Thermosensitive in situ liposomal gels loaded with antimicrobial agent for oral care in critically ill patients

2020 ◽  
Vol 11 (4) ◽  
pp. 231-243
Author(s):  
Kenchappa Vanaja ◽  
Marzieh Zare ◽  
Brinda Basavaraju ◽  
S Salwa ◽  
Sathyanarayana Narasimha Murthy ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Oral Care ◽  
Poloxamer 407 ◽  
In Situ Gel ◽  
Prophylactic Measure ◽  
Mean Size ◽  
Liposomal Suspension ◽  
Gamma Irradiated

Aim: A novel thermosensitive in situ gel loaded with meropenem (MP) liposomes was designed to improve retention in the oral cavity as a prophylactic measure to prevent ventilator-acquired pneumonia in critically ill patients. Methodology & results: Meropenem liposomes were incorporated into poloxamer 407 gels and gamma irradiated. Mean size of liposome was 247 nm, polydispersity index < 0.3 and zeta potential >-25 mV; properties remained unaltered even post sterilization. Permeation study revealed that 75.26% and 34% of MPs were released from MP in situ gel and MP in situ liposomal gel, respectively. The relation between viscosity (cp) and shear rate (1/s) indicate that in situ gels exhibited non-Newtonian behavior at 37°C. The study using Pseudomonas aeruginosa confirmed the antimicrobial activity of meropenem. Conclusion: Prolonged in situ residence, because of rapid gelation process enables an easy administration of meropenem as liposomal suspension in critically ill patients.

scholarly journals Evidence to Support Tooth Brushing in Critically Ill Patients

2011 ◽  
Vol 20 (3) ◽  
pp. 242-250 ◽  
Author(s):  
Nancy J. Ames
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Oral Care ◽  
Standard Of Care ◽  
Tooth Brushing ◽  
Oral Microbiome ◽  
Respiratory Pathogens ◽  
Adults And Children ◽  
Critically Ill Adults ◽  
Powered Toothbrush

Tooth brushing in critically ill patients has been advocated by many as a standard of care despite the limited evidence to support this practice. Attention has been focused on oral care as the evidence accumulates to support an association between the bacteria in the oral microbiome and those respiratory pathogens that cause pneumonia. It is plausible to assume that respiratory pathogens originating in the oral cavity are aspirated into the lungs, causing infection. A recent study of the effects of a powered toothbrush on the incidence of ventilator-associated pneumonia was stopped early because of a lack of effect in the treatment group. This review summarizes the evidence that supports the effectiveness of tooth brushing in critically ill adults and children receiving mechanical ventilation. Possible reasons for the lack of benefit of tooth brushing demonstrated in clinical trials are discussed. Recommendations for future trials in critically ill patients are suggested. With increased emphasis being placed on oral care, the evidence that supports this intervention must be evaluated carefully.

Application of Network Meta-Analysis to Assess the Comparative Effectiveness of Oral Care Interventions in Preventing Ventilator Associated Pneumonia in Critically Ill Patients.

2020 ◽  
Author(s):  
Satheeshkumar PS ◽  
Stephen Sonis
Keyword(s):  
Usual Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Povidone Iodine ◽  
Meta Analysis ◽  
Oral Care ◽  
Forest Plot ◽  
Care Groups ◽  
Ranking Order ◽  
Hierarchical Assessment

Abstract Background In this research, we assessed the efficacy of a novel analytic, network metanalysis (NMA), in creating a hierarchy to define the most effective oral care intervention (OCI) for the prevention and management of ventilation-associated pneumonia (VAP). Methods We applied NMA to a previously published robust pairwise meta-analysis (PMA). Statistical analyses were based on comparing rates of total VAP events between intervention groups and placebo-usual care groups. We synthesized a netgraph, reported ranking order of the treatment and summarized our output by a forest plot with a reference treatment placebo/usual care. Results With our inclusion and exclusion critiera for the NMA we extracted 25 studies (4473 subjects). The NMA included 16 treatments, 29 pairwise comparisons and 15 designs. Based on the results of multiple comparisons with frequentist ranking probability P scores, tooth brushing (P score fixed of 0.9353, P score random of 0.8892), toothbrushing with povidone iodine (P score fixed of 0.9091, P score random 0.8801), and furacillin (P score fixed of 0.8798, P score random 0.8358) were the best three interventions for preventing VAP. Conclusion NMA appeared to be an effective platform from which multiple interventions reported in disparate clinical trials could be compared to derive a hierarchical assessment of efficacy in the intervention of VAP. According to the NMA outcome, toothbrushing alone or toothbrushing along with a potent antiseptic mouthwash povidone iodine was related to the highest response rate in preventing VAP in critically ill patients followed by furacillin and chlorhexidine 0.2%, respectively.

