotland: A Bayesian spatial analysis

2020 ◽  
pp. 175114372091446
Author(s):  
Philip Emerson ◽  
David R Green ◽  
Steve Stott ◽  
Graeme Maclennan ◽  
Marion K Campbell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Spatial Analysis ◽  
Intensive Care Units ◽  
Geographical Variation ◽  
Admission Rates ◽  
Care Services ◽  
Co Morbidity ◽  
Bayesian Spatial Analysis

Background There is increasing evidence that access to critical care services is not equitable. We aimed to investigate whether location of residence in Scotland impacts on the risk of admission to an Intensive Care Unit and on outcomes. Methods This was a population-based Bayesian spatial analysis of adult patients admitted to Intensive Care Units in Scotland between January 2011 and December 2015. We used a Besag–York–Mollié model that allows us to make direct probabilistic comparisons between areas regarding risk of admission to Intensive Care Units and on outcomes. Results A total of 17,596 patients were included. The five-year age- and sex-standardised admission rate was 352 per 100,000 residents. There was a cluster of Council Areas in the North-East of the country which had lower adjusted admission rates than the Scottish average. Midlothian, in South East Scotland had higher spatially adjusted admission rates than the Scottish average. There was no evidence of geographical variation in mortality. Conclusion Access to critical care services in Scotland varies with location of residence. Possible reasons include differential co-morbidity burden, service provision and access to critical care services. In contrast, the probability of surviving an Intensive Care Unit admission, if admitted, does not show geographical variation.

scholarly journals Classic cases revisited: Mr Miura and the delusion of immortality

2018 ◽  
Vol 19 (3) ◽  
pp. 269-273
Author(s):  
Piotr Szawarski
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Critical Illness ◽  
Research Agenda ◽  
The Elderly ◽  
Ageing Population ◽  
Very Elderly ◽  
Moral Imperative ◽  
Age Related

Death continues to be viewed as a failure by many clinicians and society. For now however, it remains a biological certainty and to think otherwise is to delude oneself. Nevertheless, the society is becoming older and many individuals enjoy fulfilling life in spite of advancing years. The trajectory of age-related physiological deterioration varies, introducing an uncertainty as to the potential for survival when faced with critical illness. There is risk of harm associated with invasive interventions and utility of such remains uncertain in the very elderly. Changing demographic demands improved triage of the elderly patients and an evolution of the research agenda to acknowledge ageing population. There is also moral imperative to ensure avoidance of harm and cost-effectiveness in relation to intensive care unit utilisation by this patient population.

Update on the Treatment of Infections in the Pediatric and Neonatal Intensive Care Unit

2005 ◽  
Vol 18 (1) ◽  
pp. 3-8
Author(s):  
Karen F. Marlowe
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Intensive Care Patient ◽  
Care Patient ◽  
Hospital Acquired Infections ◽  
Age Related ◽  
Hospital Acquired

Although many similarities exist between pediatric and adult critical care, several important distinctions should be made with regard to the treatment of infections. Any discussion of age-related consideration must take into account variations in the pharmacokinetics of antibiotics for infants and children. Important variations are seen in absorption, distribution, and excretion and must be considered in the determination of appropriate age-related dosing. Some variations also exist in patterns of expected flora, suspected pathogens, and patterns of resistance. This is true for both communityacquired illnesses and hospital-acquired infections. Finally, certain infections occur predominately or uniquely in neonates and children. This review addresses these 3main areas for both the pediatric and neonatal intensive care patient.

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