Critical Care Research and Practice最新文献

{"title":"Non-Neurological Complications after Mechanical Thrombectomy for Acute Ischemic Stroke: A Retrospective Single-Center Study.","authors":"Pierre Goffin,&nbsp;Romain Thouny,&nbsp;Julien Guntz,&nbsp;Denis Brisbois,&nbsp;Philippe Desfontaines,&nbsp;Pierre Demaret","doi":"10.1155/2022/5509081","DOIUrl":"https://doi.org/10.1155/2022/5509081","url":null,"abstract":"<p><strong>Introduction: </strong>The global burden of stroke is high and mechanical thrombectomy is the cornerstone of the treatment. Incidences of acute non-neurological-complications are poorly described. Improve knowledge about these complications may allow to better prevent, detect and/or manage them. The aim is to identify risk markers of death or poor evolution.</p><p><strong>Method: </strong>We conducted a retrospective single-center study to analyzed the incidence of non-neurologicalcomplications after mechanical thrombectomy in acute ischemic stroke. Patients who had experienced a stroke and undergone thrombectomy were identified using a registry in which we prospectively collected data from each patient admitted to our hospital with a diagnosis of stroke. Quantitative and qualitative variables were analyses. The association between studied variables and hospital death was assessed using simple logistic regression models.</p><p><strong>Result: </strong>361 patients were reviewed but 16 were excluded due to a lack of medical information. Between 2012 and 2019, 345 patients were included. The median admission NIHSS score was 15. Seven percent of the patients died in the ICU. The following independent risk markers of death in the ICU were identified by logistic regression: respiratory complication, hypotension, infectious complication, and hyperglycemia.</p><p><strong>Conclusion: </strong>In this large retrospective study of stroke, respiratory complications and pulmonary infections represented the most important non-neurological adverse events encountered in the ICU and associated with a risk of death.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2022 ","pages":"5509081"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10817943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness and Perception of Healthcare Providers about Proxy Consent in Critical Care Research.","authors":"Rania Mahafzah, Karem H Alzoubi, Omar F Khabour, Rana Abu-Farha","doi":"10.1155/2021/7614517","DOIUrl":"10.1155/2021/7614517","url":null,"abstract":"<p><strong>Objective: </strong>Proxy consent respects patients' autonomy when they are incapable of providing consent for research participation. Healthcare providers need to understand the ethical regulations and practices relevant to the proxy consent process. Thus, this study aimed to assess the knowledge and attitudes of healthcare providers about research proxy consent in the ICU setting.</p><p><strong>Methods: </strong>A cross-sectional survey-based design was used in the study. Study participants were resident and specialist physicians, registered nurses, and registered pharmacists from ICU units in Jordan. Participants were asked to fill out a questionnaire developed to assess their knowledge and attitudes towards informed proxy consent for research studies conducted at the ICU.</p><p><strong>Results: </strong>In this study, 145 healthcare providers completed the study questionnaire. The healthcare providers agreed that the purpose of the proxy consent is to inform the participants about the potential benefits (66.9%) and risks (66.9%) related to the research to study and respect patient's autonomy (44%), to discuss alternative options (62.1%), and to protect the researchers from any litigation (84.1%). Regarding the assessment of proxy consent, 65.5% of respondents believed that relatives are considered as an authorized legal representative for an informed consent decision on behalf of their ICU patients (65.5%) as they are knowledgeable about patients' values and preferences and have the desire to provide the necessary help. Respondents also agreed that the informed consent process should explain research protocols and procedures (76.6%), therapeutic alternatives (84.1%), potential benefits (41.4%), and potential risks (44.1%) and that participation in the research is voluntary (66.9%). No significant differences in the responses were found among different groups of healthcare providers.</p><p><strong>Conclusion: </strong>The majority of healthcare providers had inadequate awareness about the ethical aspects regarding the informed proxy consent process. Providing training regarding the informed consent process can improve the quality of the proxy consent process in clinical research studies in the ICU setting.