scholarly journals A fixed dose approach to thrombosis chemoprophylaxis may be inadequate in heavier critically ill patients

2021 ◽  
Vol 23 (1) ◽  
pp. 94-102
Author(s):  
George Yi ◽  
◽  
Adam M Deane ◽  
Melissa Ankravs ◽  
Lucy Sharrock ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Prescribing Patterns ◽  
Fixed Dose ◽  
Single Centre ◽  
Eligibility Criteria ◽  
Once Daily ◽  
The Third ◽  
Fourth Dose ◽  
Trough Levels

Objectives: Overweight patients are at greater risk of venous thromboembolism. We aimed to describe prescribing patterns of thrombosis chemoprophylaxis in critically ill patients weighing ≥ 100 kg and quantify the effectiveness of these regimens using the surrogate biomarker of plasma anti-Xa level. Design, setting and patients: A prospective single-centre cohort study was conducted over a 6-month period. Patients weighing ≥ 100 kg who were prescribed enoxaparin for chemoprophylaxis and expected to remain in the intensive care unit for > 48 hours were eligible. Anti-Xa levels were measured once a patient had received at least three consecutive doses of enoxaparin. Peak levels were measured 4–6 hours after the third dose and trough levels were measured before the fourth dose. Anti-Xa levels were compared with established target ranges for peak and trough anti-Xa levels (0.2–0.5 IU/mL and > 0.1 IU/mL, respectively). Results: Eighty-eight patients met the eligibility criteria, and anti-Xa levels for 42 patients were obtained. Fixed dose chemoprophylaxis approaches varied considerably, with 40 mg once daily (54/88 [61%]) and 40 mg twice daily (20/88 [23%]) being the most frequently prescribed regimens. No patient had a peak anti-Xa level > 0.5 IU/mL. When comparing 40 mg once daily versus twice daily, the once daily regimen had lower median trough levels (0.01 IU/mL [interquartile range (IQR), 0.00–0.04] v 0.09 IU/mL [IQR, 0.05–0.13]; P < 0.001) and greater proportions of patients with levels below the established range (< 0.1 IU/mL) (15/16 [95%] v 7/14 [50%]; P = 0.002) and levels that were undetectable (0.00 IU/mL) (8/16 [50%] v 1/14 [7%]; P = 0.01). Conclusions: At a single centre, thrombosis chemoprophylaxis prescribing patterns for heavier critically ill patients varied considerably. Current fixed dose approaches may be inadequate in this cohort

scholarly journals Procalcitonin Clearance for Early Prediction of Survival in Critically Ill Patients with Severe Sepsis

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Mohd Basri Mat Nor ◽  
Azrina Md Ralib
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Small Sample Size ◽  
Small Sample ◽  
Sepsis Group ◽  
Single Centre ◽  
Dynamic Changes ◽  
Prediction Of Survival ◽  
Single Centre Study

Introduction. Serum procalcitonin (PCT) diagnosed sepsis in critically ill patients; however, its prediction for survival is not well established. We evaluated the prognostic value of dynamic changes of PCT in sepsis patients.Methods. A prospective observational study was conducted in adult ICU. Patients with systemic inflammatory response syndrome (SIRS) were recruited. Daily PCT were measured for 3 days. 48 h PCT clearance (PCTc-48) was defined as percentage of baseline PCT minus 48 h PCT over baseline PCT.Results. 95 SIRS patients were enrolled (67 sepsis and 28 noninfectious SIRS). 40% patients in the sepsis group died in hospital. Day 1-PCT was associated with diagnosis of sepsis (AUC 0.65 (95% CI, 0.55 to 0.76)) but was not predictive of mortality. In sepsis patients, PCTc-48 was associated with prediction of survival (AUC 0.69 (95% CI, 0.53 to 0.84)). Patients with PCTc-48 > 30% were independently associated with survival (HR 2.90 (95% CI 1.22 to 6.90)).Conclusions. PCTc-48 is associated with prediction of survival in critically ill patients with sepsis. This could assist clinicians in risk stratification; however, the small sample size, and a single-centre study, may limit the generalisability of the finding. This would benefit from replication in future multicentre study.

Relationship Between Initial Vancomycin Trough Levels and Early-Onset Vancomycin-Associated Nephrotoxicity in Critically Ill Patients

2017 ◽  
pp. 1 ◽  
Author(s):  
Masayuki Chuma ◽  
Makoto Makishima ◽  
Toru Imai ◽  
Naohiro Tochikura ◽  
Shinichiro Suzuki ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Onset ◽  
Vancomycin Trough ◽  
Trough Levels

CP-169 Dexmedetomidine for sedation in critically ill patients: a single centre experience

2015 ◽  
Vol 22 (Suppl 1) ◽  
pp. A67.2-A67
Author(s):  
C Abraira Meriel ◽  
E Martinez de Ilarduya Bolado ◽  
A Gomez Esteban ◽  
M Ochagavia Sugrategui ◽  
M Valero Dominguez ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Single Centre ◽  
Single Centre Experience

