scholarly journals External validation of 4c ISARIC mortality score in critically ill COVID-19 patients from Saudi Arabia

2022 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
WaleedTharwat Aletreby ◽  
ShahzadAhmad Mumtaz ◽  
SaimaAkhtar Shahzad ◽  
Intekhab Ahmed ◽  
MohammedAli Alodat ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Critically Ill ◽  
External Validation

scholarly journals P42 External validation of model-based dosing guidelines for vancomycin, gentamicin and tobramycin in critically ill children

2019 ◽  
Vol 104 (6) ◽  
pp. e34.2-e34
Author(s):  
S Hartman ◽  
S Zwaag ◽  
L Orriëns ◽  
T Poel ◽  
M de Hoop - Sommen ◽  
...  
Keyword(s):  
Critically Ill ◽  
Clinical Laboratory ◽  
External Validation ◽  
Interindividual Variation ◽  
Critically Ill Children ◽  
Target Range ◽  
Future Research ◽  
Target Attainment ◽  
Model Based ◽  
Trough Concentrations

BackgroundPharmacokinetic models are frequently used to simulate dosing strategies for special populations, including critically ill children. The Dutch Pediatric Formulary (DPF) partially bases its guidelines on these models. However, prospective validation of updated dosing regimens is rare. We aimed to identify target attainment and safety of vancomycin, gentamicin and tobramycin after a dose update in the DPF for critically ill neonates and children.MethodsRetropsective cohort study in PICU and NICU patients receiving vancomycin, gentamicin or tobramycin between January 2015 and March 2017 in 2 university hospitals. Demographic clinical laboratory and TDM-data were collected. Target (steady state) trough concentrations for vancomycin, gentamicin and tobramycin used were 10–15, ≤1 and ≤1 mg/l, respectively. Target gentamicin peak concentrations used were 8–12 mg/l.Results486 patients were included in total (165 vancomycin, 97 gentamicin and 224 tobramycin). Trough concentrations of vancomycin, gentamicin and tobramycin were within the target range in 37.5%, 85.3% and 77.2% of patients, respectively. Target attainment of gentamicin peak concentrations in NICU patients was 31%. Non-target trough concentrations were most prevalent in term NICU patients (vancomycin 70%, gentamicin 26% and tobramycin 36.8%). Gentamicin peak concentrations were subtherapeutic in 91% and 45.5% for term and preterm NICU patients, respectively. Creatinine concentrations correlated positively with antibiotic concentrations (correlation coefficient range 0.46–0.54, p≤0.01 in all cohorts).ConclusionDespite recent model-based dosing alterations, sub- and supratherapeutic concentrations of vancomycin, gentamicin and tobramycin are still frequent in critically ill children. Linear dose alterations did offer improvements in target attainment, but did not fully address all relevant covariates that contribute to the large interindividual variation in clearance and/or volume of distribution in these patients. Creatinine clearance was consistently correlated with concentrations of all 3 drugs, but future research is needed to identify whether including this parameter in dosing can improve target attainment and safety.Disclosure(s)Nothing to disclose

A Risk Score for Predicting the Incidence of Hemorrhage in Critically Ill Neonates: Development and Validation Study

2020 ◽  
Author(s):  
Rozeta Sokou ◽  
Daniele Piovani ◽  
Aikaterini Konstantinidi ◽  
Andreas G. Tsantes ◽  
Stavroula Parastatidou ◽  
...  
Keyword(s):  
Prediction Model ◽  
Critically Ill ◽  
Risk Score ◽  
External Validation ◽  
Prognostic Index ◽  
Bleeding Risk ◽  
Outcome Variable ◽  
Calibration Plot ◽  
Characteristic Analysis ◽  
Critically Ill Neonates

