Nadia Roumeliotis, Eleanor Pullenayegum, Paula Rochon, Anna Taddio, Chris Parshuram
BACKGROUND: There is no globally accepted definition for dosing error in adult or pediatric practice. The definition of pediatric dosing error varies greatly in the literature. The objective of this study was to develop a framework, informed by a set of principles, for a clinician-based definition of drug dosing errors in critically ill children, and to identify the range that practitioners agree is a dosing error for different drug classes and clinical scenarios. METHODS: We conducted a nationwide three staged modified Delphi from May to December 2019...
October 21, 2020: BMC Pediatrics
Awortwe Charles, Cascorbi Ingolf
Drug-drug interactions (DDI) potentially occurring between medications used in the course of COVID-19 infection and medications prescribed for the management of underlying comorbidities may cause adverse drug reactions (ADRs) contributing to worsening of the clinical outcome in affected patients. First, we conducted a meta-analysis to determine comorbidities observed in the course of COVID-19 disease associated with an increased risk of worsened clinical outcome from 24 published studies. In addition, the potential risk of DDI between medications used in the course of COVID-19 treatment in these studies and those for the management of observed comorbidities was evaluated for possible worsening of the clinical outcome...
October 12, 2020: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Richard G Wunderink, Yuko Matsunaga, Mari Ariyasu, Philippe Clevenbergh, Roger Echols, Keith S Kaye, Marin Kollef, Anju Menon, Jason M Pogue, Andrew F Shorr, Jean-Francois Timsit, Markus Zeitlinger, Tsutae D Nagata
BACKGROUND: Nosocomial pneumonia due to multidrug-resistant Gram-negative pathogens poses an increasing challenge. We compared the efficacy and safety of cefiderocol versus high-dose, extended-infusion meropenem for adults with nosocomial pneumonia. METHODS: We did a randomised, double-blind, parallel-group, phase 3, non-inferiority trial in 76 centres in 17 countries in Asia, Europe, and the USA (APEKS-NP). We enrolled adults aged 18 years and older with hospital-acquired, ventilator-associated, or health-care-associated Gram-negative pneumonia, and randomly assigned them (1:1 by interactive response technology) to 3-h intravenous infusions of either cefiderocol 2 g or meropenem 2 g every 8 h for 7-14 days...
October 12, 2020: Lancet Infectious Diseases
Nikhil Mohan, Kyle P Edmonds, Toluwalase A Ajayi, Rabia S Atayee
Tramadol is a schedule IV, monoaminergic and μ-opioid-receptor analgesic with unique pharmacology properties. Though it is well established and widely utilized, there is little guidance on tramadol's place in therapy, including tolerability, safety and monitoring guidelines. Retrospective chart review of 250 patients who received oral tramadol during their hospitalization from January 1, 2018 to December 31, 2018. Of the 250 patients, 10.8% had cancer as their primary diagnosis while 8.8% were admitted for hematologic reasons...
October 5, 2020: Journal of Pain & Palliative Care Pharmacotherapy
Mark Inman, Andrew W Lyon, Oliver A S Lyon, Martha E Lyon
CONTEXT.—: Glycemic control requires accurate blood glucose testing. The extent of hematocrit interference is difficult to assess to assure quality patient care. OBJECTIVE.—: To predict the effect of patient hematocrit on the performance of a glucose meter and its corresponding impact on insulin-dosing error. DESIGN.—: Multilevel mixed regression was conducted to assess the extent that patient hematocrit influences Roche Accu-Chek Inform II glucose meters, using the Radiometer ABL 837 as a reference method collected during validation of 35 new meters...
October 1, 2020: Archives of Pathology & Laboratory Medicine
Márcio M Boniatti, José Augusto S Pellegrini, Leonardo S Marques, Josiane F John, Luiz G Marin, Lina R D M Maito, Thiago C Lisboa, Lucas P Damiani, Diego R Falci
BACKGROUND: Highly active antiretroviral therapy (HAART) has reduced HIV-related morbidity and mortality at all stages of infection and reduced transmission of HIV. Currently, the immediate start of HAART is recommended for all HIV patients, regardless of the CD4 count. There are several concerns, however, about starting treatment in critically ill patients. Unpredictable absorption of medication by the gastrointestinal tract, drug toxicity, drug interactions, limited reserve to tolerate the dysfunction of other organs resulting from hypersensitivity to drugs or immune reconstitution syndrome, and the possibility that subtherapeutic levels of drug may lead to viral resistance are the main concerns...
