Can 1 μg of Cosyntropin Be Used to Evaluate Adrenal Insufficiency in Critically Ill Patients?

2005 ◽  
Vol 39 (4) ◽  
pp. 691-698 ◽  
Author(s):  
Elizabeth F Kozyra ◽  
Randy S Wax ◽  
Lisa D Burry
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Large Scale ◽  
Relative Adrenal Insufficiency ◽  
Acth Stimulation ◽  
Icu Patients ◽  
Insulin Tolerance

OBJECTIVE: To evaluate the utility of cosyntropin 1 μg in assessing adrenal function in critically ill patients. DATA SOURCES: A computerized literature search using MEDLINE, EMBASE, International Pharmaceutical Abstracts, and the Cochrane Database (1966–August 2004) was undertaken for trials evaluating cosyntropin 1 μg using the following search terms: adrenocorticotropin-releasing hormone (ACTH), cosyntropin, adrenal insufficiency, cortisol, corticosteroids, glucocorticoids, sepsis, septic shock, diagnosis, critically ill, intensive care, and critical care. STUDY SELECTION AND DATA SYNTHESIS: Identifying patients with sepsis with relative adrenal insufficiency (AI) using cosyntropin testing may identify those likely to benefit from corticosteroids. The results of 5 heterogeneous studies in non—intensive care unit (ICU) patients suggest that both 1 μg and 250 μg of cosyntropin stimulate similar cortisol responses and that testing using both doses correlates well with results from insulin tolerance testing. Some data from non-ICU patients suggest that the 1-μg test may be more sensitive to detect AI; 3 heterogeneous studies in ICU patients confirmed the improved sensitivity of the 1-μg test. CONCLUSIONS: Use of cosyntropin 1 μg should detect AI in all patients who would have been diagnosed using 250 μg. Unfortunately, all of the clinical trials evaluating the role of corticosteroids in septic shock that used the cosyntropin stimulation test administered 250 μg. Extrapolation of the existing guidelines to treat patients with septic shock testing positive for relative AI using the 1-μg test may provide effective therapy to appropriate patients not diagnosed by the 250-μg testing or may introduce additional adverse effects in patients who should not receive corticosteroids. Large-scale, head-to-head comparison data of steroid effectiveness after 1- and 250-μg ACTH stimulation tests are needed to expand upon these promising results.

Diagnosis of relative adrenal insufficiency in critically ill patients

The Lancet ◽  
1999 ◽  
Vol 354 (9180) ◽  
pp. 775
Author(s):  
Albertus Beishuizen ◽  
Clemens Haanen ◽  
Bonno S Hylkema ◽  
Istán Vermes
Keyword(s):  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Relative Adrenal Insufficiency

scholarly journals Discomforts in Critically ill Patients: Our Experience in Intensive Care Unit of a Tertiary Care Hospital in India

2021 ◽  
Author(s):  
Reetu Verma ◽  
Sasmita Panda ◽  
Rajeev Kumar Nishad
Keyword(s):  
Intensive Care ◽  
Environmental Factors ◽  
Critically Ill ◽  
Nursing Care ◽  
Critically Ill Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Common Cause

Introduction: Patients admitted in the Intensive Care Units (ICUs) experiences various discomforts which may be recognised or unrecognised. These discomforts may arise from the environment, may be related to the ICU care and discomfort related to the health status of the patient and critical care interventions. Aim: To identify the various discomforts in ICU patients, to classify them with respective causes, identify the most common cause among them and whether ICU sedation helps in reducing discomforts. Materials and Methods: This observational study was conducted from 15th July to 15th October 2018 on 120 mixed ICU patients in a Tertiary Care Hospital in India. Patients who were admitted to ICU for more than 24 hours, aged 18 years and above, those who gave written informed consent were observed and enquired for any discomfort. Discomforts have been identified and recorded by a fulltime intensivist by direct observation, by interacting with the patients and asking the family members and others (indirect approach). Through this study discomforts of critically ill patients were broadly classified into four categories 1. Due to existing illness, 2. Due to ICU interventions, 3. Due to improper nursing care and 4. Due to environmental factors. Results: Out of 120 patients studied, 84 patients (70%) reported some kind of discomfort during their ICU stay. Existing illness was the most common cause of discomfort, 80 patients (66.6%) suffered due to it. ICU interventions was the second most common cause, 71 patients (59.1%) had discomfort due to interventions. Thirty five patients (29.1%) suffered due to improper nursing care and 25 patients (20.8%) suffered due to the environmental factors. In this study, it was observed that sedation reduces all kind of discomforts. conclusion: In this study 70% of patients, who were admitted to ICU due to various illness reported some kind of discomfort. The most common cause of ICU discomforts was existing illness followed by ICU interventions. In this study it was observed that sedation reduces all kind of discomforts. Sedated patients tolerate the endotracheal tube better and they had less environmental and procedure related discomforts. With the present study observation it can be suggested that ICU charts of nurses and doctors can carry a separate column for mentioning discomforts in different duty shifts. However, with the use of appropriate analgesia and sedation discomfort can be reduced.

