[Clinical impact of appropriate use of antibiotic in hospital according to CARAT criteria].
Humans; *Practice Guidelines as Topic; Intensive Care Units; Anti-Bacterial Agents/pharmacology/*therapeutic use; Evidence-Based Medicine; Organizational Policy; Europe/epidemiology; Clinical Trials as Topic; *Guideline Adherence; Bacterial Infections/drug therapy/epidemiology; Drug Utilization; Hospitals/*standards; Patients' Rooms; *Drug Resistance; Multiple; Bacterial
In response to the overuse and misuse of antibiotics, leading to increasing bacterial resistance and the decreasing development of new antibiotics, the Council for Appropriate and Rational Antibiotic Therapy (an independent, interdisciplinary panel of healthcare professionals established to advocate the appropriate use of antibiotics) has developed criteria to guide proper antibiotic selection. These criteria include: establishment of a need to justify use of antibiotics (e.g., colonization versus disease); evidence-based results; therapeutic benefits; safety; use of pharmacodynamic indices for optimal drug and optimal duration; cost-effectiveness. Promoting the appropriate use of antibiotics should provide for optimal outcomes for our patients.
File Thomas M Jr
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive
2008
2008-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
A Gap, and Opportunity, in the ICU Admission, Discharge, and Triage Guidelines.
*Patient Discharge; *Triage; Hospitalization; Humans; Intensive Care Units; Patient Admission; Patient Discharge; Scales; Triage
Frakes Michael A; Wilcox Susan R; Bigham Michael T; Angelotti Timothy; Marcolini Evie G; Cohen Jason
Critical care medicine
2017
2017-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/CCM.0000000000002202" target="_blank" rel="noreferrer noopener">10.1097/CCM.0000000000002202</a>
Acute kidney injury (AKI) in paediatric critical care.
Dialysis; Child; Intensive Care Units; Kidney Function Tests; Pediatric; Kidney Failure; Creatinine; Acute – In Infancy and Childhood; Critical Care – In Infancy and Childhood
Incidence of acute kidney injury (AKI) is gradually increasing in children admitted to critical care units partly because of increased awareness of this entity. Though serum creatinine has been used in most definitions, its inability to accurately reflect kidney function has resulted in problems for clinical research in paediatric AKI. This has resulted in the use of more than 35 definitions of AKI in clinical studies, ranging from small changes in serum creatinine to requirement for dialysis. Therefore, comparisons among studies are difficult, resulting in a wide range of quoted epidemiology, morbidity, and mortality rates in the AKI paediatric literature. Acute kidney injury may be precipitated by critical illness, pre-existing medical conditions, and treatments received both before and during ICU admission. In this review we have attempted to outline the current definitions used for AKI, presence of AKI in various critical care conditions (bone marrow transplant, liver, sepsis, cardiac, primary renal conditions leading to glomerulonephritis) and outline the basic management.
Raina Rupesh; Chauvin Abigail; Deep Akash
Paediatrics & Child Health
2017
2017-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.paed.2017.01.008" target="_blank" rel="noreferrer noopener">10.1016/j.paed.2017.01.008</a>
Adherence to Endotracheal Tube Depth Guidelines and Incidence of Malposition in Infants and Children.