The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients

2017 ◽  
Vol 30 (2) ◽  
pp. 69-73 ◽  
Author(s):  
Abdullah Haghighi ◽  
Vida Shafipour ◽  
Masoumeh Bagheri-Nesami ◽  
Afshin Gholipour Baradari ◽  
Jamshid Yazdani Charati
Keyword(s):  
Health Status ◽  
Oral Health ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Oral Care ◽  
Oral Health Status ◽  
Ventilator Associated Pneumonia ◽  
The Impact

scholarly journals The management of venous thromboembolism in hospitalized patients with COVID-19

2020 ◽  
Vol 4 (16) ◽  
pp. 4028-4028 ◽  
Author(s):  
Alex C. Spyropoulos
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
High Rate ◽  
Coagulation System ◽  
High Incidence ◽  
Recent Statement ◽  
Clinical Questions

Abstract The high incidence of thromboembolic disease, and in particular venous thromboembolism (VTE), has emerged as an important consideration in hospitalized and critically ill patients with coronavirus disease 2019 (COVID-19). The coagulopathy of COVID-19 is postulated to result from interactions of the inflammatory and immune systems with the coagulation system, manifesting as a cytokine storm associated with hyperinflammation and coagulation and platelet activation. Unique characteristics of VTE in hospitalized and critically ill patients with COVID-19 include the high incidence of VTE (and especially pulmonary embolism) when compared with historical controls; the finding of in situ pulmonary embolism associated with microthrombi, which suggests a thrombotic microangiopathic process in addition to classic macrovessel disease; and, most important from a clinical perspective, the unusually high rate of VTE that has been reported despite standard thromboprophylaxis. This raises the possibility that intermediate or weight-based heparin dosing may be more effective than fixed dosing for thromboprophylaxis in high-risk subsets of patients hospitalized with COVID-19. There have been several guidance statements focusing on the management of VTE in hospitalized and critically ill patients with COVID-19, including the most recent statement by the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis, which includes comprehensive guidance on the diagnosis, prevention, and treatment of VTE in this patient population. Ongoing randomized trials that address key clinical questions, especially more intense thromboprophylactic strategies and novel antithrombotic approaches, have the potential to reduce the morbidity and mortality from VTE in hospitalized and critically ill patients with COVID-19.

The Effectiveness of Chloramphenicol In-Situ Opthalmic Gel with Base Poloxamer 407 and HPMC Against Staphylococcus Aureus Atcc 29213 And Pseudomonas Aeruginosa Atcc 27853

2019 ◽  
Vol 9 (01) ◽  
pp. 76-82 ◽  
Author(s):  
Insan Sunan Kurniawansyah ◽  
Norisca Aliza Putriana ◽  
Agung Fitri Kusuma ◽  
Tan Mei Lee
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Design Method ◽  
Storage Conditions ◽  
Poloxamer 407 ◽  
Simple Liquid ◽  
High Concentration ◽  
In Situ Gel ◽  
Gel Preparation

