scholarly journals Penetration of Isavuconazole in Ascites Fluid of Critically Ill Patients

2021 ◽  
Vol 7 (5) ◽  
pp. 376
Author(s):  
Tobias Lahmer ◽  
Gonzalo Batres Baires ◽  
Roland M. Schmid ◽  
Johannes R. Wiessner ◽  
Jörg Ulrich ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Ascites Fluid ◽  
Candida Spp ◽  
Fungal Peritonitis ◽  
Penetration Ratio ◽  
Threatening Condition ◽  
Liquid Chromatography Tandem Mass ◽  
Life Threatening ◽  
Fluid Levels

Fungal peritonitis is a life-threatening condition which is not only difficult to diagnose, but also to treat. Following recent guidelines, echinocandins and azoles are the recommended antimycotics for the management of intra-abdominal Candida spp. infections, with a favor for echinocandins in critically ill patients. However, the new extended spectrum triazole isavuconazole also has a broad spectrum against Candida spp. Data on its target-site penetration are sparse. Therefore, we assessed isavuconazole concentrations and penetration ratios in ascites fluid of critically ill patients. Obtaining of Isavuconazole plasma and ascites fluid levels as well penetration ratios using paracentesis in critically ill patients. Isavuconazole concentrations were quantified in human plasma and ascites by a liquid chromatography/tandem mass spectrometry (LC-MS/MS) method. Isavuconazole concentrations in plasma and ascites fluid were measured in sixteen critically ill patients. Isavuconazol levels in ascites fluid (1.06 µg/mL) were lower than plasma levels (3.08 µg/mL). Penetration ratio was 36%. In two out of sixteen patients, Candida spp., in detail C. glabrata and C. tropicalis, could be isolated. Cmax/MIC Ratio in plasma of 560 for C. glabrata and 2166 for C. tropicalis could be observed. Following our results, isavuconazole penetrates into ascites. Successful treatment in Candida spp. peritonitis depends on pathogen susceptibility.

Pleural Diseases in Critical Care Medicine

2019 ◽  
pp. 161-165
Author(s):  
Karthika R. Linga ◽  
Neal M. Patel
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Catheter Placement ◽  
Critical Care Medicine ◽  
Pleural Disease ◽  
Pleural Diseases ◽  
Threatening Condition ◽  
Life Threatening

Pleural disease often affects critically ill patients and is usually related to trauma (including accidental perforation) or infection. Pneumothorax, a potentially life-threatening condition, requires early clinical recognition and sometimes urgent treatment. General intensivists often encounter pneumothorax after a procedure such as catheter placement. Neurointensivists often encounter pneumothorax after polytrauma or recent tunneling of a ventriculoperitoneal catheter.

Pericardiocentesis

2015 ◽  
Author(s):  
Gerard Martí Aguasca ◽  
Bruno Garcia del Blanco ◽  
Jaume Sagristà Sauleda
Keyword(s):  
Cardiac Tamponade ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Procedure ◽  
Pericardial Fluid ◽  
Threatening Condition ◽  
Life Threatening ◽  
Optimal Imaging

Cardiac tamponade is a life-threatening condition that may require the urgent removal of pericardial fluid. Therefore, the pericardiocentesis procedure should be part of the skills of physicians treating critically ill patients. The pericardiocentesis technique has evolved from a blind and unguided procedure, prone to complications, to a safer and more effective guided technique by using echocardiography or fluoroscopy. However, as in any invasive procedure, complications still occur. Therefore, indications should be restricted to patients with cardiac tamponade or a high suspicion of specific aetiologies when performed for diagnostic purposes. Accurate indications, optimal imaging assessment, knowledge of materials required, familiarization with different techniques, and rapid recognition of complications are key for a successful procedure.

Spirituality and Surgery

2019 ◽  
pp. 43-54
Author(s):  
Daniel B. Hinshaw
Keyword(s):  
Nineteenth Century ◽  
Critically Ill ◽  
Spiritual Care ◽  
Critically Ill Patients ◽  
Basic Skills ◽  
Close Connection ◽  
Spiritual Needs ◽  
Human Suffering ◽  
Scientific Medicine ◽  
Life Threatening

Increasing evidence has demonstrated the importance of spirituality and spiritual care for patients with life-threatening illnesses. With the growth of scientific medicine from the nineteenth century, a medical dualism has developed with an intense focus on identifying and treating disease almost to the exclusion of caring for the suffering of the person with the disease. This chapter provides surgeons with an understanding of human suffering and its close connection to spirituality, reviews studies highlighting the importance of spirituality and spiritual care to critically ill patients, and outlines some basic skills surgeons can develop to address the spiritual needs of their patients.

scholarly journals Therapeutic plasma exchange in adult critically ill patients with life-threatening SARS-CoV-2 disease: A pilot study