Female; Humans; pediatrics; Male; Ohio; Random Allocation; Incidence; Chi-Square Distribution; Child; Guideline Adherence/*statistics & numerical data; Infant; intubation; Medical Errors/*statistics & numerical data; NRP; PALS; Radiography/*statistics & numerical data; Trachea/diagnostic imaging; tracheal tube malposition; United States; Odds Ratio; Intensive Care Units; Hospitals; Guideline Adherence; Radiography; Intubation; ROC Curve; Confidence Intervals; Inpatients; Human; Chi Square Test; Descriptive Statistics; P-Value; Data Analysis Software; Practice Guidelines; Retrospective Design; Preschool; Thoracic; Intratracheal/adverse effects/standards/*statistics & numerical data; Intratracheal – Standards – United States; Pediatric – Ohio
BACKGROUND: Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adherence to Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. METHODS: In a random subset (randomization table) of 2,000 initial chest radiographs obtained from January 1, 2009, to May 5, 2012, we recorded height, weight, age, sex, ETT inner diameter, and cm marking at the lip from the electronic health record. Chest radiographs of poor quality and with spinal or skeletal deformities were excluded. We defined adherence to Pediatric Advanced Life Support or Neonatal Resuscitation Program guidelines as the difference between predicted and actual ETT markings at the lip as +/- 0.25, +/- 0.50, or +/- 1.0 cm for ETTs of 2.5-4, 4.5-6.0, or \textgreater6.5 mm inner diameter, respectively. We defined the proper position as the ETT tip being below the thoracic inlet (superior border of the clavicular heads) and \textgreater/=1 cm above the carina. Descriptive statistics reported demographics, guideline adherence, and malposition incidence. The chi-square test was used to assess relationships among intubation setting, malposition, and depth guideline adherence (P \textless .05, significant). RESULTS: We reviewed 507 records, 477 of which met inclusion criteria and had sufficient data for analysis. Fifty-six percent of the subjects were male, with median (interquartile range) age 15.2 (3.4-59.4) months, and 330 ETTs (69%) were malpositioned: 39 above the thoracic inlet, and 291 \textless 1 cm above the carina. Of 79 ETTS (17%) that adhered to depth guidelines, 56 (74%) were malpositioned. Three-hundred seventy-three ETTs (83%) did not meet guidelines. Two-hundred sixty-four (68%) were malpositioned. The intubation setting did not influence malposition or guideline adherence (P = .54). CONCLUSIONS: In infants and children, a high proportion of ETTs were malpositioned on the first postintubation chest radiograph, with little influence of guideline adherence.
Volsko Teresa A; McNinch Neil L; Prough Donald S; Bigham Michael T
Respiratory Care
2018
2018-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4187/respcare.06024" target="_blank" rel="noreferrer noopener">10.4187/respcare.06024</a>
Automated bladder scan urine volumes are not reliable in complex neonatal cases.
Automation; Humans; Infant; Intensive Care Units; Neonatal; Newborn; Predictive Value of Tests; Ultrasonography/*instrumentation; Urinary Bladder/*diagnostic imaging; Urinary Catheterization; Urodynamics
PURPOSE: We investigate the accuracy of urine volumes obtained by an automated bladder scan in complex neonatal cases. MATERIALS AND METHODS: Automated bladder scan determinations of urine volumes were obtained by neonatal intensive care unit nursing staff in 10 patients with myelodysplasia and cloacal exstrophy. Urine volumes were then immediately obtained by straight catheterization. Correlation between the scan and catheter volumes was then evaluated across and within cases. RESULTS: There was low correlation between automated bladder scan volume and catheter volume across and within cases (0.037 +/- 0.37) and (0.188 +/- 0.12), respectively. Using a cutoff of 20 cc 25% of significant volumes were missed. The 95% confidence interval from these data indicates that a significant volume is missed 7% to 25% of the time. CONCLUSIONS: We urge clinicians to exercise caution in the use of automated bladder scanners for determination of urine volumes in complex neonatal intensive care unit cases.
Wyneski Holly K; McMahon Daniel R; Androulakakis Voula; Nasrallah Phillip F
The Journal of urology
2005
2005-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.ju.0000179386.31422.1a" target="_blank" rel="noreferrer noopener">10.1097/01.ju.0000179386.31422.1a</a>
Bolus gastric feeds improve nutrition delivery to mechanically ventilated pediatric medical patients: Results of the COntinuous vs BOlus multicenter trial
Background: Comparison of bolus gastric feeding (BGF) vs continuous gastric feeding (CGF) with respect to timing and delivery of energy and protein in mechanically ventilated (MV) pediatric patients has not been investigated. We hypothesized that bolus delivery would shorten time to goal nutrition and increase the percentage of goal feeds delivered.
