Abstract:
PURPOSE:To characterize physicians' stated practices in the treatment of patients with severe acute alcohol withdrawal syndrome (sAAWS) and to use intravenous (IV) phenobarbital as an adjuvant treatment for sAAWS. METHODS:A multidisciplinary, cross-sectional, self-administered survey at 2 large academic centers specializing in inner-city healthcare. RESULTS:We analyzed 105 of 195 questionnaires (53.8% response rate). On average, clinicians managed 32 cases of AAWS over a 6-month period, of which 7 (21.9%) were severe. Haloperidol (Haldol; 40 [39%]), clonidine (Catapres; 31 [30%]), phenobarbital (Luminal, Tedral; 29 [27%]) and propofol (Diprivan; 29 [28%]) were the most commonly used adjuvant medications for sAAWS. Sixty-three (60%) of respondents did not use phenobarbital in practice. Of phenobarbital users, 23 (55%) respondents used it early in patients who were refractory to symptom-triggered benzodiazepine treatment. Others waited until patients experienced seizures (5 [10%]) or required intensive care unit admission (8 [18%]). Respondents who used phenobarbital preferred to use the IV versus oral form (66% vs 29%, P < .001). Most respondents, however, were unfamiliar with the pharmacokinetics, side effects, contraindications, and evidence supporting phenobarbital use for sAAWS. Although many respondents (64 [61%]) expressed discomfort using phenobarbital, 87 (83%) expressed comfort or neutrality with enrolling patients in a trial to evaluate IV phenobarbital in sAAWS. CONCLUSIONS:Considerable stated practice variation exists in how clinicians treat patients with sAAWS. Our findings support conduct of a pilot trial to evaluate IV phenobarbital as an adjuvant treatment to symptom-triggered benzodiazepines for sAAWS and have informed trial design.
journal_name
J Intensive Care Medjournal_title
Journal of intensive care medicineauthors
Buell D,Filewod N,Ailon J,Burns KEAdoi
10.1177/0885066619847119subject
Has Abstractpub_date
2020-11-01 00:00:00pages
1250-1256issue
11eissn
0885-0666issn
1525-1489journal_volume
35pub_type
杂志文章abstract:INTRODUCTION:Cancer is associated with significant health-care expenditure, but few studies have examined the cost of patients with cancer in the intensive care unit (ICU). We aimed to describe the costs and outcomes of patients admitted to the ICU with cancer. METHODS:We conducted a retrospective cohort study of pati...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619899653
更新日期:2021-02-01 00:00:00
abstract::Objectives: Standard management strategies for lowering intracranial pressure (ICP) in traumatic brain injury has been well-studied, but the use of lesser known interventions for ICP in subarachnoid hemorrhage (SAH) remains elusive. Searches were performed in PubMed and EBSCO Host to identify best available evidence f...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066618813073
更新日期:2020-03-01 00:00:00
abstract::Bladder pressure measurement through a foley catheter is the current standard in monitoring for intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Accurate pressure transduction requires a continuous fluid column with a small volume of transducing medium at the tip of the catheter. Infusing ex...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066609335730
更新日期:2009-07-01 00:00:00
abstract:PURPOSE:Timely recognition of critical illness is associated with improved outcomes, but is dependent on accurate triage, which is affected by system factors such as workload and staffing. We sought to first study the effect of delayed recognition on patient outcomes after controlling for system factors and then to ide...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620967901
更新日期:2020-10-29 00:00:00
abstract::The aim of the study was to describe our experience with bi-level positive airway pressure (BiPAP) ventilation in oncology children with acute respiratory failure, hospitalized in a single tertiary pediatric tertiary center. This was a retrospective cohort study of all pediatric oncology patients in our center admitte...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066609344956
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Ischemic and hypoxic secondary brain insults are common and detrimental in traumatic brain injury (TBI). Treatment aims to maintain an adequate cerebral blood flow with sufficient arterial oxygen content. It has been suggested that arterial hyperoxia may be beneficial to the injured brain to compensate for c...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620944097
更新日期:2020-07-27 00:00:00
abstract:OBJECTIVE:To describe intubation practices and duration of mechanical ventilation in children with status asthmaticus admitted from emergency departments (ERs) to pediatric intensive care units (PICUs). DESIGN:Retrospective cohort study using the Virtual PICU Performance System database (VPS, LLC) of children with sta...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066613476446
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The efficacy of routinely obtained chest radiographs (CXRs) on admission to the intensive care unit (ICU) is largely unknown. The current study investigated the efficacy of routinely obtained admission CXRs and determined whether the value of this diagnostic test was dependent on patient categ...