Clinical Significance of Bioimpedance Spectroscopy in Critically Ill Patients

2017 ◽  
Vol 34 (6) ◽  
pp. 495-502 ◽  
Author(s):  
Shang-Feng Yang ◽  
Ching-Min Tseng ◽  
I-Fan Liu ◽  
Shin-Hung Tsai ◽  
Wein-Shung Kuo ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fluid Management ◽  
Laboratory Data ◽  
Acute Stage ◽  
Volume Control ◽  
Hospital Death ◽  
Icu Admission ◽  
The Third

Background: Early fluid resuscitation is a key aspect in the successful management of critically ill patients, but the optimal goal for volume control after the acute stage of critical illness remains unclear. This study aimed to evaluate the prognostic value of bioimpedance spectrometry for fluid management in critically ill patients. Methods: In this prospective observational study, patients who consented to participate were screened within the first 24 hours of admission to a medical intensive care unit (ICU) from February 4, 2015, to January 31, 2016. Information on demographics, comorbidities, primary reasons for admission, baseline laboratory data, and ventilator or inotropic use were documented. Data of fluid intake, fluid output, and body weight were recorded for the first 3 days of ICU admission. Bioimpedance spectrometry was performed on the first and third days after ICU admission. All participants were followed until death or hospital discharge. Results: Of the 140 enrolled patients (median age: 70 years, interquartile range: 60-77 years), 23 (16.4%) patients died during hospitalization. Independent predictors of hospital mortality were Acute Physiology and Chronic Health Evaluation II scores (per 1 point increase, odds ratio [OR]: 1.101) and overhydration (OH) volume on the first day (per 1 L increase, OR: 1.216). Compared to normal OH status (OH volume between −1 and 1 L), hyper OH status (OH volume < −1 L) on the third day after ICU admission was an independent predictor of hospital death (OR: 7.609). Normal OH status on the third day was associated with greater numbers of ICU-free and ventilator-free days. Conclusion: Bioimpedance spectrometry can be used to predict outcomes in critically ill patients. Increased OH volume on day 1 and hyper OH volume on day 3 of ICU admission are associated with a greater risk of hospital mortality. Volume status on day 3 is associated with durations of ventilator use and ICU stay.

scholarly journals Development of a vancomycin dosing approach for critically ill patients receiving hybrid hemodialysis using Monte Carlo simulation

2018 ◽  
Vol 6 ◽  
pp. 205031211877325 ◽  
Author(s):  
Susan J Lewis ◽  
Bruce A Mueller
Keyword(s):  
Monte Carlo ◽  
Renal Replacement Therapy ◽  
Serum Concentration ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Vancomycin Dose ◽  
The Third ◽  
Dosing Nomogram ◽  
Intermittent Renal Replacement Therapy

Objectives: Prolonged intermittent renal replacement therapy is an increasingly popular treatment for acute kidney injury in critically ill patients that runs at different flow rates and durations than conventional hemodialysis or continuous renal replacement therapies. Pharmacokinetic studies conducted in patients receiving prolonged intermittent renal replacement therapy are scarce; consequently, clinicians are challenged to dose antibiotics effectively. The purpose of this study was to develop vancomycin dosing recommendations for patients receiving prolonged intermittent renal replacement therapy. Methods: Monte Carlo simulations were performed in thousands of virtual patients derived from previously published demographic, pharmacokinetic, and dialytic information derived from critically ill patients receiving vancomycin and other forms of renal replacement therapy. We conducted “in silico” vancomycin pharmacokinetic/pharmacodynamics analyses in these patients receiving prolonged intermittent renal replacement therapy to determine what vancomycin dose would achieve vancomycin 24-h area under the curve (AUC24h) of 400–700 mg·h/L, a target associated with positive clinical outcomes. Nine different vancomycin dosing regimens were tested using four different, commonly used prolonged intermittent renal replacement therapy modalities. A dosing nomogram based on serum concentration data achieved after the third dose was developed to individualize vancomycin therapy. Results: An initial vancomycin dose of 15 or 20 mg/kg immediately followed by 15 mg/kg after subsequent prolonged intermittent renal replacement therapy treatments achieved AUC24h of ≥400 mg·h/L for ≥90% of patients regardless of prolonged intermittent renal replacement therapy duration, modality, or time of vancomycin dose relative to prolonged intermittent renal replacement therapy. Many patients experienced AUC24h of ≥700 mg·h/L, but once the dosing nomogram was applied to serum concentrations obtained after the third vancomycin dose, 67%–88% of patients achieved AUC24h of 400–700 mg·h/L. Conclusion: An initial loading dose of 15–20 mg/kg followed by a maintenance regimen of 15 mg/kg after every prolonged intermittent renal replacement therapy session coupled with serum concentration monitoring should be used to individualize vancomycin dosing. These predictions need clinical verification.

scholarly journals Medications in Bronchospasm and Asthma among the Critically Ill Patients: A Drug Utilization Study from Southern India

