There was no difference in CP development between groups KG, Getting code smart sepsis medical alert response team : multidisciplinary interventions to improve sepsis bundle performance are associated with decreased mortality Monica Shah, Pharm. Scott Mathis, Pharm. Since the SSC's first guidelines were released, sepsis mortality has decreased overall.
Implementation of bundle elements remains low due to many barriers including recognition, staffing, and care organization. Evaluation of prophylactic heparin dosage on the incidence of venous thromboembolism, bleeding, and thrombocytopenia in critically ill patients receiving mechanical ventilation Paul Reynolds, Pharm. Higher dosing has been proposed to lower incidence of VTE in these patients, but this remains unstudied.
Exclusion criteria were: switching heparin dosage, thrombolytics, orthopedics, trauma, or death before 2 days. The primary outcome was development VTE after day 2. Key secondary outcomes included major bleeding, thrombocytopenia, and mortality. VTE after day 2 occurred in 6.
There were no differences in hospital mortality Little data exist evaluating incidence and risk factors for accumulation. Univariate and multivariate logistic regressions were performed for factors associated with detectable concentrations and acute kidney injury AKI. Differences between groups were age DC, Dose reduction may be necessary in these patients to avoid potential harm. The effect of obesity on vancomycin serum concentrations in patients on continuous venovenous hemofiltration Vincent Soriano, Pharm.
Critical illness, obesity, and use of continuous venovenous hemofiltration CVVH significantly affect its clearance. Attainment of goal trough concentration has been associated with improved clinical outcomes. An optimal dosing regimen has not been established in the above patient population. METHODS: Patients were included if they were 18 years of age or older, received at least 48 hours of vancomycin therapy, adhered to our institutional vancomycin dosing protocol, and had a serum vancomycin trough concentration drawn prior to the third or fourth dose. Given the small sample size and study limitations, further studies are required to validate these findings and to explore its potential clinical implications.
Vasopressin dosing protocols may result in disparate use in obese patients Susan Smith, Pharm.
We hypothesized that dosing protocols would result in earlier initiation of vasopressin in obese patients. The primary outcome was time to vasopressin initiation. The total duration of vasopressors and the incidence of hospital mortality were similar between groups. This unintended effect has unknown clinical significance. Rifaximin for the treatment of septic shock: targeting endotoxemia Jane Lee, Pharm. Candidate 2 , Nithya Abraham, Pharm. Candidate 2 , Justin Kinney, Pharm. Rifaximin, an antibiotic normally used for traveler's diarrhea and hepatic encephalopathy, is associated with a reduction in endotoxemia; especially in patients with cirrhosis.
However, limited evidence exists exploring the effect rifaximin may have in septic patients. Pregnant patients were excluded. Lastly, we wanted to compare the same outcomes in patients with cirrhosis. Statistical analyses were conducted with SPSS, version The rifaximin group had longer lengths of stay in both the ICU However, patients with cirrhosis showed improved ICU survival with rifaximin use.
Evaluation of dexmedetomidine for alcohol withdrawal syndrome with concomitant benzodiazepine treatment on length of stay David Quach, Pharm. The primary endpoint of the study was ICU and total hospital length of stay. The secondary endpoints included length of dexmedetomidine therapy, mortality, delirium and agitation rates, hemodynamic instability, respiratory depression rates, and mechanical ventilation status. The ICU length of stay was higher in the dexmedetomidine group The mechanical ventilation rate was significantly higher in the dexmedetomidine group compared to the benzodiazepine group It is worthy to note that the study was a retrospective review with the potential limitations of patient characteristic differences that play an unknown role in patient severity between the two groups.
Further research is needed to evaluate clinically significant outcomes pertaining to the safety and efficacy of dexmedetomidine as an adjunctive treatment in this patient population. Korobey, Pharm.
At this time there is no clear evidence that any one agent results in better outcomes. Since duration of status epilepticus is one of the strongest predictors of morbidity and mortality, the ability to achieve resolution of status epilepticus rapidly is imperative. Louis following benzodiazepine treatment for SE were included.
The primary outcome was the incidence of SE resolution after one dose of levetiracetam or fosphenytoin. Incidence of SE resolution was similar between groups The most commonly used benzodiazepine was lorazepam, with similar average dosing between groups 2. Larger, prospective studies are needed to better evaluate differences in patient outcomes.
The dosing of second therapy phase agents for SE at this institution can be further optimized to ensure appropriate treatment. Eleven patients 2. One patient in each group was diagnosed with C. Patients with septic shock often have prolonged ICU stays due to persistent hypotension requiring treatment with IV vasopressors.
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A recent retrospective study identified midodrine could potentially wean vasopressors off sooner and shorten ICU stays in septic shock patients. Patients were excluded if midodrine was discontinued before vasopressors. RESULTS: patients were included total patients screened ; 60 patients received midodrine plus vasopressor therapy compared to 50 patients who received vasopressor therapy alone. There was no difference in ICU survival However, the patients who received midodrine had improved ICU mortality.
Perceptions of pharmacists regarding the cost containment strategies and proper use of vasopressin in septic shock Drayton Hammond, Pharm. Rech, Pharm. Personett, Pharm. The cost of vasopressin continues to rise, which may affect opinions and institutional initiatives.
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MeNemar's test was used to compare vasopressin use with and without cost considerations. STATA v. At institutions that implemented an initiative, more respondents indicated vasopressin was initiated at 0.
When vasopressin cost was considered, pharmacists recommended its use less frequently in multiple clinical scenarios that are grey areas. GCS was documented on days 1, 3, 5, and 7 after sedative drips discontinued, and discharge. A prospective study is warranted to determine optimal timing and whether a combination is superior to amantadine alone. Therapeutic drug monitoring of amikacin and augmented renal clearance in critically ill pediatric patients Leslie Escobar, Pharm. Augmented renal clearance ARC has been slightly described. Therapeutic drug monitoring TDM of amikacin using one level normally trough does not provide enough information about the impact of ARC on amikacin plasma concentrations.
Neonates and patients in any renal replacement therapy were excluded. GraphPad Prism 7. Median peak and C6 amikacin concentration were Also, they obtained significant lower amikacin plasma levels compared with patients with no ARC Cpeak: 21 vs A C6 sampling could be more appropriate than trough level to observe ARC for dose adjustment in these patients.
Wilder, Pharm. Foushee, Pharm. Greer, Pharm.