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

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

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/EHR‐based 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 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