Introduction: In-situ gel is a simple liquid transparent polymer solution under storage conditions, but turns into a viscoelastic gel after entering the eye due to the phase transition properties of the polymer that increase the residence time in ocular organ and bioavailability, enabling the delivery of reproducible doses and improving patient compliance. The aim of the present study was to formulate and evaluate the antibacterial effectivity of chloramphenicol in-situ ophthalmic gel with base poloxamer 407 and HPMC base against Staphylococcus aureus and Pseudomonas aeruginosa. Material and Methods: The optimization of ophthalmic gel preparation by the factorial design method has been carried out in order to know the best formula of all the formulas employed with 0.5% chloramphenicol active substance, wherein each formula was obtained from high concentration and low concentration of each base. Results: The measurement of the antibacterial effectivity against Staphylococcus aureus ATCC 29213 and Pseudomonas aeruginosa ATCC 27853 by oneway ANOVA analysis showed that formula with base poloxamer 407 5% (F1) gave the best result. F1 has a dilute consistency, clear and stable during 28 days storage time when effectiveness test performed. Conclusions: Chloramphenicol in-situ gel with base poloxamer 407 and HPMC were effective against Staphylococcus aureus ATCC 29213 with intermediate to sensitive category, and Pseudomonas aeruginosa ATCC 27853 with sensitive category in accordance to the requirements of the Clinical and Laboratory Standards Institute (CLSI).

Oral Health and Care in the Intensive Care Unit: State of the Science

2004 ◽  
Vol 13 (1) ◽  
pp. 25-34 ◽  
Author(s):  
Cindy L. Munro ◽  
Mary Jo Grap
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Health ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Dental Plaque ◽  
Oral Care ◽  
Microbial Flora ◽  
Tooth Surface ◽  
Ventilator Associated Pneumonia

Oral health is influenced by oral microbial flora, which are concentrated in dental plaque. Dental plaque provides a microhabitat for organisms and an opportunity for adherence of the organisms to either the tooth surface or other microorganisms. In critically ill patients, potential pathogens can be cultured from the oral cavity. These microorganisms in the mouth can translocate and colonize the lung, resulting in ventilator-associated pneumonia. The importance of oral care in the intensive care unit has been noted in the literature, but little research is available on mechanical or pharmacological approaches to reducing oral microbial flora via oral care in critically ill adults. Most research in oral care has been directed toward patients’ comfort; the microbiological and physiological effects of tooth brushing in the intensive care unit have not been reported. Although 2 studies indicated reductions in rates of ventilator-associated pneumonia in cardiac surgery patients who received chlorhexidine before intubation and postoperatively, the effects of chlorhexidine in reducing ventilator-associated pneumonia in other populations of critically ill patients or its effect when treatment with the agent initiated after intubation have not been reported. In addition, no evaluation of the effectiveness of pharmacological and mechanical interventions relative to each other or in combination has been published. Additional studies are needed to develop and test best practices for oral care in critically ill patients.

Oral Care in Critically Ill Patients Requiring Noninvasive Ventilation: An Evidence-Based Review

2021 ◽  
Vol 41 (4) ◽  
pp. 66-70
Author(s):  
Jace D. Johnny ◽  
Zachary Drury ◽  
Tracey Ly ◽  
Janel Scholine
Keyword(s):  
Critically Ill ◽  
Noninvasive Ventilation ◽  
Critically Ill Patients ◽  
Oral Care ◽  
Preventive Measure ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Topic Hospital-acquired pneumonia commonly develops after 48 hours of hospitalization and can be divided into non–ventilator-acquired and ventilator-acquired pneumonia. Prevention of non–ventilator-acquired pneumonia requires a multimodal approach. Implementation of oral care bundles can reduce the incidence of ventilator-acquired pneumonia, but the literature on oral care in other populations is limited. Clinical Relevance Use of noninvasive ventilation is increasing owing to positive outcomes. The incidence of non–ventilator-acquired pneumonia is higher in patients receiving noninvasive ventilation than in the general hospitalized population but remains lower than that of ventilator-acquired pneumonia. Non–ventilator-acquired pneumonia increases mortality risk and hospital length of stay. Purpose To familiarize nurses with the evidence regarding oral care in critically ill patients requiring noninvasive ventilation. Content Covered No standard of oral care exists for patients requiring noninvasive ventilation owing to variation in study findings, definitions, and methods. Oral care decreases the risk of hospital-acquired pneumonia and improves comfort. Nurses perform oral care less often for nonintubated patients, as it is perceived as primarily a comfort measure. The potential risks of oral care for patients receiving noninvasive ventilation have not been explored. Further research is warranted before this practice can be fully implemented. Conclusion Oral care is a common preventive measure for non–ventilator-acquired pneumonia and may improve comfort. Adherence to oral care is lower for patients not receiving mechanical ventilation. Further research is needed to identify a standard of care for oral hygiene for patients receiving noninvasive ventilation and assess the risk of adverse events.