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2021 ","pages":"7614517"},"PeriodicalIF":1.8,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10587318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19: A Single-Center ICU Experience of the First Wave in the Philippines.","authors":"Onion Gerald V Ubaldo, Jose Emmanuel M Palo, Jude Erric L Cinco","doi":"10.1155/2021/7510306","DOIUrl":"10.1155/2021/7510306","url":null,"abstract":"<p><p>On January 30, 2020, the WHO declared the novel coronavirus of 2019 a pandemic, causing millions of cases and thousands of deaths worldwide, exposing the vulnerabilities of healthcare systems around the world with each country having its own experience. These ranged from patient clinical profiles to management recommendations and to government interventions. There is a paucity of published data regarding Philippine experience. This study is a retrospective, descriptive study of ninety-one COVID-19 probable patients admitted in the COVID ICU of The Medical City from March 16 to May 7, 2020. We described clinical and demographic characteristics amongst COVID-19-confirmed and -negative patients. Therapeutic interventions including COVID-19 investigational drug use and other organ failure strategies were noted and tested for association with ICU survivors and nonsurvivors. We observed that there was no therapeutic intervention that was associated with improved outcomes, with some interventions showing trends favoring the ICU nonsurvivor group. These interventions include, but are not limited to, the use of hydroxychloroquine and tocilizumab, and prone positioning. We also observed that a higher SAPS-3 score was associated with the COVID-19 positive group and the ICU nonsurvivor group. On PubMed search, there seems to be no Philippine-specific literature regarding COVID-19 ICU experience. Further investigations to include more variables are recommended.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2021 ","pages":"7510306"},"PeriodicalIF":1.7,"publicationDate":"2021-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10656969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Mortality and Resource Implications of Hospitalisation with COVID-19 in London, UK: A Prospective Cohort Study.","authors":"Savvas Vlachos,&nbsp;Adrian Wong,&nbsp;Victoria Metaxa,&nbsp;Sergio Canestrini,&nbsp;Carmen Lopez Soto,&nbsp;Jimstan Periselneris,&nbsp;Kai Lee,&nbsp;Tanya Patrick,&nbsp;Christopher Stovin,&nbsp;Katrina Abernethy,&nbsp;Budoor Albudoor,&nbsp;Rishi Banerjee,&nbsp;Fatimah Juma,&nbsp;Sara Al-Hashimi,&nbsp;William Bernal,&nbsp;Ritesh Maharaj","doi":"10.1155/2021/8832660","DOIUrl":"https://doi.org/10.1155/2021/8832660","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) had a significant impact on the National Health Service in the United Kingdom (UK), with over 35 000 cases reported in London by July 30, 2020. Detailed hospital-level information on patient characteristics, outcomes, and capacity strain is currently scarce but would guide clinical decision-making and inform prioritisation and planning.</p><p><strong>Methods: </strong>We aimed to determine factors associated with hospital mortality and describe hospital and ICU strain by conducting a prospective cohort study at a tertiary academic centre in London, UK. We included adult patients admitted to the hospital with laboratory-confirmed COVID-19 and followed them up until hospital discharge or 30 days. Baseline factors that are associated with hospital mortality were identified via semiparametric and parametric survival analyses.</p><p><strong>Results: </strong>Our study included 429 patients: 18% of them were admitted to the ICU, 52% met criteria for ICU outreach team activation, and 61% had treatment limitations placed during their admission. Hospital mortality was 26% and ICU mortality was 34%. Hospital mortality was independently associated with increasing age, male sex, history of chronic kidney disease, increasing baseline C-reactive protein level, and dyspnoea at presentation. COVID-19 resulted in substantial ICU and hospital strain, with up to 9 daily ICU admissions and 41 daily hospital admissions, to a peak census of 80 infected patients admitted in the ICU and 250 in the hospital. Management of such a surge required extensive reorganisation of critical care services with expansion of ICU capacity from 69 to 129 beds, redeployment of staff from other hospital areas, and coordinated hospital-level effort.</p><p><strong>Conclusions: </strong>COVID-19 is associated with a high burden of mortality for patients treated on the ward and the ICU and required substantial reconfiguration of critical care services. This has significant implications for planning and resource utilisation.