scholarly journals Vancomycin Serum Concentration after 48 h of Administration: A 3-Years Survey in an Intensive Care Unit

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 793
Author(s):  
Nicolas Perin ◽  
Claire Roger ◽  
Grégory Marin ◽  
Nicolas Molinari ◽  
Alexandre Evrard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Concentration ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Loading Dose ◽  
Duration Of Treatment ◽  
Icu Patients ◽  
Vancomycin Concentration ◽  
Serum Vancomycin

The present study assessed the proportion of intensive care unit (ICU) patients who had a vancomycin serum concentration between 20 and 25 mg/L after 24–48 h of intravenous vancomycin administration. From 2016 to 2018, adult ICU patients with vancomycin continuous infusion (CI) for any indication were included. The primary outcome was the proportion of patients with a first-available vancomycin serum concentration between 20–25 mg/L at 24 h (D2) or 48 h (D3). Of 3894 admitted ICU patients, 179 were included. A median loading dose of 15.6 (interquartile range (IQR) = (12.5–20.8) mg/kg) was given in 151/179 patients (84%). The median daily doses of vancomycin infusion for D1 and D2 were 2000 [(IQR (1600–2000)) and 2000 (IQR (2000–2500)) mg/d], respectively. The median duration of treatment was 4 (2–7) days. At D2 or D3, the median value of first serum vancomycin concentration was 19.8 (IQR (16.0–25.1)) with serum vancomycin concentration between 20–25 mg/L reported in 43 patients (24%). Time spent in the ICU before vancomycin initiation was the only risk factor of non-therapeutic concentration at D2 or D3. Acute kidney injury occurred significantly more when vancomycin concentration was supra therapeutic at D2 or D3. At D28, 44 (26%) patients had died. These results emphasize the need of appropriate loading dose and regular monitoring to improve vancomycin efficacy and avoid renal toxicity.

scholarly journals Acute kidney injury incidence and acute renal replacement modality in intensive care unit patients in Indonesia: A result from Southeast Asia-Acute Kidney Injury Study

2020 ◽  
Author(s):  
Jonny Jonny ◽  
Moch Hasyim ◽  
Vedora Angelia ◽  
Ayu Nursantisuryani Jahya ◽  
Lydia Permata Hilman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Southeast Asia ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Apache Ii Score ◽  
Icu Patients ◽  
Three Stages

Abstract Background : Currently, there is limited data of large databases of acute kidney injury (AKI) epidemiology from Southeast Asia, especially in Indonesia, the biggest countries in. Therefore, we aimed to provide demographic data of intensive care unit (ICU) patients with AKI and the utilization of renal replacement therapy (RRT) in Indonesia. Methods : We collected demographic and clinical data from 952 ICU patients. Patients were classified into AKI and non-AKI. AKI was classified according to the Kidney Disease Improving Global Outcome (KDIGO) criteria in three stages. We then assess the Acute Physiology and Chronic Health Evaluation (APACHE) II score of AKI and non-AKI patients. RRT modalities were listed down by the number of procedures conducted. Results : Overall incidence of AKI was 43%, distributed among three stages: 18.5 % stage 1, 33% stage 2, 48.5 % stage 3. Patients developing AKI need mechanical ventilation more often in comparison with non-AKI. Patients with AKI have an average APACHE score of 16.5, while non-AKI patients have an average score of 9.9. Among AKI patients, 24.6% requires RRT. The most common RRT modalities were intermittent hemodialysis (69.4%), followed by slow low efficiency dialysis (22.1%), continuous renal replacement therapy (4.2%), and peritoneal dialysis (1.1%). Conclusions: This study showed that AKI is a common problem in Indonesian ICU with containing a high mortality rate. We strongly believe that identification the risk factor of AKI will provide the opportunity to develop the predictability score for AKI prevention and finally improve AKI outcome.

scholarly journals Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons

2021 ◽  
Vol 10 (19) ◽  
pp. 4288
Author(s):  
Alessandro Affronti ◽  
Elena Sandoval ◽  
Anna Muro ◽  
Jose Hernández-Campo ◽  
Eduard Quintana ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Deep Sternal Wound Infection ◽  
Major Morbidity ◽  
Prolonged Intubation