journal_title:Journal of intensive care medicine
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doi:10.1177/0885066610366925
更新日期:2010-07-01 00:00:00
abstract:PURPOSE:Etomidate causes adrenal insufficiency. Yet in critically ill patients, it is controversial whether it increases mortality rates above that of comparator anesthetic induction agents. We postulated that etomidate would increase relative mortality rates correspondingly to the severity of illness as defined by SAP...
journal_title:Journal of intensive care medicine
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更新日期:2020-09-10 00:00:00
abstract:PURPOSE:Methods to optimize positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) remain controversial despite decades of research. The pressure-volume curve (PVC), a graphical ventilator relationship, has been proposed for prescription of PEEP in ARDS. Whether the use of PVC's improves ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066613488747
更新日期:2014-11-01 00:00:00
abstract::Heparin-induced thrombocytopenia requires immediate alternative anticoagulation to prevent or treat thromboembolic complications. Argatroban was approved based on multiple-center studies from the 1990s, but subsequent changes in prevailing awareness, diagnostic testing and therapeutic strategies for heparin-induced th...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066605284590
更新日期:2006-03-01 00:00:00
abstract:OBJECTIVE:When patients deteriorate after decannulation from extracorporeal membrane oxygenation (ECMO), a second run of extracorporeal support may be considered. However, repeat cannulation can be difficult and poor outcomes associated with multiple ECMO runs are a concern. The aim of this study was to evaluate outcom...
journal_title:Journal of intensive care medicine
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doi:10.1177/0885066620981903
更新日期:2020-12-22 00:00:00
abstract:BACKGROUND:Sepsis coagulopathy or disseminated intravascular coagulation (DIC) mainly due to progressive endothelial disruption and damage. The glycocalyx is expressed on the endothelial cell surface and contributes to anti-thrombogenicity, anti-inflammatory, and regulates vascular permeability. We aimed to evaluate th...
journal_title:Journal of intensive care medicine
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doi:10.1177/0885066620949131
更新日期:2020-08-17 00:00:00
abstract:PURPOSE:Conflicting results exist regarding the efficacy of N-acetyl cysteine (NAC) in sepsis treatment. A pivotal factor affecting the therapeutic potency of NAC in sepsis is timing and dosing of its infusion. We aimed to assess the effect of NAC on redox status of patients with sepsis and to compare its efficacy in i...
journal_title:Journal of intensive care medicine
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doi:10.1177/0885066618823152
更新日期:2020-12-01 00:00:00
abstract::Despite an overall decline in the incidence of tuberculosis (TB), the percentage of cases representing miliary TB has remained stable. We report 2 cases of fatal miliary TB that remained unrecognized until autopsy, occurring within a 6-month period at 1 Detroit institution. These cases represent the wide range of pres...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066605279150
更新日期:2005-11-01 00:00:00
abstract::Video laryngoscopy has demonstrated utility in airway management. For the present case series, we report the use of video laryngoscopy to evaluate the airway of critically ill, mechanically ventilated patients, as a means to reduce the risk of immediate postextubation stridor by assessing the degree of laryngeal edema...
journal_title:Journal of intensive care medicine
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doi:10.1177/0885066612437528
更新日期:2013-01-01 00:00:00
abstract:INTRODUCTION:Emergence of multidrug-resistant (MDR) gram-negative (GN) pathogens and lack of novel antibiotics have increased the use of colistin, despite unknown optimal dosing. This study aimed to evaluate the safety and efficacy of a colistin loading dose, high-dose (LDHD) maintenance regimen in patients with MDR-GN...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066616646551
更新日期:2017-09-01 00:00:00
abstract::The objective of this retrospective study was to determine the optimal initial antibiotic regimen for hospital-acquired pneumonia using the frequency and sensitivity of Gram negative microorganisms found in sputum cultures. An antibiogram was constructed and compared with the hospital intensive care unit (ICU) antibio...
