Background:
Atrial fibrillation (AF) frequently develops during critical illness. In septic shock complicated by rapid AF, the use of phenylephrine may be advantageous secondary to its β-1 sparing ...properties. However, evidence supporting this strategy is lacking.
Objective:
The purpose of this study is to determine the clinical effect on rate control of transitioning norepinephrine to phenylephrine in septic shock patients who develop AF with a rapid ventricular response (RVR).
Methods:
A single-center retrospective study of septic shock patients admitted to the medical or surgical intensive care unit (ICU) who developed AF with RVR (heart rate >110 beats per minute bpm). Patients who were switched to phenylephrine were compared to those who remained on norepinephrine. The primary end point was sustained achievement of rate control. A time-varying Cox proportional hazards model was used to assess the primary end point.
Results:
A total of 67 patients were included in the study, of which 28 were switched to phenylephrine. Baseline characteristics were similar between groups. The unadjusted hazard ratio for achieving rate control was significant at 1.99 (95% confidence interval CI: 1.19-3.34; P < .01) for the phenylephrine group. The adjusted hazard ratio was 1.75 (95% CI: 0.86-3.53; P = .12). There were no statistically significant differences in mortality or ICU length of stay.
Conclusion:
Our study suggests a potential clinical effect on achieving rate control when switching to phenylephrine cannot be excluded. It remains unclear if there is a benefit on mortality or length of stay outcomes in critically ill patients.
Highlights • A previously published model of cefepime pharmacokinetics was prospectively validated and applied to a unique patient population. • 32 of 33 patients achieved a percent time that the ...free cefepime concentration above the minimum inhibitory concentration (free % T > MIC) of 100%. • A cefepime f Cmin /MIC ratio of < 2.1 predicted clinical failure in patients with Gram-negative bacterial pneumonia.
Analgosedation: The use of Fentanyl Compared to Hydromorphone Choi, Hahnl; Radparvar, Sara; Aitken, Samuel L. ...
Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures),
07/2021, Letnik:
7, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The 2018 Society of Critical Care Medicine guidelines on the "Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU" advocate ...for protocol-based analgosedation practices. There are limited data available to guide which analgesic to use. This study compares outcomes in patients who received continuous infusions of fentanyl or hydromorphone as sedative agents in the intensive care setting.
This retrospective cohort study evaluated patients admitted into the medical intensive care unit, the surgical intensive care unit, and the cardiac intensive care unit from April 1, 2017, to August 1, 2018, who were placed on continuous analgesics. Patients were divided according to receipt of fentanyl or hydromorphone as a continuous infusion as a sedative agent. The primary endpoints were ICU length of stay and time on mechanical ventilation.
A total of 177 patients were included in the study; 103 received fentanyl as a continuous infusion, and 74 received hydromorphone as a continuous infusion. Baseline characteristics were similar between groups. Patients in the hydromorphone group had deeper sedation targets. Median ICU length of stay was eight days in the fentanyl group compared to seven days in the hydromorphone group (p = 0.11) and median time on mechanical ventilation was 146.47 hours in the fentanyl group and 122.33 hours in the hydromorphone group (p = 0.31). There were no statistically significant differences in the primary endpoints of ICU length of stay and time on mechanical ventilation between fentanyl and hydromorphone for analgosedation purposes.
No statistically significant differences were found in the primary endpoints studied. Patients in the hydromorphone group required more tracheostomies, restraints, and were more likely to have a higher proportion of Critical Care Pain Observation Tool (CPOT) scores > 2.
Background:
Previous literature has suggested that a short course of corticosteroids is similarly effective as an extended course for managing an acute exacerbation of chronic obstructive pulmonary ...disease (AECOPD). However, there are limited data regarding the optimal corticosteroid regimen in critically ill patients and the dosing strategies remain highly variable in this population.
Methods:
This retrospective cohort study evaluated patients with AECOPD admitted to the intensive care unit within a 2-year period. Patients were divided into short-course (≤5 days) or extended-course (>5 days) corticosteroid taper groups. The primary end point was treatment failure, defined as the need for intubation, reintubation, or noninvasive mechanical ventilation. Secondary end points included the duration of mechanical ventilation, hospital and intensive care unit length of stay, and adverse events.
Results:
Of the 151 patients who met the inclusion criteria, 94 received an extended taper and 57 received a short taper. Treatment failure occurred in 3 patients, who were all in the extended taper group (P = .17). In a propensity score-matched cohort, the hospital length of stay was 7 days in the short taper group compared to 11 days in the extended taper group (P < .0001). No differences in adverse events were observed.
Conclusion:
A short-course corticosteroid taper in critically ill patients with AECOPD is associated with reduced hospital length of stay and decreased corticosteroid exposure without increased risk of treatment failure. A prospective randomized trial is warranted.
It is axiomatic that good measurements are integral to good public policy for environmental protection. The generalized term for "measurements" includes sampling and quantitation, data integrity, ...documentation, network design, sponsorship, operations, archiving, and accessing for applications. Each of these components has evolved and advanced over the last 200 years as knowledge of atmospheric chemistry and physics has matured. Air quality was first detected by what people could see and smell in contaminated air. Gaseous pollutants were found to react with certain materials or chemicals, changing the color of dissolved reagents such that their light absorption at selected wavelengths could be related to both the pollutant chemistry and its concentration. Airborne particles have challenged the development of a variety of sensory devices and laboratory assays for characterization of their enormous range of physical and chemical properties. Advanced electronics made possible the sampling, concentration, and detection of gases and particles, both in situ and in laboratory analysis of collected samples. Accurate and precise measurements by these methods have made possible advanced air quality management practices that led to decreasing concentrations over time. New technologies are leading to smaller and cheaper measurement systems that can further expand and enhance current air pollution monitoring networks.
Implications: Ambient air quality measurement systems have a large influence on air quality management by determining compliance, tracking trends, elucidating pollutant transport and transformation, and relating concentrations to adverse effects. These systems consist of more than just instrumentation, and involve extensive support efforts for siting, maintenance, calibration, auditing, data validation, data management and access, and data interpretation. These requirements have largely been attained for criteria pollutants regulated by National Ambient Air Quality Standards, but they are rarely attained for nonroutine measurements and research studies.
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