Plasma concentrations of caspofungin in a critically ill patient with morbid obesity

Se han propuesto varias estrategias de mejora con la finalidad de optimizar el uso de antibióticos en los pacientes críticos. Entre ellas destacan la de-escalada, el ciclado, el tratamiento anticipado o el uso de parámetros farmacocinéticos/farmacodinámicos para ajustar la dosificación. Las alteraciones fisiopatológicas que ocurren en el paciente crítico condicionan la farmacocinética y la farmacodinamia de los antibióticos, especialmente de los betalactámicos. Por ello, la predicción del resultado antimicrobiano basado en sus concentraciones plasmáticas, puede ser muy difícil de establecer en el lugar de acción, debido a dichas alteraciones, pudiendo tener esto consecuencias clínicamente relevantes. Se puede mejorar el perfil farmacodinámico de los betalactámicos, mediante una exposición más prolongada con dosis más frecuentes o con infusiones continuas o extendidas, especialmente para tratar bacterias multirresistentes. ABSTRACT OPTIMIZATION STRATEGIES FOR THE USE OF BETA -LACTAMS. The importance of the pathophysiological peculiarities in the critically ill patient. There are several strategies aimed at improving the use of antibiotics in critical patients. These strategies include de-escalation, cycling, early treatment or the use of pharmacokinetic / pharmacodynamic parameters to adjust the dosage. The pathophysiological changes that occur in the critical patient can condition the pharmacokinetics and pharmacodynamics paramethers of antibiotics, especially in beta-lactams. Therefore, anticipating the antimicrobial result based on their plasma concentrations in the place of action can be very difficult to establish, which, in turn, may have clinically relevant consequences. The pharmacodynamic profile of beta-lactams can be improved, through longer exposure with more frequent doses or with continuous or extended infusions, especially to treat multiresistant bacteria.

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How do I determine Cortisol deficiency in the critically ill patient?

Endocrine Abstracts ◽

10.1530/endoabs.44.cmw3.6 ◽

2016 ◽

Author(s):

Jeremy Tomlinson

Keyword(s):

Critically Ill ◽

Critically Ill Patient ◽

Cortisol Deficiency

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The timing of tracheostomy in critically ill patient

ORL ro ◽

10.26416/orl.35.2.2017.794 ◽

2017 ◽

Vol 2 (35) ◽

pp. 20

Author(s):

Liliana Mirea ◽

Raluca Ungureanu ◽

Daniel Mirea ◽

Mirela Țigliș ◽

Ioana Cristina Grințescu ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patient

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Effect of Implementing Gastric Residual Volume Protocol on Critically Ill Patient Outcomes

Assiut Scientific Nursing Journal ◽

10.21608/asnj.2019.58170 ◽

2019 ◽

Vol 7 (18) ◽

pp. 173-182

Author(s):

Salwa Ahmed

Keyword(s):

Critically Ill ◽

Patient Outcomes ◽

Critically Ill Patient ◽

Residual Volume ◽

Gastric Residual Volume

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Suboptimal plasma concentrations with posaconazole suspension as prophylaxis in critically ill COVID‐19 patients at risk of Covid‐associated pulmonary aspergillosis

Journal of Clinical Pharmacy and Therapeutics ◽

10.1111/jcpt.13518 ◽

2021 ◽

Author(s):

Paola Mian ◽

Ronald J. Trof ◽

Albertus Beishuizen ◽

Joost B. Masselink ◽

Alexander D. Cornet ◽

...

Keyword(s):

At Risk ◽

Critically Ill ◽

Plasma Concentrations ◽

Pulmonary Aspergillosis ◽

Patients At Risk

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

Journal of Clinical Medicine ◽

10.3390/jcm10153379 ◽

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.

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UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽

10.1136/bmjopen-2020-044752 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044752

Author(s):

Kaja Heidenreich ◽

Anne-Marie Slowther ◽

Frances Griffiths ◽

Anders Bremer ◽

Mia Svantesson

Keyword(s):

Decision Making ◽

Intensive Care ◽

Moral Responsibility ◽

Critically Ill ◽

Interpersonal Relationships ◽

Qualitative Interviews ◽

Working Environment ◽

Critically Ill Patient ◽

Decision Making Process ◽

Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

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