scholarly journals Stuck in the Unit: Three-Year Outcomes Following Prolonged Stay in the Surgical Intensive Care Unit

2014 ◽  
Vol 05 (09) ◽  
pp. 376-383
Author(s):  
Eileen Eggenberger ◽  
Samuel Marquez ◽  
Thu Doan ◽  
David M. Radosevich ◽  
Jeffrey G. Chipman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Prolonged Stay

Impact of a Prolonged Surgical Critical Illness on Patients’ Families

2002 ◽  
Vol 11 (5) ◽  
pp. 459-466 ◽  
Author(s):  
Sandra M. Swoboda ◽  
Pamela A. Lipsett
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Functional Outcome ◽  
Substantial Effect ◽  
Surgical Intensive Care Unit ◽  
Long Term Effects ◽  
Surgical Intensive Care ◽  
Prolonged Stay

• Background Long-term effects on patients’ families after a prolonged stay in a surgical intensive care unit are unclear. We hypothesized that illnesses requiring more than 7 days’ stay in the surgical intensive care unit would have significant, long-lasting effects on patients’ families that would be related to patients’ functional outcome. • Methods All patients who stayed in the general surgery intensive care unit 7 days or more between July 1, 1996, and June 30, 1997, were enrolled. A total of 128 patients met the entry criteria, and families of surviving patients were interviewed at baseline and 1, 3, 6, and 12 months later. Maximum dysfunction/impact was compared with patients’ functional outcome. • Results Significant disturbances in the families’ lives occurred throughout the 12 months of this study. Almost 60% of responding families provided a moderate or large amount of caregiving between 1 and 9 months after a prolonged illness, 44.9% had to quit work after 1 month, and more than 36.7% of families had lost savings after 1 year. Some families moved to a less expensive home, delayed educational plans, or delayed medical care for another family member. • Conclusions An acute surgical illness that results in a prolonged stay in an intensive care unit has a substantial effect on patients’ families that is maximal between 1 and 3 months and parallels the patient’s functional outcome. Systems that provide support to both patients and their families should be emphasized in the hospital and after discharge.

scholarly journals 1825. Optimizing β-lactam Therapy in Surgical Intensive Care Unit Patients Using Therapeutic Drug Monitoring

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S40-S41
Author(s):  
Mohammad H Al-Shaer ◽  
Eric Rubido ◽  
Daniel Lee ◽  
Kenneth Klinker ◽  
Charles Peloquin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Clinical Cure ◽  
Surgical Intensive Care Unit ◽  
Therapeutic Drug ◽  
Surgical Intensive Care ◽  
Days Of Therapy ◽  
Unit Increase

Abstract Background Therapeutic drug monitoring (TDM) is a powerful tool to optimize antibiotic exposure. It seldom has been used for β-lactams (BLs). We present our BL data in patients admitted to the surgical intensive care unit (SICU). Methods This retrospective study included SICU patients at UF Health (2016 and 2018) who received BL therapy and had TDM. Data collected included demographics, APACHE scores, platelet count, serum creatinine (Scr), infection source, cultures/susceptibilities, BL regimens, and plasma concentrations. Clinical cure was defined as resolution of infection-related symptoms at the end of therapy. Microbiologic eradication was defined as eradication of causative organism from the primary source out to 30 days after therapy. Pharmacokinetic and statistical analyses were performed on Phoenix v8.0 and JMP Pro v14. Results A total of 127 patients were included. Table 1 shows the baseline characteristics. The median age was 55 years, and weight was 83 kg. Eighty-three (65%) were male. P. aeruginosa was the most common isolated bacteria (n = 38). Lung was the most common source of infection (n = 50). Table 2 summarizes the median (IQR) doses, infusion times, calculated free trough concentrations (fCmin) of common BLs, and the reported minimum inhibitory concentrations (MICs). Calculated median time above the MIC (fT > MIC) for 66 (52%) patients was 100%. A total of 99 (79%) patients had clinical cure and 67 (61%) patients had microbiologic eradication. For efficacy, the Cmin/MIC ratio predicted the microbiologic eradication in wound infections only (n = 15, OR 1.09 [95% CI 1.01–1.24]). Using stepwise regression, 1-unit increase fT > MIC and APACHE score was associated with 0.84 decrease (P = 0.03) and 0.62 increase (P = 0.004) in days of therapy, respectively. For safety, Figure 2 shows the increase in Scr vs. BL free area under the concentration–time curve from time zero to end of the dosing interval (fAUC0-tau). Cefepime fAUC0-tau predicted neurotoxicity (OR per 20 unit increase 1.08 [95% CI: 1.01–1.18]). Conclusion In SICU patients, increase in fT > MIC was associated with shorter treatment duration, and fAUC0-tau increase was associated with an increase in Scr and incidence of neurotoxicity. TDM is warranted in this population to optimize therapy. Disclosures All Authors: No reported Disclosures.

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