Surgical antimicrobial prophylaxis in intensive care unit (ICU) patients: a preliminary, observational, retrospective study

Objective: To evaluate whether pain management strategies within intensive care unit (ICU) settings contribute to chronic opioid use upon hospital discharge in opioid-naive patients requiring invasive mechanical ventilation. Design: A retrospective, observational study.Setting: An 18-bed mixed ICU at a community teaching hospital located in Brooklyn, New York.Participants: This study included mechanically ventilated patients requiring continuous opioid infusion from April 25, 2017 to May 16, 2019. Patients were excluded if they received chronic opioid therapy at home or expired during this hospital admission. Eligible patients were identified using an electronic health record data query.Main outcome measure(s): The proportion of ICU patients who continued to require opioids upon ICU and hospital discharge. Results: A total of 196 ICU patients were included in this study. Of these, 22 patients were transferred to a regular floor while receiving a fentanyl transdermal patch. However, the fentanyl patch treatment was continued only for three patients (2 percent) at hospital discharge.Conclusions: This retrospective study suggested that high-dose use of opioids in mechanically ventilated, opioid-naive ICU patients was not associated with continued opioid use upon hospital discharge.

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Early indicators of intensive care unit bed requirement during the COVID-19 epidemic: A retrospective study in Ile-de-France region, France

PLoS ONE ◽

10.1371/journal.pone.0241406 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241406 ◽

Cited By ~ 1

Author(s):

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Hospital Admissions ◽

Rt Pcr ◽

Icu Patients ◽

Health Authorities ◽

Ed Visits ◽

Gp Visits ◽

Second Wave

The aim of our retrospective study was to evaluate the earliest COVID19-related signal to anticipate requirements of intensive care unit (ICU) beds. Although the number of ICU beds is crucial during the COVID-19 epidemic, there is no recognized early indicator to anticipate it. In the Ile-de-France region, from February 20 to May 5, 2020, emergency medical service (EMS) calls and the response provided (ambulances) together the percentage of positive reverse transcriptase polymerase chain reaction (RT-PCR) tests, general practitioner (GP) and emergency department (ED) visits, and hospital admissions of COVID-19 patients were recorded daily and compared to the number of ICU patients. Correlation curve analysis was performed to determine the best correlation coefficient, depending on the number of days the indicator has been shifted. Primary endpoint was the number of ICU patients. EMS calls, percentage of positive RT-PCR tests, ambulances used, ED and GP visits of COVID-19 patients were strongly associated (R2 ranging between 0.79 to 0.99, all P<0.001) with COVID-19 ICU patients with an anticipation delay of 23, 15, 14, 13, and 12 days respectively. Hospitalization did not anticipate ICU bed requirement. A qualitative analysis of the onset of the second wave period of the epidemic (August 1 to September 15, 2020) in the same region provided similar results. The daily number of COVID19-related telephone calls received by the EMS and corresponding dispatch ambulances, and the proportion of positive RT-PCR tests were the earliest indicators of the number of COVID19 patients requiring ICU care during the epidemic crisis, rapidly followed by ED and GP visits. This information may help health authorities to anticipate a future epidemic, including a second wave of COVID19, or decide additional social measures.

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Discussing protein requirements of intensive care UNIT (ICU) patients

Alexander Saltanov Intensive Care Herald ◽

10.21320/1818-474x-2018-3-59-66 ◽

2018 ◽

Vol 3 ◽

pp. 59-66 ◽

Cited By ~ 1

Author(s):

I.N. Leyderman ◽

◽

A.I. Yaroshetskiy ◽

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Icu Patients ◽

Protein Requirements

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Diuretic strategies in patients with resistance to loop-diuretics in the intensive care unit: A retrospective study from the MIMIC-III database

Journal of Critical Care ◽

10.1016/j.jcrc.2021.06.009 ◽

2021 ◽

Vol 65 ◽

pp. 282-291

Author(s):

Jean-Maxime Côté ◽

Josée Bouchard ◽

Patrick T. Murray ◽

William Beaubien-Souligny

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Loop Diuretics ◽

Mimic Iii

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Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

BMC Anesthesiology ◽

10.1186/s12871-021-01396-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stephanie-Susanne Stecher ◽

Sofia Anton ◽

Alessia Fraccaroli ◽

Jeremias Götschke ◽

Hans Joachim Stemmler ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lung Ultrasound ◽

Clinical Course ◽

Point Of Care ◽

Clinical Deterioration ◽

Normal Lung ◽

Icu Patients ◽

Standardized Protocol ◽

Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

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Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00226-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tessa L. Steel ◽

Shewit P. Giovanni ◽

Sarah C. Katsandres ◽

Shawn M. Cohen ◽

Kevin B. Stephenson ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

Patient Characteristics ◽

Response To Treatment ◽

Alternative Measure ◽

Icu Patients ◽

Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

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Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?