AbstractThe aim of the study was to develop and validate a prediction model for hemorrhage in critically ill neonates which combines rotational thromboelastometry (ROTEM) parameters and clinical variables. This cohort study included 332 consecutive full-term and preterm critically ill neonates. We performed ROTEM and used the neonatal bleeding assessment tool (NeoBAT) to record bleeding events. We fitted double selection least absolute shrinkage and selection operator logit regression to build our prediction model. Bleeding within 24 hours of the ROTEM testing was the outcome variable, while patient characteristics, biochemical, hematological, and thromboelastometry parameters were the candidate predictors of bleeding. We used both cross-validation and bootstrap as internal validation techniques. Then, we built a prognostic index of bleeding by converting the coefficients from the final multivariable model of relevant prognostic variables into a risk score. A receiver operating characteristic analysis was used to calculate the area under curve (AUC) of our prediction index. EXTEM A10 and LI60, platelet counts, and creatinine levels were identified as the most robust predictors of bleeding and included them into a Neonatal Bleeding Risk (NeoBRis) index. The NeoBRis index demonstrated excellent model performance with an AUC of 0.908 (95% confidence interval [CI]: 0.870–0.946). Calibration plot displayed optimal calibration and discrimination of the index, while bootstrap resampling ensured internal validity by showing an AUC of 0.907 (95% CI: 0.868–0.947). We developed and internally validated an easy-to-apply prediction model of hemorrhage in critically ill neonates. After external validation, this model will enable clinicians to quantify the 24-hour bleeding risk.

Development and validation of a medication regimen complexity scoring tool for critically ill patients

2019 ◽  
Vol 76 (Supplement_2) ◽  
pp. S34-S40 ◽  
Author(s):  
Morgan E Gwynn ◽  
Margaret O Poisson ◽  
Jennifer L Waller ◽  
Andrea Sikora Newsome
Keyword(s):  
Length Of Stay ◽  
Critically Ill ◽  
Patient Outcomes ◽  
Critically Ill Patients ◽  
External Validation ◽  
Medication Regimen ◽  
Patient Acuity ◽  
Medication Regimen Complexity ◽  
Regimen Complexity ◽  
Scoring Tool

Abstract Purpose The purpose of this study was to develop and validate a novel medication regimen complexity–intensive care unit (MRC-ICU) scoring tool in critically ill patients and to correlate MRC with illness severity and patient outcomes. Methods This study was a single-center, retrospective observational chart review of adults admitted to the medical ICU (MICU) between November 2016 and June 2017. The primary aim was the development and internal validation of the MRC-ICU scoring tool. Secondary aims included external validation of the MRC-ICU and exploration of relationships between medication regimen complexity and patient outcomes. Exclusion criteria included a length of stay of less than 24 hours in the MICU, active transfer, or hospice orders at 24 hours. A total of 130 patient medication regimens were used to test, modify, and validate the MRC-ICU tool. Results The 39-line item medication regimen complexity scoring tool was validated both internally and externally. Convergent validity was confirmed with total medications (p < 0.0001). Score discriminant validity was confirmed by lack of association with age (p = 0.1039) or sex (p = 0.7829). The MRC-ICU score was significantly associated with ICU length of stay (p = 0.0166), ICU mortality (p = 0.0193), and patient acuity (p < 0.0001). Conclusion The MRC-ICU scoring tool was validated and found to correlate with length of stay, inpatient mortality, and patient acuity.

scholarly journals Model-Based Quantification of Left Ventricular Diastolic Function in Critically Ill Patients with Atrial Fibrillation from Routine Data: A Feasibility Study

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Nicholas Kiefer ◽  
Maximilian J. Oremek ◽  
Andreas Hoeft ◽  
Sven Zenker
Keyword(s):  
Atrial Fibrillation ◽  
Diastolic Function ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Likelihood Function ◽  
External Validation ◽  
Left Ventricular ◽  
Monitoring Data ◽  
Diastolic Filling ◽  
Physiological Range

Introduction. Left ventricular diastolic dysfunction (LVDD) and atrial fibrillation (AF) are connected by pathophysiology and prevalence. LVDD remains underdiagnosed in critically ill patients despite potentially significant therapeutic implications since direct measurement cannot be performed in routine care at the bedside, and echocardiographic assessment of LVDD in AF is impaired. We propose a novel approach that allows us to infer the diastolic stiffness, β, a key quantitative parameter of diastolic function, from standard monitoring data by solving the nonlinear, ill-posed inverse problem of parameter estimation for a previously described mechanistic, physiological model of diastolic filling. The beat-to-beat variability in AF offers an advantageous setting for this. Methods. By employing a global optimization algorithm, β is inferred from a simple six parameter and an expanded seven parameter model of left ventricular filling. Optimization of all parameters was limited to the interval ]0, 400[ and initialized randomly on large intervals encompassing the support of the likelihood function. Routine ECG and arterial pressure recordings of 17 AF and 3 sinus rhythm (SR) patients from the PhysioNet MGH/MF Database were used as inputs. Results. Estimation was successful in 15 of 17 AF patients, while in the 3 SR patients, no reliable estimation was possible. For both models, the inferred β (0.065 ± 0.044 ml−1 vs. 0.038 ± 0.033 ml−1 (p=0.02) simple vs. expanded) was compatible with the previously described (patho) physiological range. Aortic compliance, α, inferred from the expanded model (1.46 ± 1.50 ml/mmHg) also compared well with literature values. Conclusion. The proposed approach successfully inferred β within the physiological range. This is the first report of an approach quantifying LVDF from routine monitoring data in critically ill AF patients. Provided future successful external validation, this approach may offer a tool for minimally invasive online monitoring of this crucial parameter.