scholarly journals Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

2020 ◽  
Vol 8 (2) ◽  
pp. 287 ◽  
Author(s):  
Georgios Papathanakos ◽  
Ioannis Andrianopoulos ◽  
Athanasios Papathanasiou ◽  
Efthalia Priavali ◽  
Despoina Koulenti ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acinetobacter Baumannii ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Problem ◽  
Hospital Infections ◽  
Colistin Resistance ◽  
Icu Patients ◽  
Icu Admission ◽  
Comorbidity Index

The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.

scholarly journals Low Caspofungin Exposure in Patients in Intensive Care Units

2016 ◽  
Vol 61 (2) ◽  
Author(s):  
Kim C. M. van der Elst ◽  
Anette Veringa ◽  
Jan G. Zijlstra ◽  
Albertus Beishuizen ◽  
Rob Klont ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Drug Exposure ◽  
Standard Dose ◽  
Drug Distribution ◽  
Volume Of Distribution ◽  
Primary Objective ◽  
Time Curve ◽  
Icu Patients

ABSTRACT In critically ill patients, drug exposure may be influenced by altered drug distribution and clearance. Earlier studies showed that the variability in caspofungin exposure was high in intensive care unit (ICU) patients. The primary objective of this study was to determine if the standard dose of caspofungin resulted in adequate exposure in critically ill patients. A multicenter prospective study in ICU patients with (suspected) invasive candidiasis was conducted in the Netherlands from November 2013 to October 2015. Patients received standard caspofungin treatment, and the exposure was determined on day 3 of treatment. An area under the concentration-time curve from 0 to 24 h (AUC0–24) of 98 mg · h/liter was considered adequate exposure. In case of low exposure (i.e., <79 mg · h/liter, a ≥20% lower AUC0–24), the caspofungin dose was increased and the exposure reevaluated. Twenty patients were included in the study, of whom 5 had a positive blood culture. The median caspofungin AUC0–24 at day 3 was 78 mg · h/liter (interquartile range [IQR], 69 to 97 mg · h/liter). A low AUC0–24 (<79 mg · h/liter) was seen in 10 patients. The AUC0–24 was significantly and positively correlated with the caspofungin dose in mg/kg/day (P = 0.011). The median AUC0–24 with a caspofungin dose of 1 mg/kg was estimated using a pharmacokinetic model and was 114.9 mg · h/liter (IQR, 103.2 to 143.5 mg · h/liter). In conclusion, the caspofungin exposure in ICU patients in this study was low compared with that in healthy volunteers and other (non)critically ill patients, most likely due to a larger volume of distribution. A weight-based dose regimen is probably more suitable for patients with substantially altered drug distribution. (This study has been registered at ClinicalTrials.gov under registration no. NCT01994096.)

scholarly journals Morbidity and mortality in critically ill patients with invasive Group A streptococcus infection: an observational study

2020 ◽  
Author(s):  
Viveka Björck ◽  
Lisa I Påhlman ◽  
Mikael Bodelsson ◽  
Ann_Cathrine Petersson ◽  
Thomas Kander
Keyword(s):  
Septic Shock ◽  
Renal Failure ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Saps 3 ◽  
Group A ◽  
Lower Mortality Risk

Abstract Background Group A streptococci (GAS) are known to cause serious invasive infections but little is known about outcomes when patients with these infections are admitted to intensive care. We wanted to describe critically ill patients with severe sepsis or septic shock due to invasive GAS (iGAS) and compare them with other patients with severe sepsis or septic shock. Methods Adult patients admitted to a general intensive care unit (ICU) in Sweden (2007-2019) were screened for severe sepsis or septic shock according to Sepsis 2 definition. Individuals with iGAS infection were identified. The outcome variables were mortality, days alive and free of vasopressors and invasive mechanical ventilation, maximum acute kidney injury score for creatinine, use of continuous renal replacement therapy and maximum sequential organ failure assessment score during the ICU stay. Age, simplified acute physiology score (SAPS 3) and iGAS were used as independent, explanatory variables in regression analysis. Cox regression was used for survival analyses. Results iGAS was identified in 53 of 1021 (5.2%) patients. Patients with iGAS presented lower median SAPS 3 score (62 [56–72]) vs 71 [61–81]), p < 0.001), had a higher frequency of cardiovascular cause of admission to the ICU (38 [72%] vs 145 [15%], p < 0.001) and had a higher median creatinine score (173 [100–311] vs 133 [86–208] µmol/L, p < 0.019). Of the GAS isolates, 50% were serotyped emm 1/T1 and this group showed signs of more pronounced circulatory and renal failure than patients with non- emm 1/T1, ( p = 0.036 and p = 0.007, respectively). After correction for severity of illness (SAPS 3) and age, iGAS infection was associated with lower mortality risk; 95% confidence interval (CI) of hazard ratio (HR) 0.204–0.746, p < 0.001. Morbidity analyses demonstrated that iGAS patients were more likely to develop renal failure. Conclusion Critically ill patients with iGAS infection had a lower mortality risk but a higher degree of renal failure compared to similarly ill sepsis patients. emm 1/T1 was found to be the most dominant serotype and patients with emm1 /T1 demonstrated more circulatory and renal failure than patients with other serotypes of iGAS.

