Infusion Therapy Research Articles

Research on the Causes and Nursing Interventions of Extravasation During Intravenous Infusion

Intravenous infusion, a common clinical drug treatment method, is widely used in the treatment of various diseases. Due to the invasive nature of puncture during intravenous infusion, patients may inevitably experience resistance and tension when facing nursing staff performing infusion procedures. Additionally, the complexity of the nursing staff’s work and the impact of the infusion therapy environment can exacerbate the tension between nurses and patients, leading to risks such as drug leakage and needlestick injuries. This article focuses on the factors influencing extravasation during intravenous infusion and elaborates on how high-quality nursing interventions can reduce the incidence of adverse events during intravenous infusion. These interventions aim to improve patient satisfaction with intravenous infusion nursing care and ensure the safety of intravenous infusion procedures.

Use of video lessons to disseminate knowledge of patient safety during infusion therapy: reported experiences

Use of video lessons to disseminate knowledge of patient safety during infusion therapy: reported experiences

Flow Rate Sensor inside Infusion Tube

Infusion systems are widely used in clinical medicine. Intravenous infusion therapy must be monitored to ensure patient safety. We proposed a compact flow rate sensor device based on the time-of-flight method. This device included one ceramic heater and two infrared sensors. Practical sensor prototypes were fabricated and characterized. The response time was 30 s. The sensor range was estimated to be 33 dB from μL/min to tens of mL/min, covering almost the entire usage range This flow rate sensor can be applied to common infusion tubes. Through the use of a mobile phone app, detailed information can be presented in real time.

STABILITY (Symptomatic Review during Biologic Therapy) of Inflammatory Bowel Disease Patients Receiving Infusion Therapy Improves Clinical Outcomes.

Several studies have correlate improved patient outcomes with increased physician-patient contacts, particularly in chronic diseases. Extending this approach to inflammatory bowel disease (IBD) care presents a promising means of improving outcomes. At LSU Health Shreveport (LSUHS), a new approach called "STABILITY" (Symptomatic Review during Biologic Therapy) was implemented during infusion therapy visits for IBD patients. These brief 15 min physician-patient interviews aimed to discuss the patients' current IBD-related symptoms and evaluate the need for any changes in their treatment plan. Our goal was to remove a care gap and prevent intensifying symptoms created by missed appointments and loss of contact. To analyze the effectiveness of the STABILITY approach, a retrospective chart review was conducted on 111 IBD patients (18 with ulcerative colitis, 93 with Crohn's disease) seen at LSUHS between 2011 and 2022. Since March 2019, STABILITY has been mandatory for all infusion therapy visits. The data collected included patients' demographics, lab levels for biomarkers (fecal calprotectin, C-reactive protein, and erythrocyte sedimentation rates), hospitalizations, medication changes, and diagnosis dates before and after the implementation of STABILITY. Additionally, voluntary, anonymous infusion patient satisfaction surveys post-STABILITY were used to gather patient responses. In males with IBD, disease severity and hospitalizations were reduced significantly (p = 0.004 and 0.0234, respectively). In females with IBD, disease severity and hospitalizations were also reduced significantly (p = 0.0001 and 0.0072, respectively). In patients with UC and CD, there were significant improvements in disease severity (p = 0.043 and p = 0.0001, respectively), and CD hospitalizations were also improved (p = 0.0013). In males and females with UC, disease severity was marginally and significantly reduced (p = 0.0781 and p = 0.0379, respectively). In males and females with CD, disease severity was significantly reduced (p = 0.0161 and 0.0003, respectively), and CD male and female hospitalizations were also reduced significantly (p = 0.0436 and 0.013). Analyzing of survey responses, we found that the most patients reported improved IBD symptoms (56%), gained understanding of their condition (84%) and were in favor of continuing STABILITY consultations during infusion therapy (93%). To further investigate the impact of STABILITY, we conducted a comparative analysis between IBD patients undergoing STABILITY infusion therapy and LSUHS patients solely on self-injectable biologics. Our paired data analysis showed significant improvements in disease severity in female IBD patients (1.69 ± 0.13 vs. 1.41 ± 0.12, p = 0.0001) and male IBD patients (1.58 ± 0.16 vs. 1.2 ± 0.135, p = 0.004), in UC patients (1.833 ± 0.4.2 vs. 1.444, p = 0.043), in all CD patients (1.59 ± 0.11 vs. 1.29 ± 0.01, p = 0.0001), in male CD patients (1.52 ± 0.167 vs. 1.15 ± 0.15, p = 0.016), in female CD patients (1.66 ± 0.15 vs. 1.4 ± 0.13, p = 0.0003), in female UC patients (1.82 ± 0.32 vs. 1.45 ± 0.31, p = 0.0379), and marginally in male UC patients (p = 0.0781). Similarly, hospitalizations were significantly reduced in CD patients considered in aggregate (0.21 ± 0.04 vs. 0.11 ± 0.03, p = 0.0013), in male IBD patients (0.175 ± 0.06 vs. 0.05 ± 0.035, p = 0.024), in female IBD patients (0.21 ± 0.05 vs. 0.11 ± 0.04, p = 0.0072), in male CD patients (0.18 ± 0.07 vs. 0.06 ± 0.042, p = 0.0436), and in females with CD (0.23 ± 0.06 vs. 0.13 ± 0.04, p = 0.013). Although average values for fecal calprotectin, CRP, and sedimentation rate were frequently reduced after STABILITY interviews, these data did not reach statistical significance. These preliminary findings suggest that STABILITY may be effective in maintaining low disease activity or remission in IBD patients.