2020 ◽  
Vol 60 ◽  
pp. 328-333 ◽  
Author(s):  
Fahad Faqihi ◽  
Abdulrahman Alharthy ◽  
Mohammed Alodat ◽  
Demetrios J. Kutsogiannis ◽  
Peter G. Brindley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening

scholarly journals Anidulafungin Pharmacokinetics in Ascites Fluid and Pleural Effusion of Critically Ill Patients

2018 ◽  
Vol 62 (4) ◽  
pp. e02326-17 ◽  
Author(s):  
R. Welte ◽  
P. Eller ◽  
I. Lorenz ◽  
M. Joannidis ◽  
R. Bellmann
Keyword(s):  
High Pressure ◽  
Liquid Chromatography ◽  
Pleural Effusion ◽  
Critically Ill ◽  
High Pressure Liquid Chromatography ◽  
Critically Ill Patients ◽  
Uv Detection ◽  
Ascites Fluid ◽  
Content Type

ABSTRACT Anidulafungin concentrations were quantified with high-pressure liquid chromatography (HPLC) and UV detection of the ascites fluid and pleural effusion of 10 adult critically ill patients. Samples were collected from ascites fluid and from pleural drains or during paracentesis and thoracentesis, respectively. Anidulafungin levels in ascites fluid (0.12 to 0.99 μg/ml) and in pleural effusion (0.32 to 2.02 μg/ml) were below the simultaneous levels in plasma (1.04 to 7.70 and 2.48 to 13.36 μg/ml, respectively) and below the MIC values for several pathogenic Candida strains.

The role of nutrition in critical care

2020 ◽  
Vol 11 (4) ◽  
pp. 166-171
Author(s):  
Kathryn Latimer-Jones
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Physiological Stress ◽  
Active Role ◽  
Drug Induced ◽  
Increased Risk ◽  
Anorexic Patient ◽  
Life Threatening ◽  
Improve Patient

Critically ill patients have conditions that are considered life-threatening and require comprehensive care and constant monitoring; nutritional support plays a key role in the recovery of these patients and is an area of veterinary medicine that is very easy for the registered veterinary nurse (RVN) to have an active role in. Critically ill patients are at increased risk of malnutrition; acute and chronic illness, trauma and inflammation induced stress-related catabolism, and drug-induced adverse effects may reduce appetite or increase nausea and vomiting. Challenges exist in the provision of support, especially in the anorexic patient. This article focuses on how severe physiological stress affects animals that are critically ill and how this might lead to malnutrition, how to accurately calculate energy requirements, and discusses the importance of selecting the most appropriate diet to improve patient outcomes.

scholarly journals New Colistin Population Pharmacokinetic Data in Critically Ill Patients Suggesting an Alternative Loading Dose Rationale

2014 ◽  
Vol 58 (12) ◽  
pp. 7324-7330 ◽  
Author(s):  
N. Grégoire ◽  
O. Mimoz ◽  
B. Mégarbane ◽  
E. Comets ◽  
D. Chatelier ◽  
...  
Keyword(s):  
Steady State ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
Multidrug Resistant ◽  
Pharmacokinetic Analysis ◽  
Population Pharmacokinetic ◽  
Pharmacokinetic Data ◽  
Loading Dose ◽  
Liquid Chromatography Tandem Mass

ABSTRACTColistin is an old antibiotic that has recently gained a considerable renewal of interest as the last-line defense therapy against multidrug-resistant Gram-negative bacteria. It is administered as colistin methanesulfonate (CMS), an inactive prodrug, and it was shown that due to slow CMS conversion, colistin plasma concentrations increase very slowly after treatment initiation, which constitutes the rationale for a loading dose in critically ill patients. However, faster CMS conversion was observed in healthy volunteers but using a different CMS brand, which may also have a major impact on colistin pharmacokinetics. Seventy-three critically ill patients not undergoing dialysis received multiple doses of CMS. The CMS concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and a pharmacokinetic analysis was conducted using a population approach. We confirmed that CMS renal clearance and colistin concentrations at steady state are mostly governed by creatinine clearance, but we predict a typical maximum concentration of drug in serum (Cmax) of colistin close to 2 mg/liter, occurring 3 h after an initial dose of 2 million international units (MIU) of CMS. Accordingly, the estimated colistin half-life (t1/2) was relatively short (3.1 h), with rapid attainment of steady state. Our results are only partially consistent with other recently published results. We confirm that the CMS maintenance dose should be adjusted according to renal function in critically ill patients. However, much higher than expected colistin concentrations were observed after the initial CMS dose, with rapid steady-state achievement. These discrepancies challenge the pharmacokinetic rationale for a loading dose, which may still be appropriate for rapid bacterial eradication and an improved clinical cure rate.

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