Determination of Low Dose Spinal Anesthesia in Elderly and Critically Ill Patients

2021 ◽  
pp. 23-30
Author(s):  
Ahmad Al-Shraideh
Keyword(s):  
Spinal Anesthesia ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose

scholarly journals Analysis of the impact of secondary prophylaxis on Clostridioides difficile recurrence in critically ill adults

2020 ◽  
Vol 8 ◽  
pp. 205031212093089
Author(s):  
Kathryn A Connor ◽  
Kelly M Conn
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Secondary Prophylaxis ◽  
Infection Prophylaxis ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Critically Ill Adults ◽  
Ill Adults ◽  
Infection Recurrence

Introduction: Clostridioides (formerly Clostridium) difficile infection recurrence in patients re-exposed to antibiotics for treatment of a non- Clostridioides difficile infection is high at approximately 33%. Low-dose per os vancomycin (e.g. 125 mg q12 h) or metronidazole (e.g. 500 mg intravenous/per osq8 h) may help prevent recurrences, but study of secondary prophylaxis in critically ill patients is needed. Objectives: To determine whether critically ill adults receiving low-dose per os vancomycin for secondary Clostridioides difficile infection prophylaxis have fewer recurrences of Clostridioides difficile infection in 90 days compared with patients receiving metronidazole for secondary Clostridioides difficile infection prophylaxis or control (no secondary prophylaxis). Methods: This was a retrospective, two-center, observational study in a large academic medical center and affiliated community hospital. Included patients had a history of Clostridioides difficile infection within 1 year of receiving antibiotics for clinical care. We compared patients receiving secondary prophylaxis with vancomycin or metronidazole and control patients; in addition, an unplanned fourth group (vancomycin/metronidazole combination) was identified and analyzed. The primary outcome was Clostridioides difficile infection recurrence within 90 days of a course of broad-spectrum antibiotic therapy. Fisher’s exact, analysis of variance, and Kruskal–Wallis tests were used to compare Clostridioides difficile infection recurrence with prophylaxis group and additional contributing factors. Results: Eighty-two patients were included: 38 control (46.3%), 20 metronidazole (24.4%), 17 vancomycin (20.7%), and 7 combination (8.5%). Ten of 82 patients (12.2%) had at least one Clostridioides difficile infection recurrence; 8/38 patients in the control group (21.1%), 1/7 patients in the combination group (14.3%), 1/17 patients in the per os vancomycin group (5.9%), and 0/20 in the metronidazole group (0%; p = 0.073). As a post hoc secondary analysis, the three prophylaxis groups were coalesced into one group and compared with control (4.5% vs 21%; p = 0.039). Additional factors (e.g. age, obesity, immunosuppression, acid suppression) were not significantly associated with Clostridioides difficile infection recurrence or with prophylaxis group. Conclusion: There was no difference in Clostridioides difficile infection recurrence between prophylaxis groups, however, given the low recurrence rate, prospective evaluation with a larger sample of critically ill patients is necessary.

scholarly journals Efficacy of Low-Dose Prophylactic Quetiapine on Delirium Prevention in Critically Ill Patients: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

2019 ◽  
Vol 9 (1) ◽  
pp. 69
Author(s):  
Youlim Kim ◽  
Hyung-Sook Kim ◽  
Jong Sun Park ◽  
Young-Jae Cho ◽  
Ho Il Yoon ◽  
...  
Keyword(s):  
Placebo Group ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Controlled Study ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Icu Discharge ◽  
Tertiary Teaching ◽  
Delirium Prevention

Purpose: To evaluate the efficacy of short-term low-dose quetiapine for delirium prevention in critically ill patients. Methods: In this prospective, a single-center, randomized, double-blind, placebo-controlled trial, adult patients who were admitted from July 2015 to July 2017 to a medical intensive care unit (ICU) of a tertiary teaching hospital affiliated to Seoul National University were included. Quetiapine (12.5 mg or 25 mg oral at night; N = 16) or placebo (N = 21) was administered according to randomization until ICU discharge or the 10th ICU day. The primary endpoint was the incidence of delirium within the first 10 ICU days. Secondary endpoints included the rate of positive Confusion Assessment Method for the ICU (CAM-ICU) (the number of positive CAM-ICU counts/the number of total CAM-ICU counts), delirium duration, successful extubation, and overall mortality. Result: The incidence of delirium during the 10 days after ICU admission was 46.7% (7/15) in the quetiapine group and 55.0% (11/20) in the placebo group (p = 0.442). In the quetiapine group, the rate of positive CAM-ICU was significantly lower than in the placebo group (14.4% vs. 37.4%, p = 0.048), delirium duration during the study period was significantly shorter (0.28 day vs. 1.83 days, p = 0.018), and more patients in the quetiapine than in the placebo group were weaned from mechanical ventilation successfully (84.6% vs. 47.1%, p = 0.040). Conclusions: Our study suggests that prophylactic use of low-dose quetiapine could be helpful for preventing delirium in critically ill patients. A further large-scale prospective study is needed.

Determination of 1,3-β-D-glucan in the peritoneal fluid for the diagnosis of intra-abdominal candidiasis in critically ill patients: a pilot study

2018 ◽  
Vol 84 (12) ◽  
Author(s):  
Emmanuel Novy ◽  
François-Xavier Laithier ◽  
Marie-Claire Machouart ◽  
Eliane Albuisson ◽  
Philippe Guerci ◽  
...  
Keyword(s):  
Pilot Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Peritoneal Fluid ◽  
Abdominal Candidiasis

scholarly journals The effect of low-dose furosemide in critically ill patients with early acute kidney injury: A pilot randomized blinded controlled trial (the SPARK study)

2017 ◽  
Vol 42 ◽  
pp. 138-146 ◽  
Author(s):  
Sean M. Bagshaw ◽  
R.T. Noel Gibney ◽  
Peter Kruger ◽  
Imran Hassan ◽  
Finlay A. McAlister ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Controlled Trial ◽  
Kidney Injury

Very-low-dose ketamine for the management of pain and sedation in the ICU

2018 ◽  
Vol 4 (1) ◽  
pp. 54 ◽  
Author(s):  
Mario De Pinto, MD ◽  
Jill Jelacic, MD ◽  
William T. Edwards, PhD, MD
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Respiratory Depression ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Anesthetic Agent ◽  
Cardiovascular Instability ◽  
High Doses ◽  
Very High

Management of pain in critically ill patients can be very difficult. In the attempt to provide comfort with adequate levels of opioids and sedatives, respiratory depression and cardiovascular instability may become difficult to control in patients with labile hemodynamics and poor cardiopulmonary reserve. The use of medications like ketamine, an anesthetic agent that in subanesthetic doses has been reported to be effective in preventing opioidinduced tolerance and to have analgesic properties, may be of help, especially in patients who develop tolerance, leading to rapidly escalating doses of opioids and sedatives. The case report presented here shows how a very low dose of ketamine can be helpful for the management of pain and sedation in critically ill patients, especially when they are ready to be weaned from mechanical ventilation, and very high doses of opiods and sedatives do not permit it.

Activated Partial Thromboplastin Time Elevation After Low-Dose Unfractionated Heparin in Critically Ill Patients

CHEST Journal ◽  
2013 ◽  
Vol 144 (4) ◽  
pp. 368A
Author(s):  
Ramin Pirouz ◽  
Peter Smith ◽  
Yevgeniy Vaynkof ◽  
Shashmi Balakrishna ◽  
Raja Chand ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Partial Thromboplastin Time ◽  
Low Dose ◽  
Activated Partial Thromboplastin Time
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