Evaluation of Dexmedetomidine Dosing in Obese Critically Ill Patients

2021 ◽  
pp. 089719002110215
Author(s):  
Sara A. Atyia ◽  
Keaton S. Smetana ◽  
Minh C. Tong ◽  
Molly J. Thompson ◽  
Kari M. Cape ◽  
...  
Keyword(s):  
Body Weight ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Statistical Difference ◽  
Ideal Body Weight ◽  
Weight Percentage ◽  
Before And After ◽  
Light Sedation ◽  
Icu Sedation ◽  
Dose Dependent

Background: Dexmedetomidine is a highly selective α2-adrenoreceptor agonist that produces dose-dependent sedation, anxiolysis, and analgesia without respiratory depression. Due to these ideal sedative properties, there has been increased interest in utilizing dexmedetomidine as a first-line sedative for critically ill patients requiring light sedation. Objective: To evaluate the ability to achieve goal intensive care unit (ICU) sedation before and after an institutional change of dosing from actual (ABW) to adjusted (AdjBW) body weight in obese patients on dexmedetomidine. Methods: This study included patients ≥ 18 years old, admitted to a surgical or medical ICU, required dexmedetomidine for at least 8 hours as a single continuous infusion sedative, and weighed ≥ 120% of ideal body weight. Percentage of RASS measurements within goal range (−1 to +1) during the first 48 hours after initiation of dexmedetomidine as the sole sedative agent or until discontinuation dosed on ABW compared to AdjBW was evaluated. Results: 100 patients were included in the ABW cohort and 100 in the AdjBW cohort. The median dosing weight was significantly higher in the ABW group (95.9 [78.9-119.5] vs 82.2 [72.1-89.8] kg; p = 0.001). There was no statistical difference in percent of RASS measurements in goal range (61.5% vs 69.6%, p = 0.267) in patients that received dexmedetomidine dosed based on ABW versus AdjBW. Conclusion: Dosing dexmedetomidine using AdjBW in obese critically ill patients for ongoing ICU sedation resulted in no statistical difference in the percent of RASS measurements within goal when compared to ABW dosing. Further studies are warranted.

scholarly journals A Target for Increased Mortality Risk in Critically Ill Patients: The Concept of Perpetuity

2021 ◽  
Vol 10 (17) ◽  
pp. 3971
Author(s):  
Jarrod M. Mosier ◽  
Julia M. Fisher ◽  
Cameron D. Hypes ◽  
Edward J. Bedrick ◽  
Elizabeth Salvagio Campbell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Body Weight ◽  
Relative Risk ◽  
Oxygen Saturation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Ideal Body Weight ◽  
Hospital Death ◽  
Time Varying ◽  
Ideal Body

Background: Emergency medicine is acuity-based and focuses on time-sensitive treatments for life-threatening diseases. Prolonged time in the emergency department, however, is associated with higher mortality in critically ill patients. Thus, we explored management after an acuity-based intervention, which we call perpetuity, as a potential mechanism for increased risk. To explore this concept, we evaluated the impact of each hour above a lung-protective tidal volume on risk of mortality. Methods: This cohort analysis includes all critically ill, non-trauma, adult patients admitted to two academic EDs between 1 November 2013 and 30 April 2017. Cox models with time-varying covariates were developed with time in perpetuity as a time-varying covariate, defined as hours above 8 mL/kg ideal body weight, adjusted for covariates. The primary outcome was the time to in-hospital death. Results: Our analysis included 2025 patients, 321 (16%) of whom had at least 1 h of perpetuity time. A partial likelihood-ratio test comparing models with and without hours in perpetuity was statistically significant (χ2(3) = 13.83, p = 0.0031). There was an interaction between age and perpetuity (Relative risk (RR) 0.9995; 95% Confidence interval (CI95): 0.9991–0.9998). For example, for each hour above 8 mL/kg ideal body weight, a 20-year-old with 90% oxygen saturation has a relative risk of death of 1.02, but a 40-year-old with 90% oxygen saturation has a relative risk of 1.01. Conclusions: Perpetuity, illustrated through the lens of mechanical ventilation, may represent a target for improving outcomes in critically ill patients, starting in the emergency department. Research is needed to evaluate the types of patients and interventions in which perpetuity plays a role.

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.

scholarly journals Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study

PLoS ONE ◽  
2017 ◽  
Vol 12 (8) ◽  
pp. e0182393 ◽  
Author(s):  
Qian Li ◽  
Zhongheng Zhang ◽  
Bo Xie ◽  
Xiaowei Ji ◽  
Jiahong Lu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Enteral Feeding ◽  
Critically Ill Patients ◽  
Before And After ◽  
Before And After Study ◽  
Feeding Protocol

Early Mobility for Critically Ill Patients: Building Staff Commitment Through Appreciative Inquiry

2020 ◽  
Vol 40 (4) ◽  
pp. 66-72
Author(s):  
Michelle M. Fernald ◽  
Nicholas A. Smyrnios ◽  
Joan Vitello
Keyword(s):  
Quality Improvement ◽  
Critically Ill ◽  
Appreciative Inquiry ◽  
Critically Ill Patients ◽  
Staff Members ◽  
Before And After ◽  
Trained Facilitator ◽  
Improvement Method ◽  
And Performance ◽  
Staff Commitment