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":" ","pages":"8832660"},"PeriodicalIF":1.7,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25351257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Much PEEP Does High Flow Deliver via Tracheostomy? A Literature Review and Benchtop Experiment.","authors":"Martin Thomas,&nbsp;Riddhi Joshi,&nbsp;Grant Cave","doi":"10.1155/2021/6036891","DOIUrl":"https://doi.org/10.1155/2021/6036891","url":null,"abstract":"<p><strong>Background: </strong>High flow tracheostomy (HFT) is a commonly used weaning and humidification strategy for tracheostomised patients, but little is known as to how much PEEP or mechanical benefit it offers. Patient anatomy and device characteristics differentiate it from high flow nasal cannula and the physiological effects observed.</p><p><strong>Objectives: </strong>(1) To review the available literature on the effects of HFT on airway pressure and indices of gas exchange. (2) To quantify PEEP generated by a HFT  circuit.</p><p><strong>Methods: </strong>A randomised benchtop experiment was conducted, with a size 8 uncuffed Portex tracheostomy connected to an Optiflow™ with Airvo 2™ humidifier system. The tracheostomy tube was partially immersed in water to give rise to a column of water within the inner surface of the tube. An air fluid interface was generated with flows of 40 L/min, 50 L/min, and 60 L/min. The amount of potential PEEP (pPEEP) generated was determined by the distance the water column was pushed downward by the flow delivered. <i>Findings</i>. Overall 40 L/min, 50 L/min, and 60 L/min provided pPEEP of approximately 0.3 cmH₂O, 0.5 cmH₂O, and 0.9 cmH₂O, respectively. There was a statistically significant change in pPEEP with change in flows from 40-60 L/min with an average change in pPEEP of 0.25-0.35 cmH₂O per 10 L/min flow (<i>p</i> value <0.01). <i>Interpretation</i>. HFT  can generate measurable and variable PEEP despite the open system used. The pPEEP generated with HFT is minimal despite statistically significant change with increasing flows. This pPEEP is unlikely to provide mechanical benefit in weaning patients off ventilatory support.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":" ","pages":"6036891"},"PeriodicalIF":1.7,"publicationDate":"2021-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25315596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Training Eye Care Clinical Guideline for ICU Patients on Clinical Competence of Eye Care in Nurses.","authors":"Zakieh Momeni Mehrjardi,&nbsp;Samaneh Mirzaei,&nbsp;Mohsen Gohari,&nbsp;Abbass Hafezieh,&nbsp;Khadijeh Nasiriani","doi":"10.1155/2021/6669538","DOIUrl":"https://doi.org/10.1155/2021/6669538","url":null,"abstract":"<p><strong>Introduction: </strong>Sight is one of the most important and vital human senses. Lack of proper eye care (EC) in anesthetized patients can lead to serious ocular complications and even vision loss. Insufficient knowledge, attitude, and skills of nurses are considered as a barrier to providing EC in the intensive care unit (ICU). The aim of the present study was to determine the effect of training EC clinical practice guidelines for ICU patients on nurses' knowledge, attitude, and practice of EC.</p><p><strong>Methods: </strong>This was an interventional study with a pre-post design performed on 60 ICU nurses. For the experimental group, EC clinical guideline training was performed for anesthetized patients in three sessions. The data collection tool included nurses' clinical competence of the EC questionnaire with a possible score range of 0-86. This tool consists of three domains, including knowledge (0-18), attitude (0-28), and practice (0-40), which was completed in a self-assessment manner before and three months after the training program. Data analysis was carried out using SPSS16. <i>Findings</i>. The mean scores of knowledge, attitude, and practice after the intervention in the experimental and control groups were 15.03 ± 2.72 and 11.11 ± 3.50, 25.65 ± 3.47 and 22.07 ± 3.08, and 33.88 ± 4.14 and 28.5 ± 55.08, respectively, which were statistically significant (<i>P</i> ≤ 0.001). Also, the total score of clinical competence of EC after the intervention in the experimental and control groups was 74.56 ± 7.93 and 61.74 ± 9.66, which showed a significant difference (<i>P</i> ≤ 0.001).</p><p><strong>Conclusion: </strong>Training nurses based on EC clinical guidelines for anesthetized patients can improve the knowledge, attitude, and practice of ICU nurses. Evidence-based EC practice requires continuous training based on clinical guidelines and EC practice monitoring by nursing managers according to EC clinical guideline for an anesthetized patient.