15 research outputs found
Incidence of Rebound Hypertension after Discontinuation of Dexmedetomidine
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151835/1/phar2323_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151835/2/phar2323.pd
Pharmacokinetics of Oseltamivir and Oseltamivir Carboxylate in Critically I ll Patients Receiving Continuous Venovenous Hemodialysis and/or Extracorporeal Membrane Oxygenation
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94511/1/phar1151.pd
Impact of an Intravenous Magnesium Shortage on Potassium Doses in Adult Surgical Patients Receiving Parenteral Nutrition
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141001/1/jpen0688.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141001/2/jpen0688-sup-0001.pd
Lipid Emulsion Therapies and Type 1 Hypersensitivity Reactions: Risk Assessment and Management
Over the past decades, awareness and attention given to food allergies has extended further into the realm of pharmacotherapy. Despite the presence of similar ingredients, different intravenous lipid emulsion (ILE)âbased medication products have a wide variety of warnings and contraindications for patients with food allergies. Only limited literature is available to guide clinicians in making appropriate medication therapy adjustments to reduce the risk of hypersensitivity reactions in atopic patient populations. Therefore, the authors sought to develop a comprehensive review of potential risk factors or approaches for management of patients with atopic history and need for ILE therapy. Through thorough review of available literature published worldwide, a description of potential contraindications, risk factors, and evaluation methods is presented. Although the current state of knowledge remains relatively poor, this review aims to provide clinicians a better understanding of which risk factors related to the development of hypersensitivity reactions are relevant to lipid emulsion products and how to best manage patients who may be at risk for severe reaction based on their history. Evaluating personal atopic history is essential to the development of an appropriate risk classification system and approaching an individualâs therapeutic options. By applying this assessment to local populations, providers should be able to develop an institutional guideline for screening and minimizing risk of substantial hypersensitivity reactions. Finally, a brief review of methods for managing type 1 hypersensitivity reactions is provided in the event that a breakthrough reaction does occur.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167478/1/ncp10443_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167478/2/ncp10443.pd
Critical Illness, Gastrointestinal Complications, and Medication Therapy during Enteral Feeding in Critically Ill Adult Patients
Critically ill patients who are subjected to high stress or with severe injury can rapidly break down their body protein and energy stores. Unless adequate nutrition is provided, malnutrition and protein wasting may occur, which can negatively affect patient outcome. Enteral nutrition (EN) is the mainstay of nutrition support therapy in patients with a functional gastrointestinal (GI) tract who cannot take adequate oral nutrition. EN in critically ill patients provides the benefits of maintaining gut functionality, integrity, and immunity as well as decreasing infectious complications. However, the ability to provide timely and adequate EN to critically ill patients is often hindered by GI motility disorders and complications associated with EN. This paper reviews the GI complications and intolerances associated with EN in critically ill patients and provides recommendations for their prevention and treatment. It also addresses the role of commonly used medications in the intensive care unit and their impact on GI motility and EN delivery.PublishedN/
Use of Integrated Clinical Decision Support Tools to Manage Parenteral Nutrition Ordering: Experience From an Academic Medical Center
Parenteral nutrition (PN) is a complex therapy with numerous opportunities for error during the prescribing, preparation, and administration processes. Advances in technology, such as computerized provider order entry (CPOE), electronic health records (EHRs), and clinical decision support (CDS) have helped decrease the risks associated with PN therapy. These technologies can be utilized to guide prescribing, provide automated safety checks, and increase overall safety and accuracy in PN ordering, compounding, and administration. In recent years, increased awareness of the risks associated with PN therapy, in particular issues with ordering and transcription, have magnified the need for improved support of PN ordering within currently available systems. Additionally, drug shortages continue to impact key components of PN admixtures, further increasing the risks associated with this complex therapy. These concerns and risks present an opportunity for the development of new functionality, as well as improvements in and innovative utilization of available technology within systems supporting the PN use process. This discussion will highlight the risks associated with PN, examine the role of drug shortages on the safety of this therapy, describe the application of available technology to manage shortages, and report the experience of using commercially available CDS tools at one academic medical center. It will also include a discussion of the transition from paper orders to CPOE/EHRâbased orders for PN and the transition from one commercially available electronic system to another at this particular institution.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167501/1/ncp10469.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167501/2/ncp10469_am.pd
