scholarly journals Estrategias de optimización de uso de betalactámicos

2019 ◽  
Vol 11 (9) ◽  
pp. 3
Author(s):  
Luisa Maria Charco Roca ◽  
José María Jiménez Vizuete ◽  
Antonio Ayelo Navarro
Keyword(s):  
Critically Ill ◽  
Early Treatment ◽  
Plasma Concentrations ◽  
Critically Ill Patient ◽  
Beta Lactams ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Pharmacodynamic Profile ◽  
Multiresistant Bacteria ◽  
Abstract Optimization ◽  
Critical Patients

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.

scholarly journals The Epistemology of Swarming in Patient Care: An Innovative Approach to Admitting Patients into Intensive Care Units

2021 ◽  
pp. 41-43
Author(s):  
Aretha D Miller ◽  
Cheryl Stephenson
Keyword(s):  
Patient Care ◽  
Critically Ill ◽  
Systematic Approach ◽  
Critically Ill Patient ◽  
Healthcare Team ◽  
Admission Process ◽  
Limits Of Knowledge ◽  
History Of ◽  
Critical Patients ◽  
To Receive

Epistemology is the branch of philosophy that addresses cognitive sciences, the history of science and cultural studies. It investigates the origin, methods, nature and limits of knowledge and seeks to determine what we know and how we know it. It is also used to determine truth or falsehoods as we strive to acquire knowledge. This review examined the epistemology of Swarming in patient care, following the SQUIRE guidelines. No best practices exist on how to SWARM patients, yet this process is performed by frontline nurses daily. Four examples of Swarming were examined and a systematic approach on how to SWARM critically ill patients in the admission process into ICUs was recommended. Tasks needed once the patient arrives into the ICU suite are for the primary RN to receive bedside report from the healthcare team and log into the Electronic Health Record to start the admission note. A checklist was introduced to streamline tasks with the goal to reduce the number of chores to be performed by the primary RN, thus freeing up time for assessments of the critically ill patient. This work strives to improve efficiency in the workflow of the ICU admission process, by improving communication amongst the team via practice and a consistent approach to admitting critical patients.

scholarly journals Continuous versus intermittent infusion of cefotaxime in critically ill patients: a randomized controlled trial comparing plasma concentrations

2019 ◽  
Author(s):  
Heleen Aardema ◽  
Wouter Bult ◽  
Kai van Hateren ◽  
Willem Dieperink ◽  
Daan J Touw ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
Prolonged Treatment ◽  
Therapeutic Drug ◽  
Drug Concentrations ◽  
Pharmacodynamic Profile ◽  
Continuous Dosing ◽  
Critical Care Patients

Abstract Background In critical care patients, reaching optimal β-lactam concentrations poses challenges, as infections are caused more often by microorganisms associated with higher MICs, and critically ill patients typically have an unpredictable pharmacokinetic/pharmacodynamic profile. Conventional intermittent dosing frequently yields inadequate drug concentrations, while continuous dosing might result in better target attainment. Few studies address cefotaxime concentrations in this population. Objectives To assess total and unbound serum levels of cefotaxime and an active metabolite, desacetylcefotaxime, in critically ill patients treated with either continuously or intermittently dosed cefotaxime. Methods Adult critical care patients with indication for treatment with cefotaxime were randomized to treatment with either intermittent dosing (1 g every 6 h) or continuous dosing (4 g/24 h, after a loading dose of 1 g). We defined a preset target of reaching and maintaining a total cefotaxime concentration of 4 mg/L from 1 h after start of treatment. CCMO trial registration number NL50809.042.14, Clinicaltrials.gov NCT02560207. Results Twenty-nine and 30 patients, respectively, were included in the continuous dosing group and the intermittent dosing group. A total of 642 samples were available for analysis. In the continuous dosing arm, 89.3% met our preset target, compared with 50% in the intermittent dosing arm. Patients not reaching this target had a significantly higher creatinine clearance on the day of admission. Conclusions These results support the application of a continuous dosing strategy of β-lactams in critical care patients and the practice of therapeutic drug monitoring in a subset of patients with higher renal clearance and need for prolonged treatment for further optimization, where using total cefotaxime concentrations should suffice.

