Pharmacotherapy
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Randomized Controlled Trial Comparative Study
A reliable and safe method of collecting blood samples from implantable central venous catheters for determination of plasma gentamicin concentrations.
To evaluate the extent of agreement between plasma gentamicin concentrations determined from samples collected by using implantable subcutaneous central venous catheters (ports) with the push-pull method and those collected by finger lancet punctures in children with febrile neutropenia. ⋯ The push-pull method of blood sampling is a reliable and safe option for determining plasma gentamicin concentrations in children with ports.
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To determine dosing options for decreasing the time to achieve a therapeutic international normalized ratio (INR) threshold of 2.0 when restarting warfarin in an ambulatory population whose previous warfarin maintenance doses are known, and to identify thromboembolic and major bleeding events up to 90 days after disruption of warfarin therapy. ⋯ In select patients, the option of administering a warfarin loading dose of approximately 40% greater than the previous daily maintenance dose for 2 or 3 days shortens the time to achieving therapeutic anticoagulation.
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Multicenter Study Comparative Study
The Retrospective Cohort of Extended-Infusion Piperacillin-Tazobactam (RECEIPT) study: a multicenter study.
To compare the effectiveness of extended-infusion piperacillin-tazobactam with that of similar-spectrum, nonextended-infusion [H9252]-lactam antibiotics in the treatment of gram-negative infections. ⋯ Pharmacodynamic dosing using extended-infusion piperacillintazobactam demonstrated favorable outcomes, including mortality, when compared with nonextended-infusion, similar-spectrum [H9252]-lactams in the treatment of patients with documented gram-negative infections. Prospective, randomized trials are needed to further corroborate these findings.
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To assess the effect of substituting dexmedetomidine for propofol during a nationwide propofol shortage on postoperative time to extubation and opioid requirements in patients who underwent coronary artery bypass graft (CABG) surgery. ⋯ No statistically significant differences were noted between the propofol and dexmedetomidine groups when assessing the outcomes of opioid requirements and the time to extubation. A multicenter, prospective, randomized, blinded study is needed to determine the optimal sedative after CABG surgery.
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To characterize the extent that serum gentamicin concentrations are associated with hearing loss indicated by otoacoustic emission (OAE) screen failure in critically ill neonates receiving gentamicin in accordance with a high-dose, extended-interval dosing protocol. ⋯ Neonates weighing more than 1500 g at birth and whose gentamicin C(max) exceeded 10 μg/ml were at an increased risk for OAE screen failure. Monitoring and maintaining gentamicin C(max) at or below 10 μg/ml may minimize hearing impairment; however, further studies are necessary.