2020: PloS One
David Brandariz-Nuñez, Marcelo Correas-Sanahuja, Eva Guarc, Rafael Picón, Bárbara García, Rocío Gil
Objectives: To determine the prevalence of potential interactions in COVID19 patients receiving lopinavir/ritonavir (LPV/r). The secondary objective was to develop recommendations and identify the risk factors associated with presenting potential interactions with LPV/r. Subjects and methods: Cross-sectional and multicenter study with the participation of 2 hospitals. COVID 19 patients over 18 years of age, admitted to hospital and under treatment with LPV/r were included...
September 12, 2020: Medicina clínica
Marta Miarons, María Larrosa-García, Sonia García-García, Ibai Los-Arcos, Francesc Moreso, Cristina Berastegui, Lluís Castells, Santiago Pérez-Hoyos, Javier Varela, Alba Pau-Parra, Carlota Varón-Galcera, Carlos-Javier Parramon-Teixidó, Javier Martínez-Casanova, Laura Domènech, Patricia García-Ortega, Pablo Sánchez-Sancho, Carla Alonso-Martínez, Laura Gómez-Ganda, Maria Roch-Santed, Ariadna Gracia-Moya, José-Manuel Del-Rio-Gutiérrez, Alfredo Guillén-Del-Castillo, Carla Sans-Pola, Andrés Antón, Bruno Montoro, Maria-Queralt Gorgas-Torner
BACKGROUND: The epidemiological and clinical characteristics of solid organ transplant (SOT) patients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We conducted a matched retrospective cohort study to compare clinical outcomes among SOT recipients with the general population and to assess immunosuppression management. METHODS: Adult SOT recipients with laboratory PCR-confirmed SARS-CoV-2 infection admitted to a tertiary-care hospital in Barcelona, Spain, from March 11th to April 25th 2020, were matched to controls (1:4) on the basis of sex, age and age-adjusted Charlson's Index...
September 15, 2020: Transplantation
Kunal Karamchandani, Ashley Quintili, Terra Landis, Somnath Bose
Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, is now a global pandemic affecting more than 12 million patients across 188 countries. A significant proportion of these patients require admission to intensive care units for acute hypoxic respiratory failure and are at an increased risk of developing cardiac arrhythmias. The presence of underlying comorbidities, pathophysiologic changes imposed by the disease, and concomitant polypharmacy, increase the likelihood of life-threatening arrhythmias in these patients...
August 11, 2020: Journal of Cardiothoracic and Vascular Anesthesia
Minh Patrick Lê, Quentin Le Hingrat, Pierre Jaquet, Paul-Henri Wicky, Vincent Bunel, Laurent Massias, Benoit Visseaux, Jonathan Messika, Diane Descamps, Hervé Mal, Jean-François Timsit, Gilles Peytavin
Remdesivir has reported efficacy against SARS-CoV-2 in vitro and in vivo. Drug-drug interactions limit therapeutic options in transplant patients. Remdesivir and its metabolite GS-441524 are excreted principally in urine. In ICU settings, in which multiple organ dysfunctions can occur rapidly, hemodialysis may be a viable option for maintaining remdesivir treatment, while improving tolerance, by removing both remdesivir's metabolite (GS-441524) and SEBCD. Additional studies may prove informative, particularly in the evaluations of therapeutic options for COVID-19...
August 31, 2020: Antimicrobial Agents and Chemotherapy
Lucy Graham, Mary Beth Flynn Makic
Infection with HIV is a chronic condition that requires daily medication to suppress viral replication. With appropriate treatment, people living with HIV have a life expectancy approaching that of the general population. However, they are at increased risk for comorbidities including cardiovascular disease, renal disease, type 2 diabetes, neurologic conditions, and cancers, often with worse outcomes than in patients without HIV. When they are admitted to critical care settings, care considerations, particularly regarding antiretroviral therapy, must be addressed...
September 15, 2020: AACN Advanced Critical Care
Camille R Petri, Jeremy B Richards
The explosion of the opioid epidemic in the United States and across the world has been met with advances in pharmacologic therapy for the treatment of opioid use disorder. Long-acting naltrexone is a promising strategy, but its use has important implications for critical care, as it may interfere with or complicate sedation and analgesia. Currently, there are two available formulations of long-acting naltrexone, which are distinguished by different administration routes and distinct pharmacokinetics. The use of long-acting naltrexone may be identified through a variety of strategies (such as physical exam, laboratory testing, and medical record review), and is key to the safe provision of sedation and analgesia during critical illness...
August 31, 2020: Annals of the American Thoracic Society
Ettore Crimi, Giuditta Benincasa, Neisaliz Figueroa-Marrero, Massimiliano Galdiero, Claudio Napoli
The emergence of highly pathogenic strains of influenza virus and coronavirus (CoV) has been responsible for large epidemic and pandemic outbreaks characterised by severe pulmonary illness associated with high morbidity and mortality. One major challenge for critical care is to stratify and minimise the risk of multi-organ failure during the stay in the intensive care unit (ICU). Epigenetic-sensitive mechanisms, including deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) methylation, histone modifications, and non-coding RNAs may lead to perturbations of the host immune-related transcriptional programmes by regulating chromatin structure and gene expression patterns...