Microorganisms ◽

10.3390/microorganisms9071505 ◽

2021 ◽

Vol 9 (7) ◽

pp. 1505

Author(s):

Claire Roger ◽

Benjamin Louart

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Clinical Manifestations ◽

Acute Interstitial Nephritis ◽

Convulsive Status Epilepticus ◽

Beta Lactam ◽

Beta Lactams ◽

Drug Induced ◽

Icu Patients

Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.

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Contamination of Propofol Infusions in the Intensive Care Unit: Incidence and Clinical Significance

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600205 ◽

1998 ◽

Vol 26 (2) ◽

pp. 162-164 ◽

Cited By ~ 27

Author(s):

S. A. R. Webb ◽

B. Roberts ◽

F. X. Breheny ◽

C. L. Golledge ◽

P. D. Cameron ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Nosocomial Infection ◽

Wound Infection ◽

Clinical Significance ◽

Low Grade ◽

Clinical Infection ◽

Icu Patients

Epidemics of bacteraemia and wound infection have been associated with the infusion of bacterially contaminated propofol administered during anaesthesia. We conducted an observational study to determine the incidence and clinical significance of administration of potentially contaminated propofol to patients in an ICU setting. One hundred patients received a total of 302 infusions of propofol. Eighteen episodes of possible contamination of propofol syringes were identified, but in all cases contamination was by a low-grade virulence pathogen. There were no episodes of clinical infection or colonization which could be attributed to the administration of contaminated propofol. During the routine use of propofol to provide sedation in ICU patients the risk of nosocomial infection secondary to contamination of propofol is extremely low.

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Comparing Vitamin A and Moist Chamber in Preventing Ocular Surface Disorders

Clinical Nursing Research ◽

10.1177/1054773817695618 ◽

2017 ◽

Vol 27 (6) ◽

pp. 714-729 ◽

Cited By ~ 2

Author(s):

Hassan Babamohamadi ◽

Monir Nobahar ◽

Jalaladin Razi ◽

Raheb Ghorbani

Keyword(s):

Clinical Trial ◽

Intensive Care Unit ◽

Intensive Care ◽

Vitamin A ◽

Ocular Surface ◽

Slight Reduction ◽

Moist Chamber ◽

Icu Patients ◽

Schirmer’S Test

The present study was conducted to determine the effectiveness of vitamin A eye ointment (VAEO) and moist chamber (MC) in preventing ocular surface disorders (OSD) in intensive care unit (ICU) patients. A total of 38 eligible patients were selected for participation in the present clinical trial. All the patients were randomly administered VAEO in one eye every 6 hr for 5 days and had a polyethylene cover (PC) placed on their other eye to create an MC that was replaced every 12 hr as well. The results of Schirmer’s test also increased by 2.06 mm in the VAEO group ( p < .001), while they showed a slight reduction by 0.15 mm in the MC group ( p = .669). VAEO was more effective in preventing OSD in ICU patients than MC and is, therefore, recommended to be used as a method of preventing OSD.

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Comparison of Non–Intensive Care Unit (ICU) versus ICU Rates of Catheter-Associated Urinary Tract Infection in Community Hospitals

Infection Control and Hospital Epidemiology ◽

10.1086/671000 ◽

2013 ◽

Vol 34 (7) ◽

pp. 744-747 ◽

Cited By ~ 18

Author(s):

Sarah S. Lewis ◽

Lauren P. Knelson ◽

Rebekah W. Moehring ◽

Luke F. Chen ◽

Daniel J. Sexton ◽

...

Keyword(s):

Intensive Care Unit ◽

Urinary Tract Infection ◽

Intensive Care ◽

Urinary Tract ◽

Tract Infection ◽

Community Hospitals ◽

Icu Patients ◽

Important Target

We describe and compare the epidemiology of catheter-associated urinary tract infection (CAUTI) occurring in non-intensive care unit (ICU) versus ICU wards in a network of community hospitals over a 2-year period. Overall, 72% of cases of CAUTI occurred in non-ICU patients, which indicates that this population is an important target for dedicated surveillance and prevention efforts.

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