Use of Integrated Clinical Decision Support Tools to Manage Parenteral Nutrition Ordering: Experience From an Academic Medical Center
Parenteral nutrition (PN) is a complex therapy with numerous opportunities for error during the prescribing, preparation, and administration processes. Advances in technology, such as computerized provider order entry (CPOE), electronic health records (EHRs), and clinical decision support (CDS) have helped decrease the risks associated with PN therapy. These technologies can be utilized to guide prescribing, provide automated safety checks, and increase overall safety and accuracy in PN ordering, compounding, and administration. In recent years, increased awareness of the risks associated with PN therapy, in particular issues with ordering and transcription, have magnified the need for improved support of PN ordering within currently available systems. Additionally, drug shortages continue to impact key components of PN admixtures, further increasing the risks associated with this complex therapy. These concerns and risks present an opportunity for the development of new functionality, as well as improvements in and innovative utilization of available technology within systems supporting the PN use process. This discussion will highlight the risks associated with PN, examine the role of drug shortages on the safety of this therapy, describe the application of available technology to manage shortages, and report the experience of using commercially available CDS tools at one academic medical center. It will also include a discussion of the transition from paper orders to CPOE/EHRâbased orders for PN and the transition from one commercially available electronic system to another at this particular institution.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167501/1/ncp10469.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167501/2/ncp10469_am.pd
Early Enteral Nutrition in Mechanically Ventilated Patients With COVIDâ19 Infection
BackgroundNutrition therapy is essential in critically ill adults. Little is known about appropriate nutrition therapy in patients with severe coronavirus disease 2019 (COVID- 19) infection.MethodsThis was a retrospective, observational study in adult patients with confirmed COVID- 19 infection receiving mechanical ventilation. Data regarding patient demographics and nutrition therapy were collected. Patients that received enteral nutrition within 24 hours of starting mechanical ventilation were compared with patients starting enteral nutrition later. The primary outcome was inpatient length of stay. Propensity score matching was conducted to control for baseline differences in patient groups.ResultsOne hundred fifty- five patients were included in final analysis. Patients who received enteral nutrition within 24 hours received a significantly greater daily amount of calories (17.5 vs 15.2 kcal/kg, P = .015) and protein (1.04 vs 0.85 g/kg, P = .003). There was no difference in length of stay (18.5 vs 23.5 days, P = .37). The propensity score analysis included 100 patients. Following propensity scoring, significant differences in daily calorie (17.7 [4.6] vs 15.1 [5.1] kcal/kg/d, P = .009) and protein (1.03 [0.35] vs 0.86 [0.38] g/kg/d, P = .014) provision remained. No differences in length of stay or other outcomes were noted in the propensity score analysis.ConclusionInitiation of enteral nutrition within 24 hours was not associated with improved outcomes in mechanically ventilated adults with COVID- 19. No harm was detected either. Future research should seek to clarify optimal timing of enteral nutrition initiation in patients with COVID- 19 who require mechanical ventilation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167459/1/ncp10629.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167459/2/ncp10629_am.pd
Early Enteral Nutrition in Mechanically Ventilated Patients With COVID- 19 Infection
BackgroundNutrition therapy is essential in critically ill adults. Little is known about appropriate nutrition therapy in patients with severe coronavirus disease 2019 (COVID- 19) infection.MethodsThis was a retrospective, observational study in adult patients with confirmed COVID- 19 infection receiving mechanical ventilation. Data regarding patient demographics and nutrition therapy were collected. Patients that received enteral nutrition within 24 hours of starting mechanical ventilation were compared with patients starting enteral nutrition later. The primary outcome was inpatient length of stay. Propensity score matching was conducted to control for baseline differences in patient groups.ResultsOne hundred fifty- five patients were included in final analysis. Patients who received enteral nutrition within 24 hours received a significantly greater daily amount of calories (17.5 vs 15.2 kcal/kg, P = .015) and protein (1.04 vs 0.85 g/kg, P = .003). There was no difference in length of stay (18.5 vs 23.5 days, P = .37). The propensity score analysis included 100 patients. Following propensity scoring, significant differences in daily calorie (17.7 [4.6] vs 15.1 [5.1] kcal/kg/d, P = .009) and protein (1.03 [0.35] vs 0.86 [0.38] g/kg/d, P = .014) provision remained. No differences in length of stay or other outcomes were noted in the propensity score analysis.ConclusionInitiation of enteral nutrition within 24 hours was not associated with improved outcomes in mechanically ventilated adults with COVID- 19. No harm was detected either. Future research should seek to clarify optimal timing of enteral nutrition initiation in patients with COVID- 19 who require mechanical ventilation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167459/1/ncp10629.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167459/2/ncp10629_am.pd