Extremely high myoglobin plasma concentrations producing hook effect in a critically ill patient

2012 ◽  
Vol 414 ◽  
pp. 179-181 ◽  
Author(s):  
Michelle Kurt-Mangold ◽  
Denny Drees ◽  
Matthew D. Krasowski
Keyword(s):  
Critically Ill ◽  
Plasma Concentrations ◽  
Critically Ill Patient ◽  
Hook Effect

scholarly journals Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of Co-administered Ruxolitinib and Artemether-Lumefantrine in Healthy Adults

2021 ◽  
Author(s):  
M. Farouk Chughlay ◽  
Karen I. Barnes ◽  
Myriam El Gaaloul ◽  
Nada Abla ◽  
Jörg J Möhrle ◽  
...  
Keyword(s):  
Adverse Events ◽  
Phase 1 ◽  
Geometric Mean ◽  
Plasma Concentrations ◽  
Janus Kinase ◽  
Geometric Mean Ratio ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Pharmacodynamic Profile ◽  
Transcription 3 ◽  
Single Blind

Despite repeated malaria infection, individuals living in malaria endemic areas remain vulnerable to re-infection. The Janus kinase (JAK1/2) inhibitor ruxolitinib could potentially disrupt the parasite-induced dysfunctional immune response when administered with anti-malarial therapy. This randomized, single-blind, placebo-controlled, single center phase 1 trial investigated the safety, tolerability, pharmacokinetic and pharmacodynamic profile of ruxolitinib and the approved antimalarial artemether-lumefantrine in combination. Ruxolitinib pharmacodynamics were assessed by inhibition of phosphorylation of signal transducer and activator of transcription 3 (pSTAT3). Eight healthy male and female participants aged 18–55 years were randomized to either ruxolitinib (20 mg) ( n = 6) or placebo ( n = 2) administered 2 h after artemether-lumefantrine (80/480 mg) twice daily for three days. Mild adverse events occurred in six participants (four ruxolitinib; two placebo). The combination of artemether-lumefantrine and ruxolitinib was well tolerated, with adverse events and pharmacokinetics consistent with the known profiles of both drugs. The incidence of adverse events and artemether, dihydroartemisinin (the major active metabolite of artemether) and lumefantrine exposure were not affected by ruxolitinib co-administration. Ruxolitinib co-administration resulted in a 3-fold greater pSTAT3 inhibition compared to placebo (geometric mean ratio: 3.01 [90%CI 2.14, 4.24]), with a direct and predictable relationship between ruxolitinib plasma concentrations and %pSTAT3 inhibition. This study supports the investigation of the combination of artemether-lumefantrine and ruxolitinib in healthy volunteers infected with Plasmodium falciparum malaria. (This study has been registered at ClinicalTrials.gov under registration no. NCT04456634).

scholarly journals Use of matching methods in observational studies with critical patients and renal outcomes. Scoping review

2020 ◽  
Vol 49 (2) ◽  
Author(s):  
Henry Oliveros Rodríguez ◽  
Giancarlo Buitrago ◽  
Paola Castellanos Saavedra
Keyword(s):  
Critically Ill ◽  
Scoping Review ◽  
Observational Studies ◽  
Pharmacological Intervention ◽  
Critically Ill Patient ◽  
Renal Outcomes ◽  
Matching Methods ◽  
Critical Patients ◽  
Clinical Experiments ◽  
Matching Techniques

Introduction: The use of matching techniques in observational studies has been increasing and is not always used appropriately. Clinical experiments are not always feasible in critical patients with renal outcomes, and observational studies are an important alternative. Objective: Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and assessing renal outcomes. Methods: Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and 2020 up to week 10, which studied different exposures in the critically ill patient with renal outcomes and used propensity matching methods. Results: Most publications are cohort studies 94 (94. 9 %), five studies (5. 1 %) were cross-sectional. The main pharmacological intervention was the use of antibiotics in seven studies (7. 1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10. 1%). The balance between the baseline characteristics assessed by standardized means, in only 28 studies (28. 2%). Most studies 95 (96 %) used logistic regression to calculate the propensity index. Conclusion: Major inconsistencies were observed in the use of methods and in the reporting of findings. A summary is made of the aspects to be considered in the use of the methods and reporting of the findings with the matching by propensity index.

Early Treatment with Fluconazole in Adult ICU Patients at High Risk for Severe Candidiasis

2002 ◽  
Vol 37 (9) ◽  
pp. 928-935 ◽  
Author(s):  
Jason A. Yahwak ◽  
Gilles L. Fraser
Keyword(s):  
Health Care ◽  
Drug Therapy ◽  
High Risk ◽  
Critically Ill ◽  
Early Treatment ◽  
Economic Outcomes ◽  
Critically Ill Patient ◽  
Icu Patients ◽  
Recent Advances ◽  
The Impact

This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient–an area of health care that has become increasingly complex. It will review recent advances (including evolving and controversial data) in drug therapy for adult ICU patients and assess these new modalities in terms of clinical, humanistic, and economic outcomes.