Esketamine infusion therapy: A promising alternative in the treatment of chronic endometriosis-associated pain

Introduction: Esketamine infusion therapy is currently used to reduce the process of sensitization in patients with chronic pain syndromes. Given its anti-inflammatory, anti-depressive, and analgesic properties, this drug could be effective to treat chronic endometriosis-associated pain as well. The aim of this study was (1) to provide an overview of the available literature and (2) to present the results of our retrospective cohort study on the efficacy of esketamine infusion therapy to alleviate pain symptoms in this cohort. Methods: PubMed and EMBASE were searched to select publications on this topic. For our retrospective cohort study, all patients with chronic endometriosis-associated pain that underwent esketamine infusion therapy between January 2010 and 2023 in the Isala hospital in Zwolle, the Netherlands, were reviewed. Results: PubMed and EMBASE identified no publications on this topic, except our own case report. Retrospective analysis of 17 patients (who underwent 57 esketamine infusions in total) revealed a positive effect in 64.7% of patients. Overall the treatment was considered save and well-tolerated. Currently, eight patients continue to receive esketamine infusion therapy, others underwent endometriosis surgery ( n = 2), switched pain treatment ( n = 1), or were non-responders ( n = 6). Conclusions: Esketamine infusion therapy could be a potential and a viable option to treat chronic endometriosis-associated pain in patients who are resistant to current treatment options. Our findings encourage to conduct future studies, including randomized trials. This is the first cohort study to report outcomes on the efficacy of esketamine infusion therapy for women with chronic endometriosis-associated pain.

Patients with type 2 diabetes who achieve reduced postprandial glucose levels during insulin intensive therapy may have a better recovery of β-cell function

ObjectivesTo explore parameters that may determine the improvement in C-peptide levels in patients with type 2 diabetes (T2D) receiving continuous subcutaneous insulin infusion (CSII) therapy. MethodsThe trial included a lead-in period for collecting baseline parameters and correcting hyperglycemia, a 4-day CGM period, and a 2–3 weeks treatment period. After screening, patients were hospitalized and randomized to the metformin add-on NovoRapid group or the Prandilin group. Once the glycemic target was reached, all patients underwent a 4-day CGM, with treatments maintained for 2–3 weeks. OGTTs were performed at baseline and endpoint. The primary endpoint was identifying factors contributing to better β-cell function recovery after CSII therapy. ResultsA total of 99 recruited patients were admitted as inpatients and achieved glycemic control within 3.8 ± 1.1 days. Of these, 83 (84 %) patients showed improvement in C-peptide levels, while 16 (16 %) did not show any change in C-peptide levels at the endpoint. Pearson analysis showed a negative correlation between the incremental AUC of glucose concentration (from 0700 to 1000) and the increase in incremental AUC of C-peptide levels (r = −0.199, P < 0.05). ConclusionsDrug-naïve T2D patients with lower postprandial glucose concentration during CSII therapy exhibit better β-cell function recovery.