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":" ","pages":"6669538"},"PeriodicalIF":1.7,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25316012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Analysis of Thromboembolic Phenomena in Mechanically Ventilated Patients with COVID-19.","authors":"Fahad Faqihi,&nbsp;Abdulrahman Alharthy,&nbsp;Abdullah Balhamar,&nbsp;Nasir Nasim,&nbsp;Khaled Alanezi,&nbsp;Feisal Alaklobi,&nbsp;Ziad A Memish,&nbsp;Mike Blaivas,&nbsp;Saleh A Alqahtani,&nbsp;Dimitrios Karakitsos","doi":"10.1155/2021/8737580","DOIUrl":"https://doi.org/10.1155/2021/8737580","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have shown an increased prevalence of thromboembolic disease in critically ill patients with the novel SARS-CoV-2 disease (COVID-19). However, the use of enhanced anticoagulation therapy in these patients remains controversial.</p><p><strong>Objectives: </strong>To determine the incidence of thromboembolic phenomena (TEP) and hemorrhagic events (HEs) in intensive care unit (ICU) COVID-19 patients.</p><p><strong>Methods: </strong>One hundred and sixty ICU patients with COVID-19 were enrolled. Clinical examination results, laboratory data, and imaging studies (computed tomography/Doppler ultrasound scans) for these patients were retrospectively collected and analyzed. Outcome measures including days on mechanical ventilation, ICU length of stay, and day-28 mortality were recorded.</p><p><strong>Results: </strong>Sixty patients (37.5%) developed TEP including thirty patients with deep vein thrombosis, 55 patients with pulmonary embolism, and 7 patients with arterial thromboembolism. Cardiac arrhythmias, lymphocytopenia, and increased D-dimers were more frequently observed in the TEP group compared to the non-TEP group of patients (all <i>p</i> < 0.05). The sensitivity, specificity, and positive and negative predictive values of a cutoff D-dimer level of 3.0 <i>μ</i>g/mL for predicting PE were 74.5%, 95.1%, 86.8%, and 91.9%, respectively. Thirteen patients experienced HEs, which were more frequently observed in the TEP group (<i>p</i> < 0.05). Twenty-eight-day mortality was higher in the TEP group (60%) compared to the non-TEP group (30%) of patients (<i>p</i>=0.02).</p><p><strong>Conclusions: </strong>The rates of TEP and HEs in mechanically ventilated critically ill COVID-19 patients were 37. 5% and 8.1%. Twenty-eight-day mortality was higher in the TEP group (60%) compared to the non-TEP group (30%) of patients.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":" ","pages":"8737580"},"PeriodicalIF":1.7,"publicationDate":"2021-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25316013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart-Protective Mechanical Ventilation in Postoperative Cardiosurgical Patients.","authors":"Vadim Mazurok,&nbsp;Igor Kasherininov,&nbsp;Andrey Bautin,&nbsp;Olga Kulemina,&nbsp;Ryta Rzheutskaya","doi":"10.1155/2021/6617809","DOIUrl":"https://doi.org/10.1155/2021/6617809","url":null,"abstract":"<p><strong>Background: </strong>This study compared the hemodynamic effects and gas exchange under several different ventilator settings-with regard to tidal volume, respiratory rate, and end-expiratory pressure-in patients after coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>Prospective interventional cohort study with a controlled group in a single cardiosurgical ICU involving 119 patients following on-pump CABG surgery. During the 1st postoperative hour, the intervention group patients were ventilated with Vt 10 ml × kg^-1, RR 14/min, PEEP 5 cmH₂O (\"conventional ventilation\"). During the 2nd hour, RR was reduced to 8/min (\"reduced RR ventilation\"). At 3 hrs, Vt was decreased to 6 ml × kg^-1, RR returned to 14/min, and PEEP increased to 10 cmH₂O (\"low Vt-high PEEP ventilation\").</p><p><strong>Results: </strong>Patients in the \"low Vt-high PEEP\" ventilation period showed significantly lower alveolar ventilation and thoraco-pulmonary compliance than during \"reduced RR\" ventilation. Mean airway pressure and Vds/Vt peaked during low Vt-high PEEP ventilation; however, driving pressure was lower. Vt decrease and PEEP increase did not lead to oxygenation improvement and worsened CO₂ elimination. Hemodynamically, the study revealed significant cardiac output decrease during low Vt-high PEEP ventilation. In 23.2% of patients, catecholamine therapy was initiated.