The Annals of pharmacotherapy
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OBJECTIVE:To review recent clinical studies regarding the role of dexmedetomidine for prevention and treatment of delirium in intensive care unit (ICU) patients. DATA SOURCES:MEDLINE and PubMed searches (1988-Feburary 2013) were conducted, using the key words delirium, dexmedetomidine, Precedex, agitation, α-2 agonists, critical care, and intensive care. References from relevant articles were reviewed for additional information. ⋯ Eight clinical trials, including 5 double-blind randomized trials, were reviewed to evaluate the impact of dexmede to midine on ICU delirium. CONCLUSIONS:Currently available evidence suggests that dexmedetomidine is a promising agent, not only for prevention but also for treatment of ICU-associated delirium. However, larger, well-designed trials are warranted to define the role of dexmedetomidine in preventing and treating delirium in the ICU.
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To identify and summarize published cases in which intravenous lipid emulsion was used to treat pediatric patients with acute drug toxicities. ⋯ There is an increasing interest in use of intravenous lipid emulsions to treat life-threatening toxicity from several lipophilic drugs in adults and children. Although most of the literature describes adult cases, intravenous lipid emulsion has been used in neonates and adolescents, with generally positive outcomes. Given the life-threatening, sometimes near-death situations in which an intravenous lipid emulsion is typically used after conventional resuscitation is unsuccessful and the dramatic positive response to this therapy in most published cases, its use likely will continue. Continued reporting of pediatric cases will guide the optimal use and safety profile of intravenous lipid emulsion for the emergent reversal of drug toxicity.
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Multicenter Study
Inappropriate medication administration practices in Canadian adult ICUs: a multicenter, cross-sectional observational study.
Critically ill patients often receive multiple medications via continuous intravenous infusion. Coadministration of multiple medications through the same port of a venous access device often is necessary but requires an assessment of compatibility. ⋯ Inappropriate Y-site combinations of medications continuously infused in Canadian ICUs are common. Management of medication infusions could, however, have been optimized in most of these situations.
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To review the current literature on the efficacy and safety of low- versus high-dose adrenocorticotropic hormone (ACTH) regimens, low-dose ACTH regimens, and comparison of ACTH with oral corticosteroids or vigabatrin for the treatment of West syndrome. ⋯ The current literature suggests that short-term, low-dose ACTH should be considered first-line treatment of infantile spasms.
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To provide recommendations for optimized anticoagulant therapy in the inpatient setting and outline broad elements that need to be in place for effective management of anticoagulant therapy in hospitalized patients; the guidelines are designed to promote optimization of patient clinical outcomes while minimizing the risks for potential anticoagulation-related errors and adverse events. ⋯ Anticoagulants are high-risk medications associated with a significant rate of medication errors among hospitalized patients. Several national organizations have introduced initiatives to reduce the likelihood of patient harm associated with the use of anticoagulants. Health care organizations are under increasing pressure to develop systems to ensure the safe and effective use of anticoagulants in the inpatient setting. This document provides consensus guidelines for anticoagulant therapy in the inpatient setting and serves as a companion document to prior guidelines relevant for outpatients.