Journal of critical care
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Journal of critical care · Feb 2025
Antibiotic allergy de-labeling in the intensive care unit: The prospective ADE-ICU study.
Critically ill patients in the intensive care unit (ICU) are frequently prescribed antibiotics, with many reporting an antibiotic allergy label, predominantly to penicillin. Mislabeling contributes to suboptimal antibiotic use, increasing multidrug-resistant organisms and Clostridium difficile infections, and increased hospital length of stay. This prospective study implemented an antibiotic allergy assessment and testing program in the ICU, independently of clinical immunology/allergy services. ⋯ This study shows the feasibility of ICU led antibiotic allergy assessment and testing, highlighting a potential model for implementation in settings lacking immunology/allergy services.
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Journal of critical care · Feb 2025
Observational StudyQuadriceps Muscle Layer Thickness and its association with frailty in critically ill patients: A prospective observational study.
Frailty is a well-recognized clinical entity known to influence the outcomes of critically ill patients. Muscle ultrasound, particularly Quadriceps Muscle Layer Thickness (QMLT), assesses muscle mass, which is a key component determining frailty. However, no studies have assessed the association between frailty and QMLT. This study aimed to determine the association between the QMLT and frailty in critically ill elderly patients. ⋯ We found an independent association between Quadriceps Muscle Layer Thickness (QMLT) and frailty. QMLT decreased progressively with CFS scores. Frail patients with lower QMLT had increased 28-day mortality. These findings highlight the role of incorporating QMLT measurements along with CFS in frailty evaluations to improve decision-making in critically ill elderly patients.
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Journal of critical care · Feb 2025
Target attainment of beta-lactam antibiotics and ciprofloxacin in critically ill patients and its association with 28-day mortality.
This study aims to assess pharmacodynamic target attainment in critically ill patients and identify factors influencing target attainment and mortality outcomes. ⋯ A high rate of target attainment (100 % ƒT>1xECOFF) for beta-lactams and a lower rate for ciprofloxacin was observed. Achieving exposures of 100 % ƒT>4xECOFF was associated with 28-day mortality. The impact of antibiotic target attainment on clinical outcome needs to be a focus of future research.
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Journal of critical care · Feb 2025
Shock prediction with dipeptidyl peptidase-3 and renin (SPiDeR) in hypoxemic patients with COVID-19.
Plasma dipeptidyl peptidase-3 (DPP3) and renin levels are associated with organ dysfunction and mortality. However, whether these biomarkers are associated with the subsequent onset of shock in at-risk patients is unknown. ⋯ In patients hospitalized with COVID-19 and hypoxemia without baseline hypotension, higher baseline plasma levels of DPP3 but not renin were associated with increased risk of subsequent shock and death.
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Journal of critical care · Feb 2025
Higher doses of fluconazole are needed to ensure target attainment in critically ill adults on continuous Veno-venous hemodialysis.
Critically ill patients undergoing Continuous Renal Replacement Therapy (CRRT) are treated with higher doses of fluconazole based on the literature recommendations. However, clinical follow-up data demonstrating the effectiveness of this approach are lacking. ⋯ According to the results of the study, increasing the fluconazole dose to at least 400 mg twice daily is sufficient to reach the desired target in critically ill patients undergoing CVVHD.