scholarly journals Development of a Model-Informed Dosing Tool to Optimise Initial Antibiotic Dosing—A Translational Example for Intensive Care Units

Pharmaceutics ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2128
Author(s):  
Ferdinand Anton Weinelt ◽  
Miriam Songa Stegemann ◽  
Anja Theloe ◽  
Frieder Pfäfflin ◽  
Stephan Achterberg ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Drug Exposure ◽  
Patient Characteristics ◽  
Initial Therapy ◽  
Decision Tool ◽  
Specific Patient ◽  
Decision Tools ◽  
Antibiotic Drug ◽  
Dosing Regimens

The prevalence and mortality rates of severe infections are high in intensive care units (ICUs). At the same time, the high pharmacokinetic variability observed in ICU patients increases the risk of inadequate antibiotic drug exposure. Therefore, dosing tailored to specific patient characteristics has a high potential to improve outcomes in this vulnerable patient population. This study aimed to develop a tabular dosing decision tool for initial therapy of meropenem integrating hospital-specific, thus far unexploited pathogen susceptibility information. An appropriate meropenem pharmacokinetic model was selected from the literature and evaluated using clinical data. Probability of target attainment (PTA) analysis was conducted for clinically interesting dosing regimens. To inform dosing prior to pathogen identification, the local pathogen-independent mean fraction of response (LPIFR) was calculated based on the observed minimum inhibitory concentrations distribution in the hospital. A simple, tabular, model-informed dosing decision tool was developed for initial meropenem therapy. Dosing recommendations achieving PTA > 90% or LPIFR > 90% for patients with different creatinine clearances were integrated. Based on the experiences during the development process, a generalised workflow for the development of tabular dosing decision tools was derived. The proposed workflow can support the development of model-informed dosing tools for initial therapy of various drugs and hospital-specific conditions.

scholarly journals Characterization and Outcome of Two Pediatric Intensive Care Units with Different Resources

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Rania G. Abdelatif ◽  
Montaser M. Mohammed ◽  
Ramadan A. Mahmoud ◽  
Mohamed A. M. Bakheet ◽  
Masafumi Gima ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Units ◽  
Cerebral Performance Category ◽  
Pediatric Intensive Care ◽  
Cost Effective ◽  
Patient Characteristics ◽  
Neurological Status ◽  
Pediatric Intensive Care Units ◽  
Mortality Outcome

Background. The pediatric intensive care units (PICUs) in developing countries have a higher mortality outcome due to a wide variety of causes. Identifying differences in the structure, patient characteristics, and outcome between PICUs with different resources may add evidence to the need for incorporating more PICUs with limited resources in the contemporary critical care research to improve the care provided for severely ill children. Methods. A retrospective study was conducted at Egyptian and Japanese PICUs as examples of resource-limited and resource-rich units, respectively. We collected and compared data of nonsurgical patients admitted between March 2018 and February 2019, including the patients’ demographics, diagnosis, PICU length of stay, outcome, predicted risk of mortality using pediatric index of mortality-2 (PIM-2), and functional neurological status using the Pediatric Cerebral Performance Category (PCPC) scale. Results. The Egyptian unit had a lower number of beds with a higher number of annual admission/bed than the Japanese unit. There was a shortage in the number of the skilled staff at the Egyptian unit. Nurse : patient ratios in both units were only similar at the nighttime (1 : 2). Most of the basic equipment and supplies were available at the Egyptian unit. Both actual and PIM-2 predicted mortalities were markedly higher for patients admitted to the Egyptian unit, and the mortality was significantly associated with age, severe sepsis, and PIM-2. The length of stay was shorter at the Egyptian unit. Conclusion. The inadequate structure and the burden of more severely ill children at the Egyptian unit appear to be the most important causes behind the higher mortality at this unit. Increasing the number of qualified staff and providing cost-effective equipment may help in improving the mortality outcome and the quality of care.

scholarly journals Patient Predictors of Dexmedetomidine Effectiveness for Sedation in Intensive Care Units

2014 ◽  
Vol 23 (2) ◽  
pp. 160-165 ◽  
Author(s):  
Pamela L. Smithburger ◽  
Randall B. Smith ◽  
Sandra L. Kane-Gill ◽  
Philip E. Empey
Keyword(s):  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Multiple Logistic Regression Analysis ◽  
Patient Characteristics ◽  
Specific Patient ◽  
Academic Medical ◽  
Adequate Sedation ◽  
Effective Sedation ◽  
At Home

Background Dexmedetomidine, a selective α2-adrenergic receptor agonist, is increasingly used as a sedative in intensive care despite variations in patients’ responses. Objectives To determine the effectiveness of dexmedetomidine as a sedative and specific patient characteristics that play a role in adequate sedation with dexmedetomidine. Methods A 6-month, pilot, prospective observational study was performed in a medical intensive care unit at an academic medical center. Patients receiving dexmedetomidine were followed up until use of the drug was stopped and they were classified as nonresponders or responders. Effective sedation was defined as a score of 3 to 4 on the Sedation Agitation Scale after the administration of dexmedetomidine. Patient characteristics, laboratory values, home and inpatient medications, and dexmedetomidine dosing information were collected to identify predictors of clinical response. Results During the 6-month study period, 38 patients received dexmedetomidine. The drug was ineffective as a sedative in 19 patients (50%) and effective in 11 (29%). Effectiveness could not be assessed in 8 patients because of clinical confounders. According to standard multiple logistic regression analysis, successful sedation was more likely in patients with a lower score on the Acute Physiology and Chronic Health Evaluation II (Odds Ratio [OR] 0.81; 95% CI, −0.39 to −0.03) and patients who took antidepressants at home (OR 10.27; 95% CI, 0.23 to 4.43) than in patients who had a higher score or did not take antidepressants at home. Conclusions Effective sedation with dexmedetomidine is variable.