Surgical re-explorations represent 3–5% of all cardiac surgery. Concerns regarding mortality and major morbidity of re-explorations in the intensive care unit (ICU) setting exist. We sought to investigate whether they may have different outcomes compared with those performed in the operating room (OR). Single center retrospective review of patients who underwent mediastinal re-exploration in the ICU or in the OR after cardiac surgery. Mediastinal re-explorations were also classified as: “planned” and “unplanned”. Primary outcome was 30-day mortality, secondary outcomes include deep sternal wound infection (DSWI), sepsis, ICU and hospital length of stay, prolonged intubation (>72 h), tracheostomy, pneumonia, acute kidney injury requiring dialysis and stroke. Between 2010 and 2019, 195 of 7263 patients (2.7%) underwent mediastinal re-exploration after cardiac surgery. More patients in the ICU group experienced two or more re-explorations (30.3% vs 2.3%, p < 0.001), a higher incidence of postoperative pneumonia (22% vs 7%, p = 0.004), prolonged intubation (46.8% vs 19.8%, p < 0.001) and longer hospital stay (30.3 ± 34.2 vs. 20.8 ± 18.3 days, p = 0.014). There were no differences in mortality between ICU and OR (16.5% vs. 13.9%, p = 0.24) nor in sepsis (14.7% vs 7%, p = 0.91) and DSWI rates (1.8% vs 1.2%, p = 0.14). Re-explorations in the ICU were not associated with increased mortality, sepsis and mediastinitis rate.

scholarly journals Brain death in low-income countries: a report from Malawi

2019 ◽  
Vol 49 (2) ◽  
pp. 107-112 ◽  
Author(s):  
Meghan Prin ◽  
Caroline Quinsey ◽  
Clement Kadyaudzu ◽  
Eldad Hadar ◽  
Anthony Charles
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Death ◽  
Low Income ◽  
Cardiac Death ◽  
Primary Outcome ◽  
Low Income Countries ◽  
Postoperative Monitoring ◽  
Icu Patients ◽  
Death Data

Most low-income nations have no practice guidelines for brain death; data describing brain death in these regions is absent. Our retrospective study describes the prevalence of brain death among patients treated in an intensive care unit (ICU) at a referral hospital in Malawi. The primary outcome was designation of brain death in the medical chart. Of 449 ICU patients included for analysis between September 2016 and May 2018, 43 (9.6%) were diagnosed with brain death during the ICU admission. The most common diagnostic reasons for admission among these patients were trauma (49%), malaria (16%) and postoperative monitoring after general abdominal surgery (19%). All patients diagnosed with brain death were declared dead in the hospital, after cardiac death. In conclusion, the incidence of brain death in a Malawi ICU is substantially higher than that seen in high-income ICU settings. Brain death is not treated as clinical death in Malawi.

Rationality of Administered Gentamicin Dose in Cerebral Coma Patients Treated in an Intensive Care Unit

Medicina ◽  
2011 ◽  
Vol 47 (2) ◽  
pp. 10
Author(s):  
Tomas Janušonis ◽  
Romaldas Mačiulaitis ◽  
Audrius Sveikata ◽  
Rima Kregždytė ◽  
Keyword(s):  
Intensive Care Unit ◽  
Body Weight ◽  
Intensive Care ◽  
Serum Concentration ◽  
Inverse Correlation ◽  
Volume Of Distribution ◽  
Icu Patients ◽  
Elimination Half ◽  
Dose Infusion ◽  
Gentamicin Concentration

Gentamicin is still widely used in the treatment of patients in an intensive care unit (ICU). The efficacy of aminoglycosides correlates with the peak serum concentration (Cmax), and the toxicity with the minimum serum concentration (Cmin). The aim of this study was to determine Cmax and Cmin in serum of cerebral coma ICU patients when a dosage of gentamicin of 5 mg/kg body weight was administered once daily; to evaluate the rationality of mentioned dose; and to identify factors associated with these concentrations. Material and Methods. A total of 24 ICU patients suffering from cerebral coma were included into this analysis. A dosage of gentamicin of 5 mg/kg body weight was administered once a day. Gentamicin concentrations were tested twice after the first dose infusion (immediately and 5 hours after 1-hour infusion). Cmax, Cmin, volume of distribution (Vd), and elimination half-life (T1/2) were obtained. Results. The mean Cmax was 17.96 (SD, 4.31) μg/mL (range, 10.30–27.87 μg/mL). The desirable Cmax (≥20 μg/mL) was reached only in 6 patients (25%). Cmin was calculated using a special pharmacokinetic program “Kinetica.” Cmin of 0.5 μg/mL was not exceeded in any patient. A correlative analysis indicated a significant inverse direct correlation between Cmax and Vd and between Cmax and treatment duration in the ICU. An inverse correlation was observed between Cmin and T1/2, evaluation of coma according to the Glasgow coma scale, and creatinine clearance. Conclusions. A dosage of 5 mg/kg body weight once a day was not sufficient in cerebral coma ICU patients. This dose was not associated with the nephrotoxic effect of gentamicin (additional risk factors were absent). It is recommended to obtain gentamicin concentration at two time points following administration of the first dose (e.g., immediately after 1-hour infusion and 5 hours later), and using a special pharmacokinetic software, to calculate a necessary dose and interval of administration.