Outcomes and Prognostic Factors in Critically Ill Patients with Hematologic Malignancies Admitted in an Intensive Care Unit: A Single Center Experience. Hospital De Clínicas, Montevideo, Uruguay

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 6017-6017
Author(s):  
Carolina Oliver ◽  
Adriana Peixoto ◽  
Cecilia Guillermo ◽  
Juan Zunino ◽  
Mariana Stevenazzi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Overall Survival ◽  
Risk Factor ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Univariate Analysis ◽  
Hematologic Malignancies

Abstract Introduction: patients with hematologic malignancies (HM) admitted in intensive care units (ICU) have been traditionally seen as patients with very poor prognostic. Recently reports have informed that mortality has dropped and nowadays is in the order of 40-60 %, this is still high but closer to mortality in non-malignant patients admitted in an ICU. In an attempt to change this view we perform a study in order to evaluate the results and prognostic factors that contribute to mortality in HM patients who need critical care assistance. Methods: a retrospective study in 62 patients with HM who were admitted in ICU in the University Hospital, Hospital de Clinicas from Uruguay from 2003 to 2012. These 62 patients had 82 admissions, which are the population of our trial. Statistical analysis: Values are expressed as mean +/- standard deviation (SD), median and percentages. Comparison variable most used: discharge of ICU: dead or alive. Both groups were compared using Student's t test and Chi square. Multivariate logistic regression analysis was performed. Overall survival with Kaplan Meier. Significance p<0.05. Results: 50% of the episodes were in men. The median age was 56 years old (17-80). The distribution according to HM was: Non-Hodgkin Lymphoma 40.2%, Acute Myeloid Leukemia 23.2%, Multiple Myeloma 13.4%, Chronic Lymphocytic Leukemia 7.3%, Acute Lymphoblastic Leukemia 4.9%, Hodgkin Lymphoma 3.7%, other 3.7%, Myeloproliferative Neoplasm 2.4% and aplasia 1.2%. The mortality during ICU’s treatment was 47.6%. The causes of death in ICU were: septic shock: 74.4%; disease progression: 10.3%; Other: 7.7%; refractory respiratory failure: 5,1%; severe hemorrhage: 2.6%. Median days of overall survival in ICU were 11 days (CI 1.9 to 20.06). In table 1 we show the univariate analysis of prognostic factors. The parameters that showed a significant difference were; underlying diagnosis of ALL, presence of central catheter line prior to entering ICU; need for mechanical ventilation, diagnosis of septic shock, use and hours of vasopressors and the value of APACHE II. Of the 47 patients who required mechanical ventilation 33 died (70.2%), this is a risk factor for death, with an OR of 1.83 (CI: 1.1 to 3.02). The diagnosis on admission to ICU septic shock is a significant risk factor for death with an OR of 0.449 (CI: 0.351 to 0.574). In the multivariable analysis, admission to ICU for mechanical ventilation, use of mechanical ventilation at some point and use of vasopressors were statistically significant. TABLE 1. Univariate analysis of prognostic factors: Alive Death P value Diagnostic ALL Yes: 0 No: 43 Yes: 4 No: 35 0,03 Type of Chemotherapy Standard: 19High dose: 11Allogeneic SCT: 1Purine analogs: 1No Chemotherapy: 11 Standard: 19High dose: 11Allogeneic SCT: 0Purine analogs: 1No Chemotherapy: 8 0,920,430,340,940,58 Neutropenic No data: 8 Yes: 14 No: 29 Yes: 17 No: 14 0,304 Catheter No data: 2 Yes: 16 No: 26 Yes: 24 No: 14 0,025 Cretinine, mean (SD) 1,53 ±(1,55) 1,75 ±(1,17) 0,66 Urea, mean (SD) 68,2 ±(53,41) 89,27 ±(61,24) 0,09 Prothrombin time, mean (SD) 68,36 ±(21,37) 59,65 ±(20,67) 0,87 PAFI, mean (SD) 301,63 ±(110,41) 290,24 ±(123,25) 0,22 Bilirubin, mean (SD) 1,2 ±(1,78) 1,5 ±(2,49) 0,701 Use of mechanical Ventilatory Yes: 14 No: 29 Yes: 33 No: 6 <0,001 Septic Shock at admission Yes: 0 No: 43 Yes: 4 No: 35 0,032 Use of vasopressor Yes: 7 No: 36 Yes: 31 No: 8 < 0,001 Hours of vasopressors 46,29 86,63 0,023 Renal replacement Therapy Yes: 3 No: 40 Yes: 8 No: 31 0,074 APACHE II 17,05 ± (8,24) 20,66 ± (6,00) 0,042 SOFA at admission 4,99 ± (3,84) 7,32 ± (3,24) 0,35 SOFA at 48 hours 3,89 ± (3,83) 9,20 ± (4,43) 0,13 Conclusions: this is the first report on the impact of prognostic factors in the outcome of HM patients admitted to ICU in Hospital de Clinicas. HM patient’s acute complications are strong factors that contribute to prognostic in critically ill patients and not only the hematologic disease per se or presence of neutropenia or type of chemotherapy. The mortality rate in this series is similar to international reports and also in patients without HM admitted in ICU. Therefore, we support the idea that survival in critically ill HM patient is related with the intercurrent complication in a significant part, and we have to make more efforts to improve results in this area by working together with intensive care medicine physicians. Disclosures No relevant conflicts of interest to declare.

