Right Dose, Right Now: Development of AutoKinetics for Real Time Model Informed Precision Antibiotic Dosing Decision Support at the Bedside of Critically Ill Patients

Delivery of enteral nutrition in critically ill patients is often hampered by gastric stasis necessitating direct feeding into the small intestine. Current techniques for placement of post-pyloric feeding catheters are complex, time consuming or both, and improvements in feeding tube placement techniques are required. The Cathlocator™ is a novel device that permits real time localisation of the end of feeding tubes via detection of a magnetic field generated by a small electric current in a coil incorporated in the tip of the tube. We performed a pilot study evaluating the feasibility of the Cathlocator™ system to guide and evaluate the placement of (1) nasoduodenal feeding tubes, and (2) nasogastric drainage tubes in critically ill patients with feed intolerance due to slow gastric emptying. A prospective study of eight critically ill patients was undertaken in the intensive care unit of a tertiary hospital. The Cathlocator™ was used to (1) guide the positioning of the tubes post-pylorically and (2) determine whether nasogastric and nasoduodenal tubes were placed correctly. Tube tip position was compared with data obtained by radiology. Data are expressed as median (range). Duodenal tube placement was successful in 7 of 8 patients (insertion time 12.6 min (5.3–34.4)). All nasogastric tube placements were successful (insertion time 3.4 min (0.6–10.0)). The Cathlocator™ accurately determined the position of both tubes without complication in all cases. The Cathlocator™ allows placement and location of an enteral feeding tube in real time in critically ill patients with slow gastric emptying. These findings warrant further studies into the application of this technique for placement of post-pyloric feeding tubes.

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Closed-loop glucose control in critically Ill patients using continuous glucose monitoring system (CGMS) in real time

IEEE Transactions on Information Technology in Biomedicine ◽

10.1109/titb.2003.808509 ◽

2003 ◽

Vol 7 (1) ◽

pp. 43-53 ◽

Cited By ~ 85

Author(s):

F. Chee ◽

T. Fernando ◽

P.V. van Heerden

Keyword(s):

Real Time ◽

Critically Ill ◽

Monitoring System ◽

Continuous Glucose Monitoring ◽

Critically Ill Patients ◽

Glucose Control ◽

Closed Loop ◽

Glucose Monitoring ◽

Continuous Glucose Monitoring System

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Antibiotic dosing in critically ill patients with acute kidney injury

Nature Reviews Nephrology ◽

10.1038/nrneph.2011.12 ◽

2011 ◽

Vol 7 (4) ◽

pp. 226-235 ◽

Cited By ~ 55

Author(s):

Rachel F. Eyler ◽

Bruce A. Mueller

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Antibiotic Dosing

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Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera‐Assisted Technology with Real‐Time Video Guidance

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.1313 ◽

2018 ◽

Vol 43 (1) ◽

pp. 118-125 ◽

Cited By ~ 4

Author(s):

Paul E. Wischmeyer ◽

Michelle M. McMoon ◽

Nathan H. Waldron ◽

Elizabeth J. Dye

Keyword(s):

Real Time ◽

Critically Ill ◽

Critically Ill Patients ◽

Feeding Tubes ◽

Video Guidance

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Antibiotic Dosing for Critically Ill Adult Patients Receiving Intermittent Hemodialysis, Prolonged Intermittent Renal Replacement Therapy, and Continuous Renal Replacement Therapy: An Update

Annals of Pharmacotherapy ◽

10.1177/1060028019865873 ◽

2019 ◽

Vol 54 (1) ◽

pp. 43-55 ◽

Cited By ~ 12

Author(s):

Brian M. Hoff ◽

Jenana H. Maker ◽

William E. Dager ◽

Brett H. Heintz

Keyword(s):

Renal Function ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Response To Therapy ◽

Intermittent Hemodialysis ◽

Intermittent Renal Replacement Therapy ◽

Antibiotic Dosing

Objective: To summarize current antibiotic dosing recommendations in critically ill patients receiving intermittent hemodialysis (IHD), prolonged intermittent renal replacement therapy (PIRRT), and continuous renal replacement therapy (CRRT), including considerations for individualizing therapy. Data Sources: A literature search of PubMed from January 2008 to May 2019 was performed to identify English-language literature in which dosing recommendations were proposed for antibiotics commonly used in critically ill patients receiving IHD, PIRRT, or CRRT. Study Selection and Data Extraction: All pertinent reviews, selected studies, and references were evaluated to ensure appropriateness for inclusion. Data Synthesis: Updated empirical dosing considerations are proposed for antibiotics in critically ill patients receiving IHD, PIRRT, and CRRT with recommendations for individualizing therapy. Relevance to Patient Care and Clinical Practice: This review defines principles for assessing renal function, identifies RRT system properties affecting drug clearance and drug properties affecting clearance during RRT, outlines pharmacokinetic and pharmacodynamic dosing considerations, reviews pertinent updates in the literature, develops updated empirical dosing recommendations, and highlights important factors for individualizing therapy in critically ill patients. Conclusions: Appropriate antimicrobial selection and dosing are vital to improve clinical outcomes. Dosing recommendations should be applied cautiously with efforts to consider local epidemiology and resistance patterns, antibiotic dosing and infusion strategies, renal replacement modalities, patient-specific considerations, severity of illness, residual renal function, comorbidities, and patient response to therapy. Recommendations provided herein are intended to serve as a guide in developing and revising therapy plans individualized to meet a patient’s needs.

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Antibiotic Dosing in Critically Ill Patients

Critical Care Update 2009 ◽

10.5005/jp/books/11147_12 ◽

2010 ◽

pp. 128-128

Author(s):

Marta Ulldemolins, ◽

Jason Roberts, ◽

Julie Varghese, ◽

Jeffrey Lipman

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Antibiotic Dosing

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Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

10.2337/figshare.13570862.v1 ◽

2021 ◽

Author(s):

Georgia M. Davis ◽

Eileen Faulds ◽

Tara Walker ◽

Debbie Vigliotti ◽

Marina Rabinovich ◽

...

Keyword(s):

Real Time ◽

Critically Ill ◽

Continuous Glucose Monitoring ◽

Critically Ill Patients ◽

Insulin Infusion ◽

Point Of Care ◽

Glucose Monitoring ◽

Proof Of Concept ◽

Computerized Decision Support ◽

Glucose Testing

Objective: The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment (PPE) and reduce potential exposures during COVID-19. Design and Methods: We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion (CII) and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 ICU. Results: All nine patients required mechanical ventilation and corticosteroids. Seventy six percent of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients. Conclusions: A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion.

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