Effect of Continuous Infusion Therapy With Low-dose Terlipressin Combined With Norepinephrine on Hemodynamics, Inflammatory Markers, and Prognosis in Patients With Severe Septic Shock.

The present study investigated the impact of continuous infusion therapy with low-dose terlipressin (TP) combined with norepinephrine on hemodynamics, inflammatory markers, and prognosis in patients with severe septic shock. Seventy-four patients with severe septic shock were randomly assigned to either a control group (n = 37) or an observation group (n = 37). Patients in the control group received norepinephrine alone, while those in the observation group received a continuous infusion of low-dose TP in addition to norepinephrine. To assess the effect of treatment, a set of clinical parameters was evaluated in both groups before and after treatment. These parameters included hemodynamic indicators (heart rate [HR], mean arterial pressure [MAP], central venous pressure [CVP], cardiac index [CI], and systemic vascular resistance index [SVRI]), levels of serum inflammatory markers (interleukin-8 [IL-8], tumor necrosis factor-α [TNF-α], and hypersensitivity C-reactive protein [hs-CRP]), renal function indicators (blood urea nitrogen [BUN], serum creatinine [SCr], and cystatin C [Cys-C]), serum procalcitonin (PCT), and lactate, as well as lactate clearance rate (LCR). Additionally, the acute physiology and chronic health evaluation II (APACHE II) score, 28-day mortality rate, multiple organ dysfunction syndrome (MODS) incidence rate, and adverse reaction incidence were also determined. Compared to baseline values, MAP, CVP, CI, SVRI, and LCR increased in both groups after treatment, while HR, levels of IL-8, TNF-α, hs-CRP, BUN, SCr, PCT, and lactate all decreased. Additionally, APACHE II scores also decreased. Furthermore, the observation group exhibited higher MAP, CVP, CI, SVRI, and LCR, along with lower HR, levels of IL-8, TNF-α, hs-CRP, BUN, SCr, PCT, and lactate than the control group after treatment. The observation group also had lower APACHE II score, 28-day mortality rate, MODS incidence rate, and adverse reaction incidence than the control group after treatment (P < .05). Continuous infusion therapy with low-dose TP combined with norepinephrine was effective in treating patients with severe septic shock, improving hemodynamic parameters, reducing the levels of inflammatory markers, promoting renal function recovery, and reducing the mortality rate.

Efficacy and Safety of Terlipressin Infusion in Hepatorenal Syndrome-Acute Kidney Injury (HRS-AKI): A Retrospective Observational Study.

Background Hepatorenal syndrome-acute kidney injury (HRS-AKI) is an event that occurs in chronic liver disease (CLD) and is associated with high morbidity and mortality. Terlipressin, a vasopressin analog, is used for the treatment of portal hypertension-related gastrointestinal (GI) bleeding and is found to be effective in the management of HRS-AKI. Continuous infusion of terlipressin maintains a high mean arterial pressure while reducing adverse events. It is better tolerated and equally effective at lower doses than intravenous boluses in patients with HRS-AKI. Aim of the study This study aimed to evaluate the safety and efficacy of terlipressin infusion at the rate of 4 mg/day in the treatment of HRS-AKI. Methods This retrospective study included patients who had HRS-AKI according to the modified International Club of Ascites (ICA) definition. Patients were started on a continuous intravenous infusion. The included patients received terlipressin 1 mg stat followed by a 4 mg infusion over 24 hours, and the infusion was continued until specific response criteria were met or for a maximum of seven days. Results In total, 136 patients were included in this study. The mean age of the study group was 45 years, the mean Child-Turcotte-Pugh (CTP) score was 11, the mean model for end-stage liver disease (MELD) score was 30, and the mean serum creatinine was 2.46 mg/dl. A response to treatment in the form of reduction of serum creatinine was observed in 94 (69.1%) patients, 30 (22%) patients showed no response, and worsening of creatinine was seen in 12 (8.8%) patients. The mean duration of hospital stay was 7.6 days, the mean serum creatinine was 1.17 mg/dl at the end of treatment, and the mean CTP and MELD scores in treatment responders were nine and 27, respectively. A total of 29 (21.3%) of 136 patients had adverse events during the terlipressin infusion therapy. Conclusion Terlipressin infusion has sustained effects on splanchnic hemodynamics with fewer and less severe adverse events than intravenous bolus doses. Terlipressin infusion at a dose of 4 mg/day appeared to be well tolerated, with similar outcomes to that of 2 mg/day with a significantly lower albumin dose. These findings emphasize the importance of optimizing treatment protocols, particularly those favoring infusion methods, to enhance efficacy and minimize adverse effects.

