Journal of critical care
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Journal of critical care · Feb 2022
Observational StudyTrough concentrations of meropenem and piperacillin during slow extended dialysis in critically ill patients with intermittent and continuous infusion: A prospective observational study.
Beta-lactam dosing is challenging in critically ill patients with slow extended daily dialysis (SLEDD). This prospective observational study aimed to investigate meropenem and piperacillin concentrations and half-lives during SLEDD and in SLEDD-free intervals. Critically ill patients with SLEDD-therapy and meropenem or piperacillin therapy were included. ⋯ However, none of the measured trough concentrations were subtherapeutic during SLEDD. SLEDD leads to a reduction in meropenem and piperacillin concentrations of approximately 50% independently of the initial concentration. If the concentration is twice as high as the breakpoint of target attainment before SLEDD-therapy, subtherapeutic levels can be avoided.
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Journal of critical care · Feb 2022
Observational StudyCircadian variation in new-onset atrial fibrillation in patients in ICUs.
New-onset atrial fibrillation (NOAF) is common in patients treated on an intensive care unit (ICU). Onset of certain arrhythmias exhibit circadian variation. Whether NOAF follows a circadian rhythm in patients in ICU is unknown. ⋯ We identified 2017 patients who developed NOAF during their ICU stay. NOAF onset exhibited a bimodal distribution with peaks at 8 am and 8 pm, consistent with the onset of paroxysmal AF in patients in the community. Future studies in ICUs should record time of AF onset, as understanding high risk periods may inform timing of preventative interventions.
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Journal of critical care · Feb 2022
Activation of the kynurenine pathway predicts mortality and neurological outcome in cardiac arrest patients: A validation study.
Activation of the kynurenine pathway (KP) has been shown to predict outcome in cardiac arrest (CA) patients. We validated these findings in a Swiss cohort. ⋯ Our findings validate a previous study and show associations of the activation of the KP with unfavorable outcomes after CA. Future studies should evaluate whether therapeutic modulation of the KP may impact clinical outcomes after CA.
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Journal of critical care · Feb 2022
Real time wire localization by ultrasound during central line insertion improves accurate positioning in all upper torso sites.
To investigate whether point of care ultrasound can improve central venous catheter tip positioning. ⋯ Point of care ultrasound for guidewire identification and localization, while inserting central venous catheter from all upper torso sites, improves precision positioning.
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The COVID-19 pandemic taxed critical care and its leaders in unprecedented ways. Medical directors, nursing directors, division chiefs and department chairs were forced to lead their staff through a pandemic wrought with personal and professional safety concerns, uncertainty, and more death than most critical care practitioners had ever seen. No leader was fully prepared for the COVID-19 pandemic. Herein, we describe what we believe are the three most important qualities of a leader in times of crisis: presence, transparency, and empathy.