Journal of critical care
-
Journal of critical care · Feb 2021
Levetiracetam pharmacokinetics in critically ill patients undergoing renal replacement therapy.
To determine clearance of levetiracetam in patients requiring continuous renal replacement therapy (CRRT) or sustained low efficiency dialysis (SLED). ⋯ Levetiracetam clearance was substantial with both modalities under the operating conditions reported. There is the potential for subtherapeutic concentrations with current recommended dosing strategies that account only for kidney function and not these extracorporeal routes of elimination.
-
Journal of critical care · Feb 2021
Predictors of dysrhythmias with norepinephrine use in septic shock.
Norepinephrine (NE) is recommended first-line for treatment of septic shock, partly due to its intrinsically low effect on heart rate. While dysrhythmias secondary to NE are still reported, factors associated with development of this adverse effect have not been described. Our study sought to investigate factors associated with dysrhythmias in patients receiving NE for septic shock. ⋯ Development of dysrhythmia is associated with increased mortality and is independently associated with longer duration of NE infusion and higher NE doses.
-
Journal of critical care · Feb 2021
Tuberculous ARDS is associated with worse outcome when compared with non-tuberculous infectious ARDS.
Patients with tuberculosis (TB) developing acute respiratory distress syndrome (ARDS) may have a higher mortality when compared with ARDS of other infectious etiology. ⋯ Patients with TB-ARDS presented sicker and had higher mortality when compared with ARDS due to non-TB infectious etiology.
-
Journal of critical care · Feb 2021
Epidemiology and outcomes of invasive mechanical ventilation without ICU admission in acute care hospitals in Texas: A population-based cohort study.
The high ICU bed capacity in the United States (US) allows ICU care of patients requiring invasive mechanical ventilation (IMV), absent public health crisis. The use of IMV without ICU admission (non-ICU) in acute care hospitals in the US and its impact on patients' outcomes were not examined. ⋯ Non-ICU IMV was provided in 1 in 30 IMV hospitalizations in acute care hospitals. Although non-ICU IMV hospitalizations were younger and healthier than those admitted to ICU, their hospital mortality was markedly higher.
-
Journal of critical care · Feb 2021
Observational StudyDischarge from hospital with newly administered antipsychotics after intensive care unit delirium - Incidence and contributing factors.
Delirium in the intensive care unit (ICU) is often treated with haloperidol or atypical antipsychotics. Antipsychotic treatment can lead to severe adverse effects and excess mortality. After initiation in the ICU, patients are at risk of having their antipsychotics continued unnecessarily at ICU and hospital discharge. This study aims to determine the incidence of, and risk factors for antipsychotic continuation at hospital discharge after ICU delirium. ⋯ Approximately one in five patients were discharged from the hospital with continued antipsychotics. Hospital policies should implement strategies for systematic antipsychotic tapering and better follow-up of antipsychotics at transitions of care.