High fibrinogen content in pregnant women – pathology or overdiagnosis?

An increased fibrinogen (FG) concentration during pregnancy is considered a protective mechanism against bleeding during childbirth. An enlarged amount of FG increases the aggregation of erythrocytes, blood plasma viscosity, microvascular resistance – permanent elements of the pathogenesis of arterial hypertension, stroke, coronary heart disease. It is also associated with an increased likelihood of development of preeclampsia and stroke with subsequent neurological disorders.In addition to its undeniable importance for hemostasis, FG is directly related to several physiological and pathophysiological conditions, such as infection, wound healing, tumorigenesis, and the severity of atherosclerosis. It also has a decisive role in the development of pregnancy. Maternal FG is necessary for the progress of pregnancy, as it stabilizes the utero-placental connection at the fibrinoid layer of the fetal-maternal junction. No reports on the study of pathological forms of FG in Ukraine were found.The objective: to compare the indicators of FG concentration and related elements of the blood coagulation system of pregnant and parturient women in different gestational periods and after childbirth.Materials and methods. Blood components from the ulnar vein of 30 women in labor at a gestation period of 22–27 weeks (extremely preterm birth (EPB) – I group), 37 women in labor at a term of 28–34 weeks (early preterm birth (PB) – II group) and 40 women with gestational period 37–41 weeks (control group (CG) – III group) was studied. In the collected samples the content of FG, D-dimer (Dd), prothrombin index (PI), activated partial thromboplastin time (APTT), as well as the levels of hemoglobin (Hb), hematocrit (Ht) and total protein (TP) of the blood plasma were determined.All women in labor were hospitalized in the active phase of the I labor period and did not receive infusion therapy. In terms of gestation, corresponding to EPB, early PB and CG, 10 pregnant women who were on outpatient registration at the Perinatal Center were examined for comparison of the studied indicators outside of labor.Indicators of the biochemical coagulogram were studied on a Helena C-2 semi-automatic coagulometer (Helena Biosciences, Great Britain).Results. The FG concentration increased from 4.2±0.56 g/l in the term 22–27 weeks to 4.4±0.57 g/l before delivery with a diapason of 3.5 to 5.0 g/l. In all parturients, the FG concentration was lower than 4.5 g/l, respectively by group: 4.5±0.81; 4.1±0.74 and 4.1±0.65 g/l (р&lt;0.05). In 24 hours after delivery the FG concentration increased in CG to 5.0±0.82 g/l, and after 48 hours – to 5.3±1.19 g/l, which exceeded the indicators of parturients of the EPB and early PB groups and pregnant women of these same terms, in which the highest indicator was 4.5±0.81 g/l in the EPB group (p&lt;0.05).An increase in the Dd index with growing gestational age was observed in all pregnant women (from 274±133.3 to 501±174.7 μg/l). It continued during the first postpartum day – up to 685±157.5 μg/l, decreased on the second day – 429±198.9 μg/l (p&lt;0.05), approaching the indicators of the EPB and early PB groups (487±267.0 and 397±202.3 μg/l; p&gt;0.05) and pregnant women of the same term.Hb decreased to 106±8.9 g/l, and Ht – to 35±6.1% with the progression of pregnancy. In parturients of the PB group, they were probably higher than the indicators of pregnant women of the corresponding terms, increasing on the second day after delivery – 110±6.7 g/l and 41±3.1%.There was no significant blood loss in the clinical groups. In all pregnant and parturient women the APTT and PI indicators varied from 27.0±3.51 s to 35.4±3.43 s and from 88±4.8% to 101±5.2%, respectively.Conclusions. 1. A gradual increase in the fibrinogen (FG) concentration with increasing gestational age from 4.2±0.56 g/l in 22–27 weeks to 4.4±0.57 g/l by the time of delivery indicates an increase in the level of FG in healthy pregnant women as an adaptive response of the body to the formation of an additional vascular system.2. An excessive FG increase is a consequence of hemoconcentration, not absolute hyperfibrinogenemia, and may be a sign of pathological processes underlying hypovolemia. In case of extremely preterm birth (EPB), the concentration of FG in the parturient was 4.5±0.81 g/l. Higher values of FG, hemoglobin, and hematocrit in parturients with EPB than in pregnant women at the same term are evidence of insufficient hemodilution, which can be considered as one of the pathogenetic mechanisms of premature labor.3. Laboratory indicators of the blood coagulation system – APTT, PI – in the absence of bleeding have no diagnostic value.

