19 research outputs found
The impact of a single room environment on sedation practices in intensive care
No full textIntroduction: Appropriate levels of sedation in critical illness are important because poorer outcomes are associated with over- or under- sedation. Environmental factors, such as staffing levels, decreased patient visibility, greater distance between patients and nursing patients in single rooms, also impact sedation practices because of the perception of increased personal and patient risk.
Objectives/Aims: To explore the effect of a single room environment on sedation practices in critically ill adults.
Methods: A pre-post quasi-experimental design with data collected 12 months before in an open-plan ICU (n=319) and after (n=306) the move to a new ICU with single rooms. Data were collected for the first 14d of ICU admission or until ICU discharge from all adult patients requiring mechanical ventilation for >12h.
Results: Patient characteristics such as age, sex, APACHE II score, length of stay and ventilation were similar in both groups. In the single room environment, there was no difference in the median total dose of midazolam delivered across the first 4d of ICU admission. The median total dose was statistically higher for fentanyl on days 1 (981.6mcg vs 1201.7mcg) and 3 (1019.7mcg vs 1219.1mcg) of ICU admission; for morphine on day 2 (71.9mg vs. 134.3mg) and day 3 (58.3mg vs 125.3mg); and for propofol on day 1 (1134.0mg v 1692.1mg) and day 3 (1208.7mg vs 2053.4mg). Time series analysis demonstrated a sharp increase in the proportion of patients over-sedated on days 1-3 for the 2 months following the move to single rooms; this decreased over the subsequent 10 months.
Conclusion: Moving from an open plan to a single room environment may contribute to perceptions of increased personal and patient risk which results in administration of higher levels of sedation medication. In our context initial over-sedation corrected over time to be similar to pre-move levels.No Full Tex
Population pharmacokinetics of vancomycin in critically ill patients receiving prolonged intermittent renal replacement therapy
No full textThe aim of this study was to describe the population pharmacokinetics of vancomycin during prolonged intermittent renal replacement therapy (PIRRT) in critically ill patients with acute kidney injury.Critically ill patients prescribed vancomycin across two sites had blood samples collected during 1-3 dosing intervals during which PIRRT was performed. Plasma samples were assayed with a validated immunoassay method. Population pharmacokinetic analysis and Monte Carlo simulations were performed using Pmetrics. The target vancomycin exposures were an AUC/MIC ratio of 400 for efficacy and AUC 700 for toxicity.Eleven critically ill patients (7 male) were enrolled and contributed 192 plasma samples. The patient's mean ± SD age, weight and BMI were 57 ± 13 years, 98 ± 43 kg and 31 ± 9 kg/m, respectively. A two-compartment linear model adequately described the data. The mean ± SD population pharmacokinetic parameter estimates were PIRRT clearance (CL) 3.47 ± 1.99 L/h, non-PIRRT CL 2.15 ± 2.07 L/h, volume of distribution of the central compartment (Vc) 41.85 ± 24.33 L, distribution rate constant from central to peripheral compartment 5.97 ± 7.93 h and from peripheral to central compartment 5.29 ± 6.65 h. Assuming a MIC of 1 mg/L, vancomycin doses of 25 mg/kg/day are suggested to achieve efficacious, whilst minimising toxic, exposures.This is the first population pharmacokinetic study of vancomycin in patients receiving PIRRT and we observed large pharmacokinetic variability. Empirically, weight-based doses that are appropriate for the duration of PIRRT should be selected and supplemented with therapeutic drug monitoring
Population pharmacokinetics of ticarcillin in critically ill patients receiving extended daily diafiltration
No full textThe aim of this study was to describe the population pharmacokinetics of ticarcillin during extended daily diafiltration (EDDf) in critically ill patients with acute kidney injury. Blood samples were collected from critically ill patients prescribed ticarcillin during one to two dosing intervals during which EDDf was performed. Plasma samples were measured using a validated ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method. Concentration-time data were analysed using a population pharmacokinetics approach with Pmetrics®. A total of 53 blood samples were collected from six critically ill patients (three male). The mean ± standard deviation patient age, weight and body mass index (BMI) was 43 ± 22 years, 88 ± 14 kg and 31 ± 5 kg/m, respectively. A two-compartment linear model adequately described the data. Median population pharmacokinetic parameter estimates were as follows: clearance in the presence of EDDf (CL), 6.41 L/h; clearance of EDDf (CL), 4.97 L/h; volume of distribution of the central compartment (V), 56.46 L; intercompartmental clearance from the central to peripheral compartment (k), 13.54 L/h; and intercompartmental clearance from the peripheral to central compartment (k), 21.93 L/h. This is the first population pharmacokinetic model of ticarcillin in patients receiving EDDf. Large pharmacokinetic variability was found, supporting further investigation of the pharmacokinetics of less-studied β-lactam antibiotics in prolonged intermittent renal replacement therapy
The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT):A cluster randomised trial
