Intensive care medicine
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Intensive care medicine · Jul 2014
Multicenter Study Observational StudyTigecycline use in critically ill patients: a multicentre prospective observational study in the intensive care setting.
This prospective observational study aimed at describing prescription patterns of tigecycline and patient outcomes in 26 French intensive care units (ICU). ⋯ Tigecycline success rates appear comparable to those reported in clinical studies in ICU with severe infections. Tigecycline could be an alternative in ICU patients.
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Intensive care medicine · Jul 2014
Observational StudyPredictors of insufficient amikacin peak concentration in critically ill patients receiving a 25 mg/kg total body weight regimen.
Amikacin requires pharmacodynamic targets of peak serum concentration (Cmax) of 8-10 times the minimal inhibitory concentration, corresponding to a target Cmax of 60-80 mg/L for the less susceptible bacteria. Even with new dosing regimens of 25 mg/kg, 30% of patients do not meet the pharmacodynamic target. We aimed to identify predictive factors for insufficient Cmax in a population of critically ill patients. ⋯ Despite an amikacin dose of 25 mg/kg of total body weight, 33% of patients still had an amikacin Cmax < 60 mg/L. Positive 24-h fluid balance was identified as a predictive factor of Cmax < 60 mg/L. When total body weight is used, low BMI tended to be associated with amikacin underdosing. These results suggest the need for higher doses in patients with a positive 24-h fluid balance in order to reach adequate therapeutic targets.
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Intensive care medicine · Jul 2014
Observational StudyCapillary refill time exploration during septic shock.
During septic shock management, the evaluation of microvascular perfusion by skin analysis is of interest. We aimed to study the skin capillary refill time (CRT) in a selected septic shock population. ⋯ CRT is a clinical reproducible parameter when measured on the index finger tip or the knee area. After initial resuscitation of septic shock, CRT is a strong predictive factor of 14-day mortality.
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Intensive care medicine · Jul 2014
My paper 20 years later: Effect of positive end-expiratory pressure on right ventricular function in humans.
In 1992, we published a report on the effect of positive end-expiratory pressure (PEEP) on right ventricular (RV) function in humans. ⋯ Subsequent studies confirmed our findings which can be summarized as 1) RV filling is independent of Pra; thus central venous pressure cannot be used to estimate RV preload; and 2) for cardiac output to increase by the Starling mechanism the RV must dilate increasing RV ESV. Since the pericardium limits absolute biventricular volume, there is a finite limit to which cardiac output can increase by the Starling mechanism defined not by left ventricular contractility but by RV function. And 3) if fluid loading causes Pra to increase without increasing cardiac output, then resuscitation should stop as the patient is going into acute cor pulmonale. These truths help bedside clinicians understand the echocardiographic and hemodynamic signatures of both RV failure and volume responsiveness.