Automated Insulin Delivery Technology in the Hospital: Update on Safety and Efficacy Data

ObjectiveAutomated insulin delivery (AID) systems are a rapidly growing component in the area of continuous subcutaneous insulin infusion (CSII) therapy. As more patients use these systems in the outpatient setting, it is important to assess safety if their use is allowed to continue in the inpatient setting. MethodsAnalysis was conducted of the records of patients using AID technology upon admission to our hospital between June 2020 and December 2022. Adverse events and glycemic control of AID users were compared with patients using non-AID systems and with patients who had CSII discontinued. ResultsThere were 185 patients analyzed: 64 on AID, 86 on non-AID, and 35 who had CSII discontinued. The number of patients on AID increased over the course of the observation period, whereas non-AID users decreased. Pairwise comparisons indicated that patient-stay mean glucose levels and percentage of hypoglycemic events were similar between all groups, but the percentage of patient hyperglycemic measurements was significantly lower in the AID cohort. No adverse events (diabetic ketoacidosis, pump site complications, equipment malfunction) were reported in any either CSII cohort. ConclusionThe type of CSII technology encountered in the hospital is shifting from non-AID toward AID technologies. This analysis supports earlier findings that outpatient AID systems can be successfully transitioned into the inpatient setting. Further study is needed to define if AID systems offer any advantage in glycemic control.

A Retrospective Review of 22 patients on Anifrolumab in Refractory Cutaneous Lupus

Cutaneous lupus erythematosus (CLE) is a heterogeneous disorder that can present alone as cutaneous disease or in conjunction with systemic lupus erythematosus (SLE). Despite CLE often being severe and worsening quality of life, there is still no FDA approved drug for CLE. Anifrolumab, a fully humanized IgG1κ monoclonal antibody, has become a drug of interest because of its significant skin improvement in the SLE trials. We performed a retrospective chart review of a cohort of twenty-four patients initiating anifrolumab infusion therapy from January to November 2022. Twenty-two patients were also identified as having CLE in addition to SLE. Chart review occurred up to August 21, 2023. Of the twenty-two patients, thirteen (59%) were able to reduce or stop either prednisone or a disease-modifying antirheumatic drug (DMARD). Specifically, eight patients (36%) of the twenty-two completely stopped at least one DMARD. Notably sixteen patients (70%) started anifrolumab on prednisone with eight (50%) being able to discontinue prednisone completely. Seventeen (77%) of the twenty-two had improvement of skin lesions by resolution of rash, no flares since therapy initiation, repigmentation, hair regrowth, or decrease in erythema and scale. Two of the total twenty-four patients reviewed did not have clear evidence of cutaneous lupus although did have cutaneous disease likely related to SLE, therefore were not included in data analysis although are represented in Table 2. The decrease in disease burden, ability to decrease other therapies, and overall tolerability of anifrolumab makes it a promising therapy for those with CLE.