Outcomes of Prophylactic Pantoprazole in Adult Intensive Care Unit Patients Receiving Dialysis: Results of a Randomized Trial

2019 ◽  
Vol 50 (4) ◽  
pp. 312-319 ◽  
Author(s):  
Joerg C. Schefold ◽  
Mette Krag ◽  
Søren Marker ◽  
Anders Perner ◽  
Jørn Wetterslev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Kidney Injury ◽  
Statistical Analysis Plan ◽  
Gi Bleeding ◽  
Icu Patients ◽  
Once Daily ◽  
Adult Intensive Care Unit ◽  
Icu Discharge ◽  
Ulcer Prophylaxis

Background: Intensive care unit (ICU) patients with acute kidney injury requiring renal replacement therapy (RRT) are considered at high risk of gastrointestinal (GI) bleeding and stress ulcer prophylaxis (SUP) is often prescribed. We aimed to assess the incidence of GI bleeding and effects of SUP in these patients. Methods: We assessed GI bleeding in ICU patients receiving RRT at baseline (and at any time in the ICU) and effects of prophylactic pantoprazole versus placebo in the international SUP in the ICU (SUP-ICU) trial. All analyses were conducted according to a published protocol and statistical analysis plan. Results: Data of 3,291 acutely admitted adult ICU patients with one or more risk factors for GI bleeding randomized to pantoprazole or placebo intravenously once daily during ICU stay (until ICU discharge, death, or a maximum of 90 days) were analyzed. Some 20 out of 258 (7.8%, 95% CI 4.5–11.1%) and 52 out of 568 (9.2%, 95% CI 6.8–11.6%) of the patients receiving RRT at baseline and at any time in ICU, respectively, developed clinically important GI bleeding in the ICU. We did not observe statistically significant differences in the intervention effect (pantoprazole vs. placebo) in the proportion of patients with clinically important GI bleeding, clinically important events, infectious adverse events, use of interventions to stop GI bleeding, or 90-day mortality in patients with versus without RRT at baseline. Conclusions: In adult ICU patients receiving RRT at baseline, we observed high incidences of clinically important GI bleeding, but did not observe effects of pantoprazole versus placebo in this subgroup.

scholarly journals Assessment of Postresuscitation Volume Status by Bioimpedance Analysis in Patients with Sepsis in the Intensive Care Unit: A Pilot Observational Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Bram Rochwerg ◽  
Jason H. Cheung ◽  
Christine M. Ribic ◽  
Faraz Lalji ◽  
France J. Clarke ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Pressure ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Volume Status ◽  
Bioimpedance Analysis ◽  
Consent Rate ◽  
Icu Patients ◽  
Unit Increase

Background. Bioimpedance analysis (BIA) is a novel method of assessing a patient’s volume status.Objective. We sought to determine the feasibility of using vector length (VL), derived from bioimpedance analysis (BIA), in the assessment of postresuscitation volume status in intensive care unit (ICU) patients with sepsis.Method. This was a prospective observational single-center study. Our primary outcome was feasibility. Secondary clinical outcomes included ventilator status and acute kidney injury. Proof of concept was sought by correlating baseline VL measurements with other known measures of volume status.Results. BIA was feasible to perform in the ICU. We screened 655 patients, identified 78 eligible patients, and approached 64 for consent. We enrolled 60 patients (consent rate of 93.8%) over 12 months. For each 50-unit increase in VL, there was an associated 22% increase in the probability of not requiring invasive mechanical ventilation (IMV) (p=0.13). Baseline VL correlated with other measures of volume expansion including serum pro-BNP levels, peripheral edema, and central venous pressure (CVP).Conclusion. It is feasible to use BIA to predict postresuscitation volume status and patient-important outcomes in septic ICU patients.Trial Registration. This trial is registered with clinicaltrials.govNCT01379404registered on June 7, 2011.

Impact of Early Reinitiation of Neuropsychiatric Medications on Agitation and Delirium in the Intensive Care Unit: A Retrospective Study

2020 ◽  
Vol 55 (1) ◽  
pp. 15-24
Author(s):  
Michaelia D. Cucci ◽  
Brittany S. Cunningham ◽  
Jaimini S. Patel ◽  
Alan T. Shimer ◽  
Dania I. Mofleh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Group Versus ◽  
Care Hospital ◽  
Icu Patients ◽  
Independent Risk Factors ◽  
The Impact