Background Immobility contributes to many adverse effects in critically ill patients. Early progressive mobility can mitigate these negative sequelae but is not widely implemented. Appreciative inquiry is a quality improvement method/change philosophy that builds on what works well in an organization. Objectives To explore whether appreciative inquiry would reinvigorate an early progressive mobility initiative in a medical intensive care unit and improve and sustain staff commitment to providing regular mobility therapy at the bedside. Secondary goals were to add to the literature about appreciative inquiry in health care and to determine whether it can be adapted to critical care. Methods Staff participated in appreciative inquiry workshops, which were conducted by a trained facilitator and structured with the appreciative inquiry 4-D cycle. Staff members’ attitudes toward and knowledge of early progressive mobility were evaluated before and after the workshops. Performance of early progressive mobility activities was recorded before and 3 and 10 months after the workshops. Results Sixty-seven participants completed the program. They rated the workshops as successfully helping them to understand the importance of early progressive mobility (98%), explain their responsibility to improve patient outcomes (98%), and engender a greater commitment to patients and the organization (96%). Regarding mobility treatments, at 3 months orders had improved from 62% to 88%; documentation, from 52% to 89%; and observation, from 39% to 87%. These improvements were maintained at 10 months. Conclusion Participation in the workshops improved the staff’s attitude toward and performance of mobility treatments. Appreciative inquiry may provide an adjunct to problem-based quality improvement techniques.

The Effects of Tribulus Terrestris on Body Composition and Exercise Performance in Resistance-Trained Males

2000 ◽  
Vol 10 (2) ◽  
pp. 208-215 ◽  
Author(s):  
Jose Antonio ◽  
John Uelmen ◽  
Ramsey Rodriguez ◽  
Conrad Earnest
Keyword(s):  
Body Composition ◽  
Body Weight ◽  
Dietary Intake ◽  
Exercise Performance ◽  
Bench Press ◽  
Mood States ◽  
Tribulus Terrestris ◽  
Weight Percentage ◽  
Leg Press ◽  
Before And After

The purpose of this study was to determine the effects of the herbal preparation Tribulus terrestris (tribulus) on body composition and exercise performance in resistance-trained males. Fifteen subjects were randomly assigned to a placebo or tribulus (3.21 mg per kg body weight daily) group. Body weight, body composition, maximal strength, dietary intake, and mood states were determined before and after an 8-week exercise (periodized resistance training) and supplementation period. There were no changes in body weight, percentage fat, total body water, dietary intake, or mood states in either group. Muscle endurance (determined by the maximal number of repetitions at 100—200% of body weight) increased for the bench and leg press exercises in the placebo group (p < .05; bench press ±28.4%. leg press ±28.6%), while the tribulus group experienced an increase in leg press strength only (bench press ±3.1 %, not significant; leg press ±28.6%, p < .05). Supplementation with tribulus does not enhance body composition or exercise performance in resistance-trained males.

scholarly journals Population Pharmacokinetic Study of the Suitability of Standard Dosing Regimens of Amikacin in Critically Ill Patients with Open-Abdomen and Negative-Pressure Wound Therapy

2020 ◽  
Vol 64 (4) ◽  
Author(s):  
Cédric Carrié ◽  
Faustine Delzor ◽  
Stéphanie Roure ◽  
Vincent Dubuisson ◽  
Laurent Petit ◽  
...  
Keyword(s):  
Monte Carlo ◽  
Body Weight ◽  
Monte Carlo Simulations ◽  
Critically Ill ◽  
Negative Pressure ◽  
Critically Ill Patients ◽  
Open Abdomen ◽  
Population Pharmacokinetic ◽  
Pressure Therapy ◽  
Dosing Regimens

ABSTRACT The aim was to assess the appropriateness of recommended regimens for empirical MIC coverage in critically ill patients with open-abdomen and negative-pressure therapy (OA/NPT). Over a 5-year period, every critically ill patient who received amikacin and who underwent therapeutic drug monitoring (TDM) while being treated by OA/NPT was retrospectively included. A population pharmacokinetic (PK) modeling was performed considering the effect of 10 covariates (age, sex, total body weight [TBW], adapted body weight [ABW], body surface area [BSA], modified sepsis-related organ failure assessment [SOFA] score, vasopressor use, creatinine clearance [CLCR], fluid balance, and amount of fluids collected by the NPT over the sampling day) in patients who underwent continuous renal replacement therapy (CRRT) or did not receive CRRT. Monte Carlo simulations were employed to determine the fractional target attainment (FTA) for the PK/pharmacodynamic [PD] targets (maximum concentration of drug [Cmax]/MIC ratio of ≥8 and a ratio of the area under the concentration-time curve from 0 to 24 h [AUC0–24]/MIC of ≥75). Seventy critically ill patients treated by OA/NPT (contributing 179 concentration values) were included. Amikacin PK concentrations were best described by a two-compartment model with linear elimination and proportional residual error, with CLCR and ABW as significant covariates for volume of distribution (V) and CLCR for CL. The reported V) in non-CRRT and CRRT patients was 35.8 and 40.2 liters, respectively. In Monte Carlo simulations, ABW-adjusted doses between 25 and 35 mg/kg were needed to reach an FTA of >85% for various renal functions. Despite an increased V and a wide interindividual variability, desirable PK/PD targets may be achieved using an ABW-based loading dose of 25 to 30 mg/kg. When less susceptible pathogens are targeted, higher dosing regimens are probably needed in patients with augmented renal clearance (ARC). Further studies are needed to assess the effect of OA/NPT on the PK parameters of antimicrobial agents.

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