scholarly journals Not-so-Trivial Pursuit: Mechanical Ventilation Risk Reduction

2009 ◽  
Vol 18 (4) ◽  
pp. 299-309 ◽  
Author(s):  
Mary Jo Grap
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Management Practices ◽  
Oral Care ◽  
Ventilator Associated Pneumonia ◽  
Care Providers ◽  
Trivial Pursuit ◽  
Open Versus ◽  
Ventilator Synchrony

As many as half of critically ill patients require mechanical ventilation. In this article, a program of research focused on reduction of risk associated with mechanical ventilation is reviewed. Airway management practices can have profound effects on outcomes in these patients. How patients are suctioned, types of processes used, effects of suctioning in patients with lung injury, and open versus closed suctioning systems all have been examined to determine best practices. Pneumonia is a common complication of mechanical ventilation (ventilator-associated pneumonia), and use of higher backrest elevations reduces risk of pneumonia, although compliance with such recommendations varies. The studies reviewed here describe backrest elevation practices, factors that affect backrest elevation, and the effect of backrest elevation on ventilator-associated pneumonia. Oral care strategies also have been investigated to determine their effect on ventilator-associated pneumonia. Oral care practices are reported to hold a low care priority, vary widely across care providers, and differ in intubated versus nonintubated patients. However, in several studies, oral applications of chlorhexidine have reduced the occurrence of ventilator-associated pneumonia. Although ventilator patients require sedation, sedation is associated with significant risks. The overall goals of sedation are to provide physiological stability, to maintain ventilator synchrony, and to ensure patients’ comfort—although methods to evaluate achievement of these goals are limited. Reducing risks associated with mechanical ventilation in critically ill patients is a complex and interdisciplinary process. Our understanding of the risks associated with mechanical ventilation is constantly changing, but care of these patients must be based on the best evidence.

An oral care survey for critically ill patients

2016 ◽  
Vol 11 (2) ◽  
pp. 30-34 ◽  
Author(s):  
Mary Jo Grap ◽  
Cindy L. Munro ◽  
Marie Gardner
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Oral Care ◽  
Care Survey

scholarly journals Formulation and Evaluation of Sustained Release Sumatriptan Mucoadhesive Intranasal in-Situ Gel

2019 ◽  
Vol 28 (2) ◽  
pp. 95-104
Author(s):  
Hussein K. Alkufi ◽  
Hanan J. Kassab
Keyword(s):  
Drug Release ◽  
Ex Vivo ◽  
Poloxamer 407 ◽  
Gelation Temperature ◽  
In Vitro Drug Release ◽  
In Situ Gel ◽  
Ex Vivo Permeation ◽  
Ex Vivo Permeation Study

     Objective: The purpose of this study to develop and optimize nasal mucoadhesive in situ gel IG of sumatriptan ST (serotonin agonist) to enhance nasal residence time for migraine management.      Method: Cold method was used to prepare ST nasal in-situ gel, using thermosensitive polymers (poloxamer 407  and/or poloxamer 188) with a mucoadhesive polymer (hyaluronic acid HA) which were examined for gelation temperature and gelation time, pH, drug content, gel strength, spreadability, mucoadhesive force determination, viscosity,  in-vitro drug release, and the selected formula was subjected to ex-vivo permeation study and histological evaluation of the sheep mucosal tissue after application.     Results: The results showed that the formula IG7 prepared from poloxamer 407(19%), poloxamer188 (4%) and HA (0.5%)   had an optimum gelation temperature (32.66±1.52°C), gel  strength (43.66± 1.52 sec),  mucoadhesive force (8067.93± 746.45dyne\cm2), in-vitro drug release (95.98%) over 6hr, ex-vivo permeation study release (89.6%)  during the 6 h. study with no  histological or pathological change in the nasal sheep tissue.     Conclusion: The ease of administration via a nasal drop of ST coupled with less frequent administration and prolong drug release, will enhance patient compliance.

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