1970 ◽  
Vol 1 (2) ◽  
pp. 57-59
Author(s):  
Lisha Jenny John ◽  
Jenny John ◽  
Padmini Devi ◽  
Mohamed Arifulla ◽  
Shoba Guido
Keyword(s):  
Drug Therapy ◽  
Adverse Effects ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Therapeutic Agents ◽  
Prescribing Patterns ◽  
Drug Utilization Study ◽  
Male Preponderance ◽  
Utilization Patterns

Objective: Critically ill patients are prone for altered reactivity of the airway and drug therapy has pivotal role in the management of bronchospasm. The objective of the study was to evaluate the prescribing patterns and adverse effects of therapeutic agents for bronchospasm and asthma in the medical ICU.Methods: A prospective observational study was carried out among inpatients of the medical ICU receiving drugs for bronchospasm and asthma.Results: 220 patients received drugs for bronchospasm and asthma. Male preponderance was noticed (60.5%). Salbutamol (R03AC02) 92.7% was the most common bronchodilator prescribed. Ipratropium plus salbutamol (R03AK04) 55.5% was most frequently used bronchodilator combination. All bronchodilators were administered by inhalational route (nebulization) except methylxanthines Conclusion: Utilization patterns of drugs for bronchospasm and asthma were in concordance with treatment guidelines.Key words: Bronchospasm; Asthma; Southern IndiaDOI: http://dx.doi.org/10.3126/nje.v1i2.5136 Nepal Journal of Epidemiology 2011;1 (2):57-59

Dalteparin Thromboprophylaxis in Critically Ill Patients with Severe Renal Insufficiency: The Direct Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 304-304
Author(s):  
James Douketis ◽  
Deborah Cook ◽  
Nicole Zytaruks ◽  
Diane Heels-Ansdell ◽  
Mark Crowther
Keyword(s):  
Renal Insufficiency ◽  
Creatinine Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bleeding Risk ◽  
Open Label ◽  
Once Daily ◽  
Major Bleed ◽  
Severe Renal Insufficiency ◽  
Pharmacodynamic Profile

Abstract Background: Critically ill patients with renal insufficiency are at high risk for deep vein thrombosis (DVT). Low-molecular-weight heparins (LMWHs) effectively prevent DVT but are avoided in patients with renal insufficiency because of potential bioaccumulation and potential bleeding risk. However, evidence is lacking that LMWHs bioaccumulate in such patients. Objectives: The objectives of DIRECT were, in critically ill patients with severe renal insufficiency, to determine if dalteparin prophylaxis leads to bioaccumulation and bleeding from excessive anticoagulation and to determine the pharmacodynamic profile of dalteparin. Methods: Multi-center, open-label, prospective cohort study of critically ill patients with a creatinine clearance <30 mL/min who receive dalteparin, 5000 IU once-daily, subcutaneously for up to 30 days. Dalteparin bioaccumulation in a patient was defined by a trough anti-Xa level >0.40 IU/mL, measured twice-weekly 20 hours after the prior dalteparin dose. The pharmacodynamic profile of dalteparin was assessed by anti-Xa levels measured at 0, 1, 2, 4, 8, 12, 20, and 24 hours after the prior dose on days 3, 10, and 17 of treatment. Results: We enrolled 156 patients with a mean (SD) creatinine clearance of 18.9 (6.5) mL/min; of these, 18 were excluded because they died or were discharged before testing (n = 3) or had prevalent DVT (n = 14) or pulmonary embolism (n = 1) within 48 hours of enrollment. Of 138 patients included, the median (inter-quartile range [IQR]) duration of dalteparin treatment was 7 days (4, 12). In 120 pa tients who had ≥1 trough anti-Xa measured (427 total), none had dalteparin bioaccumulation; the median (IQR) trough anti-Xa level was <0.1 IU/mL (<0.1, <0.1). In 138 patients who received ≥1 dose of dalteparin,10 patients (7.2%; 95% CI: 4.0, 12.8) had a major bleed, all with trough anti-Xa levels ≤0.18 IU/mL. The pharmacodynamic profile of dalteparin, shown in the Figure, was typical for drugs that do not bioaccumulate, with a typical peak and decline after 3, 10, and 17 days of treatment. Conclusions: In critically ill patients with severe renal insufficiency, thromboprophylaxis with dalteparin did not bioaccumulate. Dalteparin, 5000 IU once-daily, appears to be a reasonable option for thromboprophylaxis of critically ill patients with severe renal insufficiency. Figure Figure

ONCE-DAILY AMINOGLYCOSIDE DOSING FOR CRITICALLY ILL PATIENTS WITH RENAL INSUFFICIENCY

1999 ◽  
Vol 27 (Supplement) ◽  
pp. A124 ◽  
Author(s):  
Candace J Smith ◽  
Corrado P Marini ◽  
Garry S Ritter
Keyword(s):  
Renal Insufficiency ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Once Daily
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