A case of neonatal sepsis, early diagnosis and preventive intensive care

Neonatal sepsis is a pathological process that occurs as a complication of any infectious processes and is a life-threatening condition for newborns. Aim. To inform practitioners with the case of neonatal sepsis, when timely diagnosis and intensive care helped to prevent the development of septic shock and multiple organ failure. Materials and methods. A child was treated in the Department of Anesthesiology and Intensive Care of Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using the hospital equipment. Results. The child with a complicated prenatal history was born by emergency caesarean section for severe pre-eclampsia at 34 weeks’ gestation. On the tenth day of life, the infant developed a worsening intoxication syndrome and febrile temperature. X-ray examinations revealed right-sided pneumonia; clinical blood count showed leukocytosis with acute inflammatory changes, thrombocytopenia, and an elevated procalcitonin level. A day later, the inflammatory changes dramatically deteriorated, and the cerebrospinal fluid cytosis was increased up to 850 cells and dominated by neutrophils. Blood cultures tested positive for Enterobacter cloacae. The child was prescribed antibacterial therapy according to the de-escalation principle (meronem and vancomycin) with subsequent changes according to the results of microbiological examinations, infusion therapy with parenteral nutrition, immunosupportive (intravenous immunoglobulin) and antifungal therapy. As a result of intensive therapy, clinical blood count inflammatory abnormalities were regressed, cerebrospinal fluid was completely restored to health, procalcitonin and C-reactive protein levels were normalized, and pneumonia was resolved within a week. Positive laboratory changes were correlated with the general condition: normalization of body temperature, increased activity, and enteral feeding ability. Conclusions. Timely diagnosis and intensive care of neonatal sepsis caused by gram-negative flora helped to prevent the development of multiple organ failure and septic shock. The use of antibiotic therapy according to the de-escalation principle is justified in newborns at high risk of developing septicaemia.

Recent Advances in Gene Therapy for Hemophilia: Projecting the Perspectives.

One of the well-known X-linked genetic disorders is hemophilia, which could be hemophilia A as a result of a mutation in the F8 (factor VIII) gene or hemophilia B as a result of a mutation in the F9 (factor IX) gene, leading to insufficient levels of the proteins essential for blood coagulation cascade. In patients with severe hemophilia, factor VIII or factor IX activities in the blood plasma are considerably low, estimated to be less than 1%. This is responsible for spontaneous or post-traumatic bleeding episodes, or both, leading to disease complications and death. Current treatment of hemophilia relies on the prevention of bleeding, which consists of expensive lifelong replacement infusion therapy of blood plasma clotting factors, their recombinant versions, or therapy with recombinant monoclonal antibodies. Recently emerged gene therapy approaches may be a potential game changer that could reshape the therapeutic outcomes of hemophilia A or B using a one-off vector in vivo delivery and aim to achieve long-term endogenous expression of factor VIII or IX. This review examines both traditional approaches to the treatment of hemophilia and modern methods, primarily focusing on gene therapy, to update knowledge in this area. Recent technological advances and gene therapeutics in the pipeline are critically reviewed and summarized. We consider gene therapy to be the most promising method as it may overcome the problems associated with more traditional treatments, such as the need for constant and expensive infusions and the presence of an immune response to the antibody drugs used to treat hemophilia.