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

Critical Care ◽  
2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Rafael Ferriols-Lisart ◽  
Gerardo Aguilar ◽  
Alejandro Pérez-Pitarch ◽  
Jaume Puig ◽  
Carlos Ezquer-Garín ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Critically Ill ◽  
Plasma Concentrations ◽  
Critically Ill Patient

scholarly journals Checklist para o transporte intra-hospitalar seguro do doente crítico: A scoping review

2020 ◽  
Vol 19 (4) ◽  
pp. 525-572
Author(s):  
Madalena Canellas ◽  
Isabel Palma ◽  
Patrícia Pontífice-Sousa ◽  
Isabel Rabiais
Keyword(s):  
Patient Safety ◽  
Critically Ill ◽  
Scoping Review ◽  
Critically Ill Patients ◽  
Full Text ◽  
Scientific Evidence ◽  
Critically Ill Patient ◽  
Intrahospital Transport ◽  
Preparation Phase ◽  
Critical Patients

Transportar a un paciente crítico conlleva una serie de riesgos que pueden poner en peligro su seguridad. Conocer los riesgos asociados con el transporte intrahospitalario es esencial para mejorar su seguridad. Elegimos estudiar la lista de verificación de transporte intrahospitalario, ya que la literatura los describe como una forma práctica y simple de aumentar la seguridad.Objetivo: Mapear la envidencia científica existente sobre los aspectos del check list o lista de verificación garantizando la seguridad del paciente crítico en el transporte intrahospitalario. Material y método: Se realizó un scoping review através de la metodologia The Joanna Briggs Institute, utilizando los motores de búsqueda EBSCOhost y B-on. La investigación fue realizada en portugués, inglés y español. Fueron seleccionados artículos con texto libre, sin límite de tiempo. Los criterios incluídos: el paciente crítico adulto/anciano, transporte intrahospitalario, la lista de verificación y la seguridad del paciente.Resultados: Se incluyeron 7 artículos. La mayoría de los aspectos de la lista de verificación se enfoca en la preparación del transporte, el aspecto que más se menciona es la monitorización del paciente. La parte después del transporte, aspectos de la lista de verificación solo es mencionada en 3 de los 7 artículos.Conclusión: Todos los estudios constatan aspectos que pueden incluírse en una lista de verificación y que mejoran la seguridad de los pacientes críticos en el transporte intrahospitalario. No hay unanimidad en cuanto a qué aspectos incluir en la lista de verificación. Transporting critically ill patients is has a set of risks that may jeopardize their safety. Knowing the risks associated with intrahospitalar transport of critically ill patients is essential to improving patient safety. For the sake of improving patient safety, was chosen to approach it as an intrahospitalar transport checklist, as the literature describes it as a practical and simple way to increase safety.Objective: Map available scientific evidence regarding aspects of a checklist that ensure the safety of critically ill patients in intrahospitalar transport.Material and Method: A scoping review was performed following the methodology proposed by The Joanna Briggs Institute in databases using the EBSCOhost and B-on search engines. Conducted research in Portuguese, English, and Spanish. Selected free full text articles, with no time limit. Inclusion criteria: adult/elderly critically ill patient, intrahospital transport, a checklist and patient safety.Results: Included 7 articles for analysis. Most verification requests that ensure the safety of critical patients on intrahospitalar transport concern the transport preparation phase, in which patient is monitored was the most mentioned aspect. From the post-transportation phase, checklist aspects are only available in 3 of 7 articles Conclusion: All studies address aspects that improve the safety of critically ill patients in intrahospitalar transport and are likely to be included in the checklist. There is no unanimity as to which aspects to include in the checklist. O transporte do doente crítico acarreta um conjunto de riscos para a sua segurança. Conhecer os riscos associados ao transporte intra-hospitalar do doente crítico é essencial para melhorar a segurança do mesmo. Optou-se por abordar a checklist de transporte intra-hospitalar, uma vez que a literatura a descreve como uma forma prática e simples de aumentar a segurança.Objetivo: Mapear a evidência científica disponível referente aos aspetos de uma checklist que garantem a segurança do doente crítico no transporte intra-hospitalar.Material e Método: Realizou-se uma scoping review recorrendo à metodologia do The Joanna Briggs Institute, nas bases de dados utilizando os motores de busca EBSCOhost e B-on. Realizada pesquisa em Português, Inglês e Espanhol. Selecionados artigos free full text, sem limite temporal. Critérios de inclusão: o doente crítico adulto/idoso, o transporte intra-hospitalar, a checklist e a segurança do doente.Resultados: Foram incluídos 7 artigos. A maioria dos aspetos da checklist que garantem a segurança do doente crítico no transporte intra-hospitalar, dizem respeito à fase da preparação do transporte, na qual o aspeto mais mencionado é a monitorização do doente. Da fase posterior ao transporte, aspetos da checklist apenas são mencionados em 3 dos 7 artigos.Conclusão: Todos os estudos abordam aspetos que são passíveis de incluir em checklist e melhoram a segurança do doente. Não existe unanimidade quanto aos aspetos a incluir na checklist do transporte intra-hospitalar.

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