Relative adrenal insufficiency: an identifiable entity in nonseptic critically ill patients?

2007 ◽  
Vol 66 (5) ◽  
pp. 732-739 ◽  
Author(s):  
Margriet F. C. de Jong ◽  
Albertus Beishuizen ◽  
Jan-Jaap Spijkstra ◽  
Armand R. J. Girbes ◽  
A. B. Johan Groeneveld
Keyword(s):  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Relative Adrenal Insufficiency

scholarly journals Acinetobacterinfections: a growing threat for critically ill patients

2007 ◽  
Vol 136 (8) ◽  
pp. 1009-1019 ◽  
Author(s):  
M. E. FALAGAS ◽  
E. A. KARVELI ◽  
I. I. SIEMPOS ◽  
K. Z. VARDAKAS
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Relative Frequency ◽  
The United States ◽  
Considerable Proportion ◽  
Southern Europe ◽  
Icu Patients

SUMMARYThere has been increasing concern regarding the rise ofAcinetobacterinfections in critically ill patients. We extracted information regarding the relative frequency ofAcinetobacterpneumonia and bacteraemia in intensive-care-unit (ICU) patients and the antimicrobial resistance ofAcinetobacterisolates from studies identified in electronic databases.Acinetobacterinfections most frequently involve the respiratory tract of intubated patients andAcinetobacterpneumonia has been more common in critically ill patients in Asian (range 4–44%) and European (0–35%) hospitals than in United States hospitals (6–11%). There is also a gradient in Europe regarding the proportion of ICU-acquired pneumonias caused byAcinetobacterwith low numbers in Scandinavia, and gradually rising in Central and Southern Europe. A higher proportion ofAcinetobacterisolates were resistant to aminoglycosides and piperacillin/tazobactam in Asian and European countries than in the United States. The data suggest thatAcinetobacterinfections are a growing threat affecting a considerable proportion of critically ill patients, especially in Asia and Europe.

The Concerns of Recovery Practitioners Assisting in the Care of ICU Patients

2001 ◽  
Vol 2 (3-4) ◽  
pp. 6-8 ◽  
Author(s):  
Lynn Sealey
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Training And Development ◽  
Small Study ◽  
Icu Patients ◽  
Recovery Unit ◽  
High Dependency

When high dependency and intensive care units are full, which occurs more and more often nationally, recovery wards are being utilised to hold critically ill patients. Recovery practitioners are often expected to assist in the care of these patients.A small study established the views of a sample of recovery practitioners regarding the recovery unit being used as stop-gap, or ICU overflow. There were positive and negative opinions from recovery practitioners who were involved in the care of these critically ill patients. Recovery practitioners often reported feeling inexperienced and ill equipped, with increased levels of stress when working in the ICU bay. Only 20% of recovery practitioners in the study, expressed optimism about working in the ICU bay, and 60% identified that training and development was a strategy which may help to overcome some of their perceived problems.This paper reports these concerns and identifies strategies which have been implemented to address some of these concerns.

Sign in / Sign up

Export Citation Format

Share Document