No abstract available.
Intensive Care Units*

Introduction: The increasing trend of extensively drugresistant gram negative bacteria responsible for nosocomial infections has prompted resurgence colistin usage. Colistin-induced nephrotoxicity is a concern with disparity in the reported rates between previous studies. This study aims to evaluate colistin-induced nephrotoxicity among Malaysian population. Methods: The medical records of ICU patients receiving colistin therapy in Hospital Serdang and Hospital Sungai Buloh from 2010 to 2012 were retrospectively reviewed. Demographics data, treatment characteristic as well as culture result and creatinine level were documented. Nephrotoxicity was determined based on RIFLE criteria. Results: A total of 100 patients were included. Median daily dose, cumulative dose and duration of colistin therapy were 3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180) and seven days (IQR: 4, range 1-30). Nephrotoxicity was found in 23% of the study population. All cases were reversible but marginally associated with higher mortality. No statistical association exist between age, gender and race as well as administration routes with nephrotoxicity by univariable analysis. The association of dose and duration with nephrotoxicity was also not significant by univariable analysis. After adjustment for confounders, statistical association between the independent variables and dependent variable remains not significant. Conclusion: Lower dose and shorter duration in local settings contribute to lack of association between colistin therapy and nephrotoxicity in this study. Higher dosing regimen with loading dose application has been introduced in the latest National Antibiotic Guideline. Further evaluation of colistin-induced nephrotoxicity and potential risk factors is therefore warranted.
Colistin ; Intensive Care Units

No abstract available.
Intensive Care Units* ; Tracheostomy*

Humans ; Intensive Care Units

Objective: To evaluate the efficacy, safety, and clinical outcomes of, and protocol deviations with the use of the Modified Yale Insulin Infusion Protocol (IIP) compared to usual/standard care in the local setting. Methods: Chart review of patients admitted in two ICUs over a 2-year period was done. Patients eligible for intensive glycemic control were identified. Efficacy, safety and clinical outcomes were compared between the Modified Yale IIP and usual/standard care. Charts managed with the IIP were appraised for protocol deviations. Results: Eighty-one patients met the inclusion criteria and 34.6% used the IIP. The IIP group achieved a lower mean blood glucose (185.1 vs 212.1 mg/dl, p<0.05). They reached normoglycemia (5 vs 12 hours, p<0.05) and target range of 140-180 mg/dl (8.3 vs 18.3 hours, p<0.05) earlier. Hypoglycemia was rare (median 0%) in both groups. No difference in mortality or morbidity was seen. Hospital (13.9 vs 8.1 days, p<0.05) and ICU stay (5.5 vs 3.0 days, p<0.05) were longer in the IIP group. A mean of 11 deviations per patient occurred, the majority of which were errors on insulin dose administered (66.6%). Conclusion The Modified Yale IIP is efficaceous, safe and yielded better glycemic profiles than usual care. Majority of protocol deviations were on the insulin dose administered
Hyperglycemia ; Intensive Care Units

No abstract available.
Intensive Care Units* ; Critical Care*

No abstract available.
Critical Care ; Intensive Care Units

No abstract available.
Critical Care ; Intensive Care Units

No abstract available.
Intensive Care Units* ; Critical Care*

No abstract available.
Intensive Care Units* ; Critical Care*