August 19, 2020: British Journal of Anaesthesia
Antonis S Manolis, Antonis A Manolis, Theodora A Manolis, Evdoxia J Apostolopoulos, Despoina Papatheou, Helen Melita
As the coronavirus 2019 (COVID-19) pandemic marches unrelentingly, more patients with cardiac arrhythmias are emerging due to the effects of the virus on the respiratory and cardiovascular (CV) systems and the systemic inflammation that it incurs, and also as a result of the proarrhythmic effects of COVID-19 pharmacotherapies and other drug interactions and the associated autonomic imbalance that enhance arrhythmogenicity. The most worrisome of all arrhythmogenic mechanisms is the QT prolonging effect of various anti-COVID pharmacotherapies that can lead to polymorphic ventricular tachycardia in the form of torsade des pointes and sudden cardiac death...
August 16, 2020: Trends in Cardiovascular Medicine
Ali Elbeddini, Anthony To, Yasamin Tayefehchamani, Cindy Wen
Background: COVID-19 has made itself known to health care providers and families across the world in a matter of months. While primarily a respiratory disorder, it has also been shown to cause neurological symptoms, which can be a concern for Parkinson's disease (PD) patients. Although PD is not as common as other conditions such as cardiovascular diseases, it affects millions of patients around the world whose care has been affected by the global pandemic. Objectives: The aim of this review is to provide insight into the direct and indirect associations between COVID-19 and PD patient care...
2020: Journal of Clinical Movement Disorders
Adam Wedin, Stina Sandström, Linda Sandström, Angelica Forsberg
BACKGROUND: Patients intoxicated after abusing illicit drugs constitute a significant proportion of patients cared for in intensive care units. Intensive critical care nurses who nurse accidentally intoxicated patients face complex and demanding situations, and there is a lack of studies regarding this topic. AIMS AND OBJECTIVES: To illuminate Swedish intensive critical care nurses' experiences of nursing accidentally intoxicated patients after abuse of illicit drugs...
August 4, 2020: Nursing in Critical Care
Julia Hippisley-Cox, Duncan Young, Carol Coupland, Keith M Channon, Pui San Tan, David A Harrison, Kathryn Rowan, Paul Aveyard, Ian D Pavord, Peter J Watkinson
BACKGROUND: There is uncertainty about the associations of angiotensive enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) drugs with COVID-19 disease. We studied whether patients prescribed these drugs had altered risks of contracting severe COVID-19 disease and receiving associated intensive care unit (ICU) admission. METHODS: This was a prospective cohort study using routinely collected data from 1205 general practices in England with 8.28 million participants aged 20-99 years...
July 31, 2020: Heart
Giovanni Ostuzzi, Chiara Gastaldon, Davide Papola, Andrea Fagiolini, Serdar Dursun, David Taylor, Christoph U Correll, Corrado Barbui
People with coronavirus disease (COVID-19) might have several risk factors for delirium, which could in turn notably worsen the prognosis. Although pharmacological approaches for delirium are debated, haloperidol and other first-generation antipsychotics are frequently employed, particularly for hyperactive presentations. However, the use of these conventional treatments could be limited in people with COVID-19, due to the underlying medical condition and the risk of drug-drug interactions with anti-COVID treatments...
2020: Therapeutic Advances in Psychopharmacology
David Brandariz-Nuñez, Marcelo Correas-Sanahuja, Eva Guarc, Rafael Picón, Bárbara García, Rocío Gil
OBJECTIVES: To determine the prevalence of potential interactions in COVID-19 patients receiving lopinavir/ritonavir (LPV/r). The secondary objective was to develop recommendations and identify the risk factors associated with presenting potential interactions with LPV/r. SUBJECTS AND METHODS: Cross-sectional and multicenter study with the participation of 2 hospitals. COVID-19 patients over 18 years of age, admitted to hospital and under treatment with LPV/r were included...
July 9, 2020: Medicina Clínica
Gulser Esen Besli, Elif Yuksel Karatoprak, Sıla Yilmaz
PURPOSE: Although phenytoin is one of the most commonly used antiepileptic drugs (AEDs), it has potential serious side effects and drug interactions. Levetiracetam is a relatively newer AED with favorable pharmacokinetics and could be an effective and safer option for the treatment of convulsive status epilepticus (CSE). We aimed to compare the efficacy and safety profile of intravenous levetiracetam and phenytoin as second-line treatment agents in children with CSE and acute repetitive seizures (ARS)...
October 2020: Epilepsy & Behavior: E&B
Fetch more papers »
Fetching more papers... Fetching...
Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"