</p><p><strong>Conclusions: </strong>In postoperative cardiosurgical patients, MV with Vt 6 ml × kg^-1 and PEEP 10 cm H₂O is characterized by worsened oxygenation and elimination of CO₂ and a less favorable hemodynamic profile than ventilation with Vt 10 ml × kg^-1 and PEEP 5 cmH₂O. <i>New and Noteworthy</i>. (i) Patients after CABG may be especially sensitive to low tidal volume and increased PEEP as it negatively affects hemodynamic profile by means of the right heart preload decrease and afterload increase. (ii) Mechanical ventilation settings aiming to minimize mean airway pressure reduce the negative effects of positive inspiratory pressure and are favorable for hemodynamics.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2021 ","pages":"6617809"},"PeriodicalIF":1.7,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10292843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey.","authors":"Mazen Alqahtani, Faizan Kashoo, Msaad Alzhrani, Fuzail Ahmad, Mohammed K Seyam, Mehrunnisha Ahmad, Adel A Alhusaini, Ganeswara Rao Melam, Syamala Buragadda","doi":"10.1155/2020/6610027","DOIUrl":"10.1155/2020/6610027","url":null,"abstract":"<p><strong>Background: </strong>Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia.</p><p><strong>Aim: </strong>To determine the current standard of ICU PT practice, attitude, and barriers.</p><p><strong>Methods: </strong>A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU.</p><p><strong>Results: </strong>The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (<i>n</i> = 111, 89%) and stroke (<i>n</i> = 102, 82.3%) as compared to congestive heart failure (<i>n</i> = 20, 16.1%) and pulmonary infections (<i>n</i> = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (<i>n</i> = 102, 82.2%) and positioning (<i>n</i> = 73, 58.8%), whereas functional electrical stimulation (<i>n</i> = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (<i>n</i> = 89, 71.7%) followed by inadequate training (<i>n</i> = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (<i>n</i> = 8, 6.4%).</p><p><strong>Conclusion: </strong>PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"6610027"},"PeriodicalIF":1.7,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38829465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Area under the Curve-Based Dosing of Vancomycin in Critically Ill Patients Using 6-Hour Urine Creatinine Clearance Measurement.","authors":"Bita Shahrami, Farhad Najmeddin, Saeideh Ghaffari, Atabak Najafi, Mohammad Reza Rouini, Mojtaba Mojtahedzadeh","doi":"10.1155/2020/8831138","DOIUrl":"10.1155/2020/8831138","url":null,"abstract":"<p><strong>Background: </strong>The area under the curve- (AUC-) guided vancomycin dosing is the best strategy for individualized therapy in critical illnesses. Since AUC can be calculated directly using drug clearance (CL_van), any parameter estimating CL_van will be able to achieve the goal of 24-hour AUC (AUC_24 h). The present study was aimed to determine CL_van based on 6-hour urine creatinine clearance measurement in critically ill patients with normal renal function.</p><p><strong>Method: </strong>23 adult critically ill patients with an estimated glomerular filtration rate (eGFR) ≥60 mL/min who received vancomycin infusion were enrolled in this pilot study. Vancomycin pharmacokinetic parameters were determined for each patient using serum concentration data and a one-compartment model provided by MONOLIX software using stochastic approximation expectation-maximization (SAEM) algorithm. Correlation of CL_van with the measured creatinine clearance in 6-hour urine collection (CL_6 h) and estimated creatinine clearance by the Cockcroft-Gault formula (CL_CG) was investigated.</p><p><strong>Results: </strong>Data analysis revealed that CL_6 h had a stronger correlation with CL_van rather than CL_CG (<i>r</i> = 0.823 vs. 0.594; <i>p</i> < 0.001 vs. 0.003). The relationship between CL_van and CL_6 h was utilized to develop the following equation for estimating CL_van: CL_van (mL/min) = ─137.4 + CL_6 h (mL/min) + 2.5 IBW (kg) (<i>R</i> ^<i>2</i>  = 0.826, <i>p</i> < 0.001). Regarding the described model, the following equation can be used to calculate the empirical dose of vancomycin for achieving the therapeutic goals in critically ill patients without renal impairment: total daily dose of vancomycin (mg) = (─137.4CL_6-h (mL/min) + 2.5 IBW (kg)) × 0.06 AUC_24 h (mg.hr/L).</p><p><strong>Conclusion: </strong>For AUC estimation, CL_van can be obtained by collecting urine in a 6-hour period with good approximation in critically ill patients with normal renal function.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2020 ","pages":"8831138"},"PeriodicalIF":1.7,"publicationDate":"2020-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39151885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}