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1.
J Crit Care ; 76: 154291, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37043893

RESUMO

PURPOSE: Tocilizumab has been shown to decrease mortality when used concomitantly with steroids in COVID-19 with 8 mg/kg (max 800 mg) being the standard dose. Our study sought to assess whether a low dose (400 mg) shows similar benefit compared to a high dose for COVID patients concurrently on the same median dose of steroids. MATERIALS/METHODS: A retrospective, multihospital observational study of COVID-19 patients who received tocilizumab in conjunction with steroids between March 2020 and August 2021 was conducted. RESULTS: A total of 407 patients were analyzed with low dose group being significantly more ill at baseline as a higher percentage of patients received vasopressors, were admitted to the ICU and on mechanical ventilation. In the propensity-matched analysis, both groups receiving a median dexamethasone equivalent dose of 10 mg showed no difference in 28-day mortality (p = 0.613). The high dose group had a higher rate of fungal and viral infections. CONCLUSION: Compared to low dose tocilizumab, the high dose did not provide additional efficacy and mortality benefit but resulted in higher fungal and viral infections. This study illustrates that low dose tocilizumab can be an alternative to high dose during a drug shortage of tocilizumab without compensating for efficacy and safety, conserving resources for more patients.


Assuntos
COVID-19 , Insuficiência Respiratória , Humanos , SARS-CoV-2 , Estudos Retrospectivos , Resultado do Tratamento , Tratamento Farmacológico da COVID-19 , Insuficiência Respiratória/tratamento farmacológico
2.
J Crit Care ; 71: 154098, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35724444

RESUMO

PURPOSE: PRIS is a potentially fatal syndrome characterized by various clinical symptoms and abnormalities. Experts suggest that propofol treatment duration ≥48 h or dose ≥83 µg/kg/min is associated with developing PRIS. We hypothesized PRIS might be underdiagnosed due to the overlap of PRIS clinical manifestations with critical illnesses. MATERIALS AND METHODS: Multihospital, retrospective study of adult patients who received continuous propofol infusion ≥48 h or dose ≥60µg/kg/min for >24 h since admission were assessed for the development of PRIS. RESULTS: The incidence of PRIS was 2.9% with a PRIS-associated mortality rate of 36.8%. In PRIS patients, propofol was administered at a median dose of 36.4 µg/kg/min and over a median duration of 147.0 h. The development of PRIS was observed at a median of 125.0 h post-propofol initiation and a cumulative dose of 276.5 mg/kg. The development of metabolic acidosis (78.9%), cardiac dysfunction (52.6%), hypertriglyceridemia (100%), and rhabdomyolysis (26.3%) were observed in our PRIS patients. CONCLUSION: PRIS can often be overlooked and underdiagnosed. It is important to monitor for early signs of PRIS in patients who are on prolonged propofol infusion. Prompt recognition and interventions can minimize the dangers resulting from PRIS.


Assuntos
Síndrome da Infusão de Propofol , Propofol , Adulto , Estado Terminal , Humanos , Hipnóticos e Sedativos/efeitos adversos , Incidência , Propofol/efeitos adversos , Síndrome da Infusão de Propofol/diagnóstico , Síndrome da Infusão de Propofol/etiologia , Estudos Retrospectivos
3.
J Clin Pharmacol ; 62(3): 359-365, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34542174

RESUMO

The use of population pharmacokinetics (PK) to optimize cefepime dosing could be an effective strategy, given the increasing prevalence of resistant gram-negative organisms. The objective of this study is to retrospectively compare dosing using a PK approach (intervention) vs traditional dosing (control) for cefepime in patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). Adult hospitalized patients with HAP or VAP receiving cefepime for ≥72 hours were screened first from August 2018 to January 2019 to be included in the intervention group, then screened during the preintervention period from August 2017 to July 2018 for the control group. Clinical improvement on day 7 of cefepime therapy was achieved in 72% of the patients in the intervention group and 70% of the patients in the control group (P = .8110). However, the clinical cure rate in the intervention group was higher than that of the control group (50% vs 36.5%; P = .0034). Cefepime dosing using population PK appears to be a novel, effective, and safe dosing strategy for patients with HAP or VAP.


Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Cefepima/administração & dosagem , Cefepima/farmacocinética , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Cefepima/uso terapêutico , Creatinina/sangue , Cálculos da Dosagem de Medicamento , Feminino , Meia-Vida , Humanos , Masculino , Taxa de Depuração Metabólica , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Int J Clin Pharm ; 42(6): 1419-1424, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32860596

RESUMO

Background Despite the advantages of dexmedetomidine (DEX) over propofol (PRO) including minimal respiratory depression and the potential for preventing and/or treating intensive care unit (ICU) delirium, PRO has been the preferred agent due to its lower cost. However, the acquisition cost of DEX has considerably decreased as a generic version of DEX has recently become available. Objective To evaluate clinical and economic outcomes of DEX-based sedation compared to PRO in the ICU. Setting A retrospective cohort study of 86 ICU patients who received either DEX or PRO for a period ≥ 12 h. Method Patients were matched by age, sex, and Sequential Organ Failure Assessment scores in a 1:1 ratio. Main outcome measure Clinical outcomes included the duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), and requirements of concomitant sedatives and opioids. Economic outcomes included the ICU and hospital costs as well as the cost of sedatives or combined sedatives and opioids per patient. Results There were no significant differences in ICU and hospital LOS and time on MV in both groups (median ICU LOS 7 [DEX] vs. 9 [PRO] days, p = 0.07; median hospital LOS 12 [DEX] vs. 14 [PRO] days, p = 0.261; median time of MV 144 [DEX] vs. 158 [PRO] hours, p = 0.176). DEX-based sedation compared to PRO was associated with similar ICU and hospital costs (US$ 67,561 vs. 78,429, p = 0.39; US$ 71,923 vs. 71,084, p = 0.1). Conclusion The clinical outcomes and economic impact associated with DEX- and PRO-based sedation were similar.


Assuntos
Anestésicos Intravenosos/economia , Cuidados Críticos/economia , Dexmedetomidina/economia , Custos de Medicamentos , Medicamentos Genéricos/economia , Custos Hospitalares , Hipnóticos e Sedativos/economia , Propofol/economia , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/economia , Anestésicos Intravenosos/administração & dosagem , Análise Custo-Benefício , Dexmedetomidina/administração & dosagem , Medicamentos Genéricos/administração & dosagem , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Respiração Artificial/economia , Estudos Retrospectivos
5.
Am J Infect Control ; 43(7): 729-34, 2015 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-25868650

RESUMO

BACKGROUND: We aimed to investigate the frequency of standard precautions (SPs) compliance and the factors affecting the compliance among nursing students (NSs). METHODS: A cross-sectional survey study guided by the health belief model was conducted in 2009. The study questionnaire is valid (content validity index, 0.81) and reliable (Cronbach α range, 0.65-0.94). RESULTS: There were 678 questionnaires analyzed, with a response rate of 68.9%. The mean frequency score of SPs compliance was 4.38 ± 0.40 out of 5. Tukey honest significant difference post hoc test indicated that year 2 and year 4 students had better SPs compliance than year 3 students. Further analysis using a univariate general linear model identified an interaction effect of perceived influence of nursing staff and year of study (F1,593 = 3.72; P < .05). The 5 following predictors for SPs compliance were identified: knowledge of SPs, perceived barriers, adequacy of training, management support, and influence of nursing staff. CONCLUSION: Although the SPs compliance among NSs was high, the compliance varied by year of study and was affected by the nursing staff. Furthermore, SPs compliance among NSs can be enhanced by increasing SPs knowledge, providing more SPs training, promoting management support, reducing identified SPs barriers, and improving nursing staff compliance to SPs.


Assuntos
Atitude do Pessoal de Saúde , Fidelidade a Diretrizes , Controle de Infecções/métodos , Estudantes de Enfermagem , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
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