Soluble T-cadherin secretion from endothelial cells is regulated via insulin/PI3K/Akt signalling

Aim and objectiveOur recent report showed that soluble T-cadherin promotes pancreatic beta-cell proliferation. However, how and where the secretion of soluble T-cadherin is regulated remain unclear. Methods and resultsSoluble T-cadherin levels significantly increased in leptin receptor-deficient db/db mice with hypoinsulinaemia or in wild-type mice treated with insulin receptor blockade by S961. Similar results were observed in human subjects; Diabetic ketoacidosis patients at the time of hospitalization had increased plasma soluble T-cadherin levels, which decreased after insulin infusion therapy. Patients with recurrent ovarian cancer who were administered a phosphatidylinositol-3 kinase (PI3K)-alpha inhibitor (a new anticancer drug) had increased plasma soluble T-cadherin and plasma C-peptide levels. Endothelial cell-specific T-cadherin knockout mice, but not skeletal muscle- or cardiac muscle-specific T-cadherin knockout mice, showed a 26 % reduction in plasma soluble T-cadherin levels and a significant increase in blood glucose levels in streptozocin-induced diabetes. The secretion of soluble T-cadherin from human endothelial cells was approximately 20 % decreased by insulin and this decrease was canceled by blockade of insulin receptor/Akt signalling, not Erk signalling. ConclusionWe conclude that insulin regulates soluble T-cadherin levels and soluble T-cadherin secretion from endothelial cells is positively regulated by insulin/insulin receptor/Akt signalling.

Does Two-Step Infusion Improve the Pharmacokinetics/Pharmacodynamics Target Attainment of Meropenem in Critically Ill Patients?

The optimal method for administering meropenem remains controversial. This study was conducted to explore the optimal two-step infusion strategy (TIT), and to investigate whether TIT is superior to intermittent infusion therapy (IIT) and prolonged infusion therapy (PIT). A physiologically based pharmacokinetics model for critically ill patients was established and evaluated. The validated model was utilized to evaluate the pharmacokinetics/pharmacodynamics (PK/PD) target attainment of meropenem. The PK/PD target attainment of different TITs varied greatly, and the total infusion duration and the first-step dose greatly affected these values. The optimal TIT was 0.25 g (30 min) + 0.75 g (150 min) at MICs of ≤2 mg/L, and 0.25 g (45 min) + 0.75 g (255 min) at MICs of 4–8 mg/L. The PK/PD target attainment of optimal TIT, PIT, and IIT were 100 % at MICs of ≤1 mg/L. When MIC increased to 2–8 mg/L, the PK/PD target attainment of optimal TIT was similar to that of PIT and higher than IIT. In conclusion, TIT did not significantly improve the PK/PD target attainment of meropenem compared with PIT. IIT is adequate at MICs of ≤1 mg/L, and PIT may be the optimal meropenem infusion method in critically ill patients with MICs of 2–8 mg/L.

Valproic acid induced Stevens–Johnson syndrome

A 27-year-old transgender female at the stage of gender transition with bipolar disorder for which she received valproic acid developed multiple petechial rashes on the chest, upper and lower extremities, local erythematous lesions with forming blisters, large-platelet peeling on the face, neck, chest and inguinal area, erosion on the oral mucosa. She was diagnosed with drug eruption, Stevens–Johnson syndrome. The diagnosis was verified on the basis of complaints, medical history, clinical picture, laboratory findings. Treatment included valproic acid withdrawal, dexamethasone, infusion therapy, vancomycin, cyclosporine A. Against the background of the therapy, skin condition was improved: there was the epithelization of ulcerative defects and the absence of new elements.

Effect of in-line filtration in newborns: study protocol of the Intravenous Neonatal Central Access Safety (INCAS) randomized controlled trial