Background: Approximately 17% of intensive care unit (ICU) patients are prescribed at least 1 home neuropsychiatric medication (NPM). When abruptly discontinued, withdrawal symptoms may occur manifesting as agitation or delirium in the ICU setting. Objective: To evaluate the impact of early reinitiation of NPMs. Methods: This was a retrospective, observational cohort of adult ICU patients in a tertiary care hospital. Patients were included if admitted to the ICU and prescribed a NPM prior to arrival. Study groups were based on the timing of reinitiation of at least 50% of NPMs: ≤72 hours (early group) versus >72 hours (late group). Results: The primary outcome was the proportion of patients with at least 1 agitation or delirium episode in the first 72 hours. Agitation and delirium were defined as at least 1 RASS assessment between +2 to +4 and a positive CAM-ICU assessment, respectively. A total of 300 patients were included, with 187 (62%) and 113 (38%) in the early and late groups, respectively. There was no difference in agitation or delirium (late 54 [48%] vs early 62 [33%]; adjusted odds ratio [aOR] = 1.5; 95% CI = 0.8-2.8; P = 0.193). Independent risk factors found to be associated with the primary outcome were restraints (aOR = 12.9; 95% CI = 6.9-24.0; P < 0.001) and benzodiazepines (BZDs; aOR = 2.0; 95% CI = 1.0-3.7; P = 0.038). Conclusions: After adjustment for baseline differences, there was no difference in agitation or delirium. Independent risk factors were restraint use and newly initiated BZDs.

scholarly journals Efficacy of Corticosteroids in Non-Intensive Care Unit Patients with COVID-19 Pneumonia from the New York Metropolitan region

2020 ◽  
Author(s):  
Monil Majmundar ◽  
Tikal Kansara ◽  
Joanna Marta Lenik ◽  
Hansang Park ◽  
Kuldeep Ghosh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Primary Outcome ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Composite Outcome ◽  
Icu Patients ◽  
Icu Transfer ◽  
Primary Composite Outcome ◽  
Over Time

AbstractIntroductionThe role of systemic corticosteroid as a therapeutic agent for patients with COVID-19 pneumonia is controversial.ObjectiveThe purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID-19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF).MethodsThis was a single-center retrospective cohort study, comprising of 205 patients admitted to the general wards with COVID-19 pneumonia. The primary outcome was a composite of ICU transfer, intubation, or in-hospital mortality. Cox-proportional hazard regression was implemented.ResultAmong 205 patients, 60 (29.27%) were treated with corticosteroid. The mean age was ∼57 years, and ∼75% were men. Thirteen patients (22.41%) developed a primary composite outcome in the corticosteroid cohort vs. 54 (37.5%) patients in the non-corticosteroid cohort (P=0.039). The adjusted hazard ratio (HR) for the development of the composite primary outcome was 0.15 (95% CI, 0.07 – 0.33; P <0.001). The adjusted hazard ratio for ICU transfer was 0.16 (95% CI, 0.07 to 0.34; P < 0.001), intubation was 0.31 (95% CI, 0.14 to 0.70; P – 0.005), death was 0.53 (95% CI, 0.22 to 1.31; P – 0.172), and discharge was 3.65 (95% CI, 2.20 to 6.06; P<0.001). The corticosteroid cohort had increasing SpO2/FiO2 over time compared to the non-corticosteroid cohort who experience decreasing SpO2/FiO2 over time.ConclusionAmong non-ICU patients hospitalized with COVID-19 pneumonia complicated by AHRF, treatment with corticosteroid was associated with a significantly lower risk of the primary composite outcome of ICU transfer, intubation, or in-hospital death.

scholarly journals Microalbuminuria can predict the development of acute kidney injury in intensive care unit admission

2020 ◽  
Vol 7 (9) ◽  
pp. 1372
Author(s):  
Bharath G. ◽  
Prasanna Kumar ◽  
Mahendra S. V.
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Statistical Significance ◽  
Prognostic Significance ◽  
Kidney Injury ◽  
Common Finding ◽  
P Value ◽  
Icu Patients ◽  
Icu Stay

Background: Microalbuminuria, defined as 30–300 mg/day of albumin excretion in urine is a common finding in ICU patients and has shown not only as a predictor of organ failure but prolonged intensive care unit (ICU)  stay. Objective of the study was to determine the prediction of acute kidney injury using urine microalbuminuria and to determine the presence of urine microalbuminuria and relationship between ICU length of stay.Methods: The present study is conducted on patients admitted to Medical ICU in SDMCMSH, Dharwad from December 2016 to November 2017. 75 patients who met the inclusion and exclusion criteria were included in the study.Results: The present study included 75 patients, among which 50 were males and 25 were females. The mean age was 60.2years. AKI was developed more in non-diabetics than diabetics and non-hypertensives than hypertensives. The median urine microalbumin at admission in AKI was 80.9 and at 48 hr was130.1 predicted the AKI mean (1.79) in 59 patients with a p value of <0.001 using Mann Whitney test and P value statistically significant.Conclusions: Urine microalbuminuria at 48 hr has predicted AKI in 59 patients with median of 130.1 with statistical significance. Urine microalbuminuria of high value in AKI is directly proportional to prolonged ICU stay. At 48 hours of admission, increased levels of microalbuminuria compared at admission and 48 hour, indicates its prognostic significance among AKI and NON-AKI’s in ICU patients.

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