Methods: Multicenter, prospective, randomized comparative effectiveness trial conducted in seven pediatric intensive care units (PICUs). Eligibility criteria included patients aged 1 month to 12 years who were intubated within 24 h of PICU admission, with expected duration of ventilation at least 48 h, and who were eligible to begin enteral nutrition within 48 h. Exclusion criteria included patients with acute or chronic gastrointestinal pathology or acute surgery.
Results: We enrolled 158 MV children between October 2015 and April 2018; 147 patients were included in the analysis (BGF = 72, CGF = 75). Children in the BGF group were slightly older than those in the CGF; otherwise, the two groups had similar demographic characteristics. There was no difference in the percentage of patients in each group who achieved goal feeds. Time to goal feeds was shorter in the BGF group (hazard ratio 1.5 [CI 1.02-2.33]; P = 0.0387). Median percentage of target kilocalories (median kcal 0.78 vs 0.59; P ≤ 0.0001) and median percentage of protein delivered (median protein 0.77 vs 0.59; P ≤ 0.0001) was higher for BGF patients. There was no difference in serial oxygen saturation index between groups.
Conclusion: Our study demonstrated shorter time to achieve goal nutrition via BGF compared with CGF in MV pediatric patients. This resulted in increased delivery of target energy and nutrition. Further study is needed in other PICU populations.
Ann-Marie Brown
Sharon Y Irving
Charlene Pringle
Christine Allen
Miraides F Brown
Sholeen Nett
Marcy N Singleton
Theresa A Mikhailov
Erik Madsen
Vijay Srinivasan
Heather Anthony
Michael L Forbes
The NutriNet and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
JPEN J Parenter Enteral Nutr
. 2022 Jul;46(5):1011-1021. doi: 10.1002/jpen.2305. Epub 2022 Jan 27.
2022
English
Cyanide toxicity in the surgical intensive care unit: a case report.
Female; Humans; Aged; Intensive Care Units; Cyanides/*poisoning; Hypertension/complications/*drug therapy; Nitroprusside/administration & dosage/pharmacokinetics/*poisoning; Poisoning/diagnosis/therapy; Wounds and Injuries/complications/therapy
Hypertension is a widespread entity in the surgical intensive care unit. Not only is the clinical spectrum varied, but the armamentarium available to the clinician is also wide-ranging. Sodium nitroprusside, a potent vasodilator with a short half-life, is often used for hypertensive crisis and to deliberately maintain a low blood in certain clinical conditions. Cyanide toxicity is a known complication of sodium nitroprusside use. Herein is reported a case of probable cyanide toxicity in an elderly trauma patient. The pharmacology of sodium nitroprusside and the pitfalls of making the diagnosis of cyanide toxicity are discussed.
Sipe E K; Trienski T L; Porter J M
The American surgeon
2001
2001-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Delays in immunizations of high-risk infants during the first two years of life: special care for the high-risk infant should not mean special immunization schedules.
Female; Humans; Male; Time Factors; Infant; Gestational Age; Follow-Up Studies; Risk Factors; Intensive Care Units; Physicians; Family; Parents/psychology; *Immunization Schedule; Immunization/*statistics & numerical data; Infant Care/*standards; Primary Health Care/*standards; Newborn; Practice Patterns; Physicians'; Premature; Neonatal
Because experience in our newborn intensive care unit follow-up clinic since 1982 suggested that immunizations of newborn intensive care unit graduates in the first 2 years of life were inappropriately delayed, questionnaires were sent to families and to the four categories of primary care providers (family practitioners, pediatricians, local health clinics, and neonatalogists) in our region to assess immunization rates and practices. Delays in the first diphtheria, tetanus, and pertussis immunization and the polio vaccine were greater the less the birth weight and less the gestational age of the infant. Delays in subsequent immunizations were considerable and did not correlate with gestational age. A substantial proportion of primary care providers are not immunizing infants in compliance with the American Academy of Pediatrics recommendation, but some improvement is seen when the time period 1982 to 1986 is compared with 1987 to 1991.