journal_title:Journal of intensive care medicine
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更新日期:2005-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Impaired physical functioning is common and long lasting after an intensive care unit (ICU) admission. The 6-minute walk test (6MWT) is a validated and widely used test of functional capacity. This systematic review synthesizes existing data in order to: (1) evaluate 6-minute walk distance (6M...
journal_title:Journal of intensive care medicine
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doi:10.1177/0885066619885838
更新日期:2019-11-05 00:00:00
abstract::Respiratory complications before and after liver transplant are common, diverse, and potentially have a negative impact on patient outcomes. In this review, we discuss the most frequent respiratory conditions that patients may develop in the perioperative period. Their prevention and/or treatment may help to maximize ...
journal_title:Journal of intensive care medicine
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更新日期:2019-05-01 00:00:00
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更新日期:2020-01-09 00:00:00
abstract::Hypercalcemia may be seen in a variety of clinical settings and often requires intensive management when serum calcium levels are dramatically elevated. All of the many etiologies of mild hypercalcemia can lead to severe hypercalcemia. Knowledge of the physiologic mechanisms involved in maintaining normocalcemia and b...
journal_title:Journal of intensive care medicine
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更新日期:2015-07-01 00:00:00
abstract::Left ventricular assist devices (LVADs) and total artificial hearts (TAHs) are surgically implanted as permanent treatment of unrecoverable heart failure. Both LVADs and TAHs are durable mechanical circulatory support (MCS) devices that can prolong patient survival but also alter end-of-life trajectory. The permissibi...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066611432415
更新日期:2014-01-01 00:00:00
abstract:INTRODUCTION:The invasive nature and potential complications associated with pulmonary artery (PA) catheters (PACs) have prompted the pursuit of less invasive monitoring options. Before implementing new hemodynamic monitoring technologies, it is important to determine the interchangeability of these modalities. This st...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066614530085
更新日期:2016-02-01 00:00:00
abstract:INTRODUCTION:Although magnesium plays an important role in aerobic metabolism and magnesium deficiency is a common phenomenon in critical illness, the association between magnesium deficiency and lactic acidosis in the intensive care unit (ICU) has not been defined. METHODS:This was a retrospective, cross-sectional st...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066614530659
更新日期:2016-03-01 00:00:00
abstract::Echodynamics refers to the use of echocardiography as hemodynamic tool mostly in intensive and acute care settings. It implies a smooth drift from the classic cardiology use to a more critical care adjusted use. A more personalized approach is advocated in critical care, and echo is one way to reach such goal. Correct...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066617734151
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVE:Fluid responsiveness is the ability to increase the cardiac output in response to a fluid challenge. Only about 50% of patients receiving fluid resuscitation for acute circulatory failure increase their stroke volume, but the other 50% may worsen their outcome. Therefore, predicting fluid responsiveness is ne...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,meta分析
doi:10.1177/0885066617752308
更新日期:2020-04-01 00:00:00
abstract::The purpose of this study was to analyze the relationship of intrahospital transport patterns with patient throughput and outcomes in an oncological intensive care unit. We retrospectively reviewed all patients admitted to a closed medical-surgical intensive care unit at a cancer center between January 1, 2004 and Dec...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066608329946
更新日期:2009-03-01 00:00:00
abstract:PURPOSE:Atrial fibrillation (AF) is common in the intensive care unit (ICU), notably in patients with septic shock for whom inflammation is an already identified risk factor. The aim of this study was to evaluate the effect of low-dose hydrocortisone on AF occurrence in patients with septic shock. METHODS:We performed...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
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更新日期:2019-03-01 00:00:00
abstract::Thrombolytic therapy has been established as a safe and effective therapeutic strategy in acute myocardial infarction (MI). Its efficacy is improved with early administration, although modest benefits can be demonstrated for up to 12 hours. Tissue plasminogen activator (TPA) appears to offer benefits over streptokinas...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/088506669501000202
更新日期:1995-03-01 00:00:00