No full textBackground Hospital-acquired pressure ulcers are a serious patient safety concern, associated with poor patient outcomes and high healthcare costs. They are also viewed as an indicator of nursing care quality. Objective To evaluate the effectiveness of a pressure ulcer prevention care bundle in preventing hospital-acquired pressure ulcers among at risk patients. Design Pragmatic cluster randomised trial. Setting Eight tertiary referral hospitals with >200 beds each in three Australian states. Participants 1600 patients (200/hospital) were recruited. Patients were eligible if they were: ≥18 years old; at risk of pressure ulcer because of limited mobility; expected to stay in hospital ≥48 h and able to read English. Methods Hospitals (clusters) were stratified in two groups by recent pressure ulcer rates and randomised within strata to either a pressure ulcer prevention care bundle or standard care. The care bundle was theoretically and empirically based on patient participation and clinical practice guidelines. It was multi-component, with three messages for patients’ participation in pressure ulcer prevention care: keep moving; look after your skin; and eat a healthy diet. Training aids for patients included a DVD, brochure and poster. Nurses in intervention hospitals were trained in partnering with patients in their pressure ulcer prevention care. The statistician, recruiters, and outcome assessors were blinded to group allocation and interventionists blinded to the study hypotheses, tested at both the cluster and patient level. The primary outcome, incidence of hospital-acquired pressure ulcers, which applied to both the cluster and individual participant level, was measured by daily skin inspection. Results Four clusters were randomised to each group and 799 patients per group analysed. The intraclass correlation coefficient was 0.035. After adjusting for clustering and pre-specified covariates (age, pressure ulcer present at baseline, body mass index, reason for admission, residence and number of comorbidities on admission), the hazard ratio for new pressure ulcers developed (pressure ulcer prevention care bundle relative to standard care) was 0.58 (95% CI: 0.25, 1.33; p = 0.198). No adverse events or harms were reported. Conclusions Although the pressure ulcer prevention care bundle was associated with a large reduction in the hazard of ulceration, there was a high degree of uncertainty around this estimate and the difference was not statistically significant. Possible explanations for this non-significant finding include that the pressure ulcer prevention care bundle was effective but the sample size too small to detect this.</p
Correction: Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies (Critical Care, (2023), 27, 1, (3), 10.1186/s13054-022-04294-5)
No full textFollowing publication of the original article [1], the authors identified that the collaborating authors part of the collaborating author group CCCC Consortium was missing. The collaborating author group is available and included as Additional file 1 in this article
Dysnatremia and 6-Month Functional Outcomes in Critically Ill Patients With Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study
No full textOBJECTIVES: To investigate the association between plasma sodium concentrations and 6-month neurologic outcome in critically ill patients with aneurysmal subarachnoid hemorrhage. DESIGN: Prospective cohort study. SETTING: Eleven ICUs in Australia and New Zealand. PARTICIPANTS: Three-hundred fifty-six aneurysmal subarachnoid hemorrhage patients admitted to ICU between March 2016 and June 2018. The exposure variable was daily measured plasma sodium. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Six-month neurologic outcome as measured by the modified Rankin Scale. A poor outcome was defined as a modified Rankin Scale greater than or equal to 4. The mean age was 57 years (± 12.6 yr), 68% were female, and 32% (n = 113) had a poor outcome. In multivariable analysis, including age, illness severity, and process of care measures as covariates, higher mean sodium concentrations (odds ratio, 1.17; 95% CI, 1.05-1.29), and greater overall variability-as measured by the sd (odds ratio, 1.53; 95% CI, 1.17-1.99)-were associated with a greater likelihood of a poor outcome. Multivariable generalized additive modeling demonstrated, specifically, that a high initial sodium concentration, followed by a gradual decline from day 3 onwards, was also associated with a poor outcome. Finally, greater variability in sodium concentrations was associated with a longer ICU and hospital length of stay: mean ICU length of stay ratio (1.13; 95% CI, 1.07-1.20) and mean hospital length of stay ratio (1.08; 95% CI, 1.01-1.15). CONCLUSIONS: In critically ill aneurysmal subarachnoid hemorrhage patients, higher mean sodium concentrations and greater variability were associated with worse neurologic outcomes at 6 months, despite adjustment for known confounders. Interventional studies would be required to demonstrate a causal relationship
Sepsis-associated acute kidney injury in patients with chronic kidney disease: Patient characteristics, prevalence, timing, trajectory, treatment and associated outcomes
No full textPredicting a strongly positive fluid balance in critically ill patients with acute kidney injury: A multicentre, international study
No full textEpidemiology of hypophosphatemia in critical illness: A multicentre, retrospective cohort study
No full textHypothermia and Influence of Rewarming Rates on Survival Among Patients Admitted to Intensive Care with Bloodstream Infection: A Multicenter Cohort Study
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