Magoon M W; Belardo L J; Caldito G
Journal of perinatology : official journal of the California Perinatal Association
1995
1995-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Evaluation of Inpatient Starter Parenteral Nutrition Use in the Neonatal Intensive Care Unit
Objective: Parenteral nutrition (PN) promotes growth and development in neonatal patients while avoiding malnutrition and metabolic derangements. Very low birth weight premature infants should be started on PN within 24 to 48 hours after birth. The objective of this study was to compare starter PN solution use at a freestanding children's hospital health care system before and after the development of a standard starter PN protocol. The secondary objective was to evaluate the estimated annual cost savings due to a standard protocol.
Methods: A single-center, retrospective chart review of neonates who received starter PN in the NICU setting from October through December 2020 after the implementation of the protocol was conducted. The protocol was developed based on usage trends from October through December 2019. Starter PN use was compared within neonatology groups before and after the development of a standardized protocol.
Results: In 2019, 108 neonates weighing <1.8 kg were admitted to the NICUs, while 101 were admitted in 2020. However, 170 neonates received starter PN in 2019, while only 94 neonates received starter PN in 2020. Overall, protocol adherence was 88%. The mean gestational age for patients who were initiated on starter PN decreased from 31 weeks in the pre-protocol group to 28 weeks in the post-protocol group (p < 0.001). The mean birth weight pre-protocol was 1.61 kg, which decreased to a mean of 1.23 kg in the post-protocol group (p < 0.001). The estimated annual cost savings for the inpatient pharmacy department was approximately $13,000 with the initiation of a standard protocol.
Conclusions: The implementation of a standard starter PN protocol decreased usage and variability in NICU practice and aligned more with the American Society for Parenteral and Enteral Nutrition recommendations.
Kayla Novick
M Petrea Cober
J Pediatr Pharmacol Ther
. 2022;27(6):524-528. doi: 10.5863/1551-6776-27.6.524. Epub 2022 Aug 19.
2022
English
Lean Six Sigma: Trimming the fat! Effectively managing precious resources*.
Female; Male; Intensive Care Units; Critical Care; Human; Outcome Assessment; Pediatric; Systems Analysis; Patient Rounds – Administration
Besunder JB; Super DM
Critical care medicine
2012
2012-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/ccm.0b013e3182372bd4" target="_blank" rel="noreferrer noopener">10.1097/ccm.0b013e3182372bd4</a>
Mechanical Ventilation Antioxidant Trial.