BackgroundParticulate contamination due to infusion therapy (administration of parenteral nutrition and medications) carries a potential health risk for infants in neonatal intensive care units (NICUs). This particulate consists of metals, drug crystals, glass fragments, or cotton fibers and can be generated by drug packaging, incomplete reconstitution, and chemical incompatibilities. In-line filters have been shown to remove micro-organisms, endotoxin, air, and particles in critically ill adults and older infants, but its benefits in newborn remain to be demonstrated. Moreover, 50% of inflammatory episodes in the setting of NICUs are blood culture-negative. These episodes could be partly related to the presence of particles in the infusion lines.MethodsA multicenter randomized single-blind controlled trial was designed. All infants admitted to NICUs for which prolonged infusion therapy is expected will be enrolled in the study and randomized to the Filter or Control arm. All patients will be monitored until discharge, and data will be analyzed according to a “full analysis set.” The primary outcome is the frequency of patients with at least one sepsis-like event, defined by any association of suspected sepsis symptoms with a level of c-reactive protein (CRP) > 5 mg/L in a negative-culture contest. The frequency of sepsis, phlebitis, luminal obstruction, and the duration of mechanical ventilation and of catheter days will be evaluated as secondary outcomes. The sample size was calculated at 368 patients per arm.DiscussionThis is the first multicenter randomized control trial that compares in-line filtration of parenteral nutrition and other intravenous drugs to infusion without filters. Sepsis-like events are commonly diagnosed in clinical practice and are more frequent than sepsis in a positive culture contest. The risk of these episodes in the target population is estimated at 30–35%, but this data is not confirmed in the literature. If the use of in-line filters results in a significant decrease in sepsis-like events and/or in any other complications, the use of in-line filters in all intravenous administration systems may be recommended in NICUs.Trial registrationClinicalTrials.gov, NCT05537389, registered on 12 September 2022 (https://classic.clinicaltrials.gov/ct2/show/results/NCT05537389?view=results).

Detailed regimens for the prolonged β-lactam infusion therapy

A recent systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the efficacy and safety of prolonged versus intermittent β-lactam infusion in adult sepsis patients. The findings revealed a significant decrease in all-cause mortality and marked clinical success in the prolonged infusion group. Unfortunately, however, the manuscript lacked data and discussion for the specific regimens of prolonged β-lactam infusion defined in the included 15 RCT studies, which are herein additionally provided. Excluding one RCT, all protocols adopted a continuous infusion for the prolonged treatment. Except for three RCTs, dosages and timings of bolus injection were clearly defined. The total daily antibiotic dose for the continuous therapy was equivalent to those recommended for intermittent therapy. We believe this supplementary data aids clinicians in providing prolonged β-lactam infusions, contributing to enhanced treatment outcomes for patients suffering from severe sepsis or septic shock.

Monotherapy with infusion therapies - useful or not?

Infusion pump-based therapies are an effective treatment option for patients with advanced Parkinson´s disease. Achieving monotherapy with infusion-based therapies could simplify the treatment regimen, provide better medication adherence, reduce adverse events and drug interactions. This review presents the literature data on the efficacy, safety, and achievability of monotherapy with all available infusion-based therapies, including apomorphine, levodopa-carbidopa-intestinal gel (LCIG), levodopa-entacapone-carbidopa intestinal gel (LECIG), and foslevodopa-foscarbidopa (LDp/CDp). In summary, monotherapy is achievable and effective in most patients on intestinal levodopa infusion therapy and in some patients on apomorphine infusion. There is a need for further investigation of monotherapy compared to polytherapy, especially in new pump treatment options (LECIG and LDp/CDp). Future research should reveal which patients on infusion-based therapies could benefit from monotherapy, including identification of potential baseline predictors of achieving monotherapy in patients treated with specific infusion-based therapies.

The effects of temperament type on infusion extravasation in newborns

Infusion extravasation has an increased incidence in newborns, which can result in various adverse outcomes. This study aimed to investigate the effects of different types of temperament on infusion extravasation in newborns. A total of 209 newborns aged 4–7 days who were treated with infusion therapy were assessed for temperament type using the neonatal behavioral assessment scale score (NBAS). The 2009 Infusion Nurses Society clinical grading criteria for extravasation were used, and the clinical data of the newborns, such as gestational age and body weight, were collected. Out of 209 newborns assessed, 107 developed infusion extravasations, with an incidence rate of 51.2%. Newborns with intermediate temperament type were more prone to develop infusion extravasation. Newborns with low body weight, amniotic fluid aspiration syndrome, or meconium aspiration syndrome were prone to develop infusion extravasation. Body weight, temperament type of consolability, temperament type of peak of excitement, diseases, general temperament type, and NBAS total scores of the neonates were independent risk factors for infusion extravasation. Thus, different types of temperament can have an impact on neonatal extravasation.