scholarly journals External Validation of Model-Based Dosing Guidelines for Vancomycin, Gentamicin, and Tobramycin in Critically Ill Neonates and Children: A Pragmatic Two-Center Study

2020 ◽  
Vol 22 (4) ◽  
pp. 433-444 ◽  
Author(s):  
Stan J. F. Hartman ◽  
Lynn B. Orriëns ◽  
Samanta M. Zwaag ◽  
Tim Poel ◽  
Marika de Hoop ◽  
...  
Keyword(s):  
Critically Ill ◽  
External Validation ◽  
Model Based ◽  
Critically Ill Neonates ◽  
Center Study

scholarly journals Population Pharmacokinetics and Dosing Simulation of Vancomycin Administered by Continuous Injection in Critically Ill Patient

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1228
Author(s):  
Romain Garreau ◽  
Benoît Falquet ◽  
Lisa Mioux ◽  
Laurent Bourguignon ◽  
Tristan Ferry ◽  
...  
Keyword(s):  
Critically Ill ◽  
External Validation ◽  
Ideal Body Weight ◽  
Intermittent Infusion ◽  
Compartment Model ◽  
Critically Ill Patient ◽  
Population Pharmacokinetic ◽  
Measured Concentration ◽  
Icu Patients ◽  
Final Model

Background: Vancomycin is widely used for empirical antimicrobial therapy in critically ill patients with sepsis. Continuous infusion (CI) may provide more stable exposure than intermittent infusion, but optimal dosing remains challenging. The aims of this study were to perform population pharmacokinetic (PK) analysis of vancomycin administered by CI in intensive care unit (ICU) patients to identify optimal dosages. Methods: Patients who received vancomycin by CI with at least one measured concentration in our center over 16 months were included, including those under continuous renal replacement therapy (CRRT). Population PK was conducted and external validation of the final model was performed in a dataset from another center. Simulations were conducted with the final model to identify the optimal loading and maintenance doses for various stages of estimated creatinine clearance (CRCL) and in patients on CRRT. Target exposure was defined as daily AUC of 400–600 mg·h/L on the second day of therapy (AUC24–48 h). Results: A two-compartment model best described the data. Central volume of distribution was allometrically scaled to ideal body weight (IBW), whereas vancomycin clearance was influenced by CRRT and CRCL. Simulations performed with the final model suggested a loading dose of 27.5 mg/kg of IBW. The maintenance dose ranged from 17.5 to 30 mg/kg of IBW, depending on renal function. Overall, simulation showed that 55.8% (95% CI; 47–64%) of patients would achieve the target AUC with suggested dosages. Discussion: A PK model has been validated for vancomycin administered by CI in ICU patients, including patients under CRRT. Our model-informed precision dosing approach may help for early optimization of vancomycin exposure in such patients.

scholarly journals COVID 19 CRITICAL CARE TRAINING SURGE EXPERIENCE FOR PHYSICIANS IN RIYADH HEALTH CLUSTER ONE, SAUDI ARABIA

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
AF Mady ◽  
O Ramdan ◽  
R Al Yousef ◽  
A Ishag ◽  
G Bakirova ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Basic Knowledge ◽  
The World ◽  
Medical City ◽  
Care Training ◽  
Icu Physicians

As the COVID-19 pandemic spreads, the number of critically ill patients is expected to surge in hospitals across the world. This may result in non-ICU clinicians being needed to care for critically ill patients, In line with Pandemic COVID – 19 situations that we are facing currently; the Critical Care Department Training Committee of King Saud Medical City in collaboration with the Riyadh Health Cluster One, Saudi Arabia conducted a series of training projects. Its goal is to help non – ICU Physicians to be equipped and be more competent to handle critically ill patients when the situation will have the need for it. We aim to provide basic knowledge and skills to successfully manage critically ill patients with suspected or confirmed COVID – 19 cases in a critical care setting.

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