Adult; Female; Humans; Male; Middle Aged; Time Factors; Aged; Length of Stay; Treatment Outcome; Prospective Studies; Oxidative Stress; Double-Blind Method; Intensive Care Units; Antioxidants/*therapeutic use; Antioxidants; Oxidative Stress/*drug effects; Critical Care/*methods; Human; Chi Square Test; Funding Source; Data Analysis Software; Middle Age; T-Tests; Ascorbic Acid/therapeutic use; Critical Illness; Cystine/analogs & derivatives/therapeutic use; Inflammation/*drug therapy/*etiology; Vitamin E/therapeutic use; Vitamins/therapeutic use; 80 and over; Artificial; Respiration; Artificial/*adverse effects; Randomized Controlled Trials; Double-Blind Studies; Acetylcysteine; Critically Ill Patients; Dietary Supplementation; Log-Rank Test; Mantel-Haenszel Test; Ventilator Weaning; Vitamin E; 80 and Over; Ascorbic Acid – Administration and Dosage
BACKGROUND: Many patients each year require prolonged mechanical ventilation. Inflammatory processes may prevent successful weaning, and evidence indicates that mechanical ventilation induces oxidative stress in the diaphragm, resulting in atrophy and contractile dysfunction of diaphragmatic myofibers. Antioxidant supplementation might mitigate the harmful effects of the oxidative stress induced by mechanical ventilation. OBJECTIVE: To test the clinical effectiveness of antioxidant supplementation in reducing the duration of mechanical ventilation. METHODS: A randomized, prospective, placebo-controlled double-blind design was used to test whether enterally administered antioxidant supplementation would decrease the duration of mechanical ventilation, all-cause mortality, and length of stay in the intensive care unit and hospital. Patients received vitamin C 1000 mg plus vitamin E 1000 IU, vitamin C 1000 mg plus vitamin E 1000 IU plus N-acetylcysteine 400 mg, or placebo solution as a bolus injection via their enteral feeding tube every 8 hours. RESULTS: Clinical and statistically significant differences in duration of mechanical ventilation were seen among the 3 groups (Mantel-Cox log rank statistic = 5.69, df = 1, P = .017). The 3 groups did not differ significantly in all-cause mortality during hospitalization or in the length of stay in the intensive care unit or hospital. CONCLUSIONS: Enteral administration of antioxidants is a simple, safe, inexpensive, and effective intervention that decreases the duration of mechanical ventilation in critically ill adults.
Howe Kimberly P; Clochesy John M; Goldstein Lawrence S; Owen Hugh
American journal of critical care : an official publication, American Association of Critical-Care Nurses
2015
2015-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4037/ajcc2015335" target="_blank" rel="noreferrer noopener">10.4037/ajcc2015335</a>
Randomized comparison of gastric pH control with intermittent and continuous intravenous infusion of famotidine in ICU patients.
Female; Humans; Male; Middle Aged; Aged; Treatment Outcome; Prospective Studies; Analysis of Variance; Double-Blind Method; Hydrogen-Ion Concentration; Intensive Care Units; Drug Administration Schedule; Famotidine/administration & dosage/*therapeutic use; Stomach Ulcer/blood/etiology/*prevention & control; Stomach/*drug effects/physiopathology; Infusions; Intravenous
OBJECTIVE: To compare gastric pH control using intravenous famotidine as a primed, continuous infusion versus intermittent infusion. METHODS: In a prospective, double-blind study, 40 ICU patients at risk for stress ulceration were randomly assigned to receive either famotidine 20 mg intravenous bolus followed by 1.67 mg/h infusion or famotidine 20 mg intravenously every 12 h. Intraluminal gastric pH was recorded at baseline and every 4 h using a glass electrode. Clinical outcome indicators were also monitored. Subjects were studied for a minimum of 24 h and a maximum of 6 days. Continuous variables were analyzed by ANOVA and nominal variables by Fisher's exact test (alpha = 0.05). RESULTS: Nineteen patients were randomized to the continuous infusion group, and 21 were randomized to the intermittent group. Using gastric pH greater than 4.0 as an endpoint, the continuous group exhibited better pH control, both in terms of percentage of total measurements (83% versus 63%, p \textless 0.001) and time spent above pH 4.0 (91% versus 76%, p \textless 0.01). Similar results were found at pH greater than 5.0 (78% versus 56% for all measurements for the continuous and bolus groups, respectively (p \textless 0.001), and 88% versus 72% for the time spent above pH 5.0 (p \textless 0.01). Clinical outcomes, including evidence for gastrointestinal bleeding and hospital mortality, did not differ significantly between groups. CONCLUSION: Famotidine infusion at 1.67 mg/h, when preceded by a bolus dose of 20 mg, provides a greater and more sustained increase in gastric pH than intermittent administration of famotidine 20 mg every 12 h.
Heiselman D E; Hulisz D T; Fricker R; Bredle D L; Black L D
The American journal of gastroenterology
1995
1995-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).