Nurse-led extubation in the post-anaesthesia care unit

2018 ◽  
Vol 28 (12) ◽  
pp. 362-365
Author(s):  
Olivia Sonneborn ◽  
Gill Robers
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Patient Outcomes ◽  
Patient Group ◽  
Specific Patient ◽  
Post Anaesthesia Care Unit ◽  
Hospital Resources ◽  
Anaesthesia Care

Weaning of mechanical ventilation occurs in intensive care units by nurses, which stimulates the prospect of nurse-led extubation extending into the PACU environment for improved patient outcomes and reduced demand of hospital resources. Nurse-led patient extubation in the PACU, would involve specially trained nurses weaning mechanical ventilation via an established protocol for a specific patient group, prior to the patient being extubated by an anaesthetist or intensivist.

scholarly journals Rationality of Time-Dependent Antimicrobial Use in Intensive Care Units in China: A Nationwide Cross-Sectional Survey

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiao Liu ◽  
Sheng Zhang ◽  
Sisi Huang ◽  
Yizhu Chen ◽  
Lidi Zhang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Intensive Care Units ◽  
Drug Exposure ◽  
Time Dependent ◽  
Therapeutic Drug ◽  
Multivariable Logistic Regression Analysis ◽  
Prescribing Practices ◽  
Cross Sectional Survey

Background: Extended/continuous infusion and therapeutic drug monitoring (TDM) of time-dependent antimicrobials are recommended for optimizing drug exposure for patients in intensive care units (ICUs), although practical application of these measures remains uncertain. We surveyed current practices in infusion and monitoring of commonly prescribed time-dependent antimicrobials in ICUs across China.Methods: From December 2019 to January 2020, we sent online questionnaires about various aspects of infusion and monitoring of time-dependent antimicrobials to intensivists across China. Responses from clinicians were matched with their professional titles using the Sankey diagram. Univariate and multivariate logistic regression analyses were performed to find factors associated with TDM.Results: A total of 3,687 ICU specialists from 31 provincial administrative regions of China responded to our questionnaires. Antibiotic stewardship (ABS) teams were available in hospitals as reported by 3,243 (88.0%) intensivists, including 1,308 (35.5%) who were ABS team members. Although most intensivists (3,490, 94.7%) were acquainted with the concept of prolonged/continuous infusion, nearly half of them (1,634, 44.3%) commonly administered β-lactam antibiotics intermittently. Nearly two-thirds of the respondents reported that their hospitals could not perform TDM. Our multivariable logistic regression analysis revealed that at the hospital level, knowledge of drug sample timing and attitude toward monitoring treatment effects, and drug trough or peak concentration influenced the decision to conduct TDM.Conclusions: We found great variability in prescribing practices, from drug administration to TDM, for several time-dependent antibiotics commonly used for patients with severe infections. Further studies are necessary to effectively evaluate strategies to promote consistent prescribing behavior.

Delayed Cord Clamping and Umbilical Cord Milking among Infants in California Neonatal Intensive Care Units

2019 ◽  
Vol 37 (02) ◽  
pp. 151-157 ◽  
Author(s):  
Chinh L. Tran ◽  
Janella M. Parucha ◽  
Priya Jegatheesan ◽  
Henry C. Lee
Keyword(s):  
Intensive Care ◽  
Confidence Interval ◽  
Intensive Care Units ◽  
Odds Ratio ◽  
Neonatal Intensive Care ◽  
Quality Care ◽  
Patient Characteristics ◽  
Neonatal Intensive Care Units ◽  
Delayed Cord Clamping ◽  
Cord Clamping

Objective To assess the current practice of delayed cord clamping (DCC) and to determine patient and hospital factors that predict DCC. Study Design The California Perinatal Quality Care Collaborative (CPQCC) collects data on preterm and acutely ill infants. In 2016, 52 CPQCC neonatal intensive care units (NICUs) collected data on DCC. Hospital and patient characteristics were analyzed using multivariable logistic regression. Results Of 5,332 deliveries, 1,555 (29%) newborns received DCC. Hospital rates ranged from 0 to 74.5% and increased from 21 to 37% throughout 2016. Infants delivered at <32 weeks or with birth weight <1,500 g were more likely to receive DCC (odds ratio: 2.80; 95% confidence interval: 2.33, 3.36). Cesarean delivery was associated with less likelihood of DCC (odds ratio: 0.68; 95% confidence interval: 0.59, 0.79). After risk adjustment, 17 (33%) hospitals had higher than expected DCC rate. Hospitals with less than 50 NICU beds are more likely to practice DCC, whereas Level 3 American Academy of Pediatrics NICUs, nonprofit owned hospitals, and teaching institutions were less likely to practice DCC (p < 0.001). Conclusion There are opportunities to implement quality improvement activities to increase DCC rates.

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