Showing papers by "Lena M. Napolitano published in 2012"

A prospective, multicenter, observational study of complicated skin and soft tissue infections in hospitalized patients: clinical characteristics, medical treatment, and outcomes.

Abstract: Background Complicated skin and soft tissue infections (cSSTIs) occur frequently, but limited data do not allow any consensus on an optimal treatment strategy. We designed this prospective, multicenter, observational study to to explore the current epidemiology, treatment, and resulting clinical outcomes of cSSTIs to help develop strategies to potentially improve outcomes.

Pharmacokinetics of oseltamivir and oseltamivir carboxylate in critically ill patients receiving continuous venovenous hemodialysis and/or extracorporeal membrane oxygenation.

Abstract: tudy Objective To investigate oseltamivir and oseltamivir carboxylate pharmacokinetics in critically ill patients who were receiving continuous venovenous hemodialysis (CVVHD) and/or extracorporeal membrane oxygenation (ECMO). Design Prospective, open-label, pharmacokinetic study. Setting Intensive care units of an academic medical center. Patients Thirteen critically ill patients aged 13 years or older with suspected or confirmed H1N1 influenza who had a prescription for oseltamivir and were concurrently receiving CVVHD and/or ECMO between October 2009 and January 2010. Intervention Oseltamivir 150 mg was administered nasogastrically or nasoenterically every 12 hours. Blood samples were collected at baseline and at 1, 2, 4, 6, 8, 10, and 12 hours after administration of the fourth oseltamivir dose or subsequent doses. In patients receiving CVVHD, effluent also was collected at the same time points. Urine was collected throughout the 12-hour dosing interval. Measurements and Main Results Eight patients received CVVHD only, four patients received both CVVHD and ECMO, and one patient received ECMO only. Pharmacokinetic parameters for the patient who received only ECMO were not reported. The median maximum plasma concentration and area under the plasma concentration–time curve for the 12-hour dosing interval (AUC0–12) for the remaining 12 patients were 83.4 ng/ml and 216 ng•hour/ml, respectively, for oseltamivir and 2000 ng/ml and 21,500 ng•hour/ml, respectively, for oseltamivir carboxylate. Mean clearance due to CVVHD was 33.8 ml/minute for oseltamivir and 50.2 ml/minute for oseltamivir carboxylate. For patients who received ECMO, no substantial differences between pre- and post-ECMO oxygenator plasma concentrations were found for oseltamivir or oseltamivir carboxylate. Conclusion Although the optimal pharmacokinetic-pharmacodynamic targets for oseltamivir carboxylate remain unclear, in the patients receiving CVVHD with or without ECMO, a regimen of oseltamivir 150 mg every 12 hours yielded a median oseltamivir carboxylate AUC0–12 considerably higher than would be expected in non–critically ill patients receiving the same dosage regimen.

The role and value of surgical critical care, an essential component of Acute Care Surgery, in the Affordable Care Act: a report from the Critical Care Committee and Board of Managers of the American Association for the Surgery of Trauma.

Abstract: Heidi L. Frankel, MD, Karyn L. Butler, MD, Joseph Cuschieri, MD, Randall S. Friese, MD, Toan Huynh, MD, Alicia M. Mohr, MD, Miren A. Schinco, MD, Lena M. Napolitano, MD, L.D. Britt, MD, MPH, Raul Coimbra, MD, PhD, Martin A. Croce, MD, James W. Davis, MD, Gregory J. Jurkovich, MD, Ernest E. Moore, MD, John A. Morris, Jr., MD, Andrew B. Peitzman, MD, Basil A. Pruitt, MD, Grace S. Rozycki, MD, MBA, Thomas M. Scalea, MD, and J. Wayne Meredith, MD, Baltimore, Maryland

Will they fit? Development of a measurement device to assess body habitus compatibility with MRI bore diameter for emergency trauma imaging

Abstract: Excessive obesity poses a significant limitation to radiographic magnetic resonance imaging (MRI), particularly related to aperture or bore diameter due to the patient’s girth. Determination of whether a patient will fit into the bore of the MRI scanner is currently accomplished using patient height, weight, and MRI technician experience. These simple methods have proven unreliable. We sought to develop a device and method which could accurately determine whether a patient would fit into the MRI scanner. We developed an MRI template prototype which was tested against the standard radiology methods in a pilot study (n = 6). We then performed a prospective validation study in adult human volunteers (n = 100) to assess the accuracy of the MRI template. We collected height, weight, shoulder and pelvis girth/diameter for each study participant to evaluate the body dimension measurements that would assist in determination of whether a patient would fit into the MRI scanner. Using the MRI template, we determined that 11 of the 100 study participants would not fit in the MRI scanner and 10 were confirmed to not fit into the MRI aperture [positive predictive value (PPV) 0.91 (0.58–0.99); negative predictive value (NPV) 1.00 (0.95–1.00), sensitivity 1.00 (0.69–1.00), specificity 0.99 (0.93–0.99), likelihood ratio positive test 90 (12.81–632), likelihood ratio negative test 0, accuracy 99%]. In comparison, the body measurement method did not perform as well [PPV 0.66 (0.34–0.90), NPV 0.97 (0.92–0.99), sensitivity 0.80 (0.44–0.97), specificity 0.95 (0.89–0.98), likelihood ratio positive test 17.97 (6.56–49.2), likelihood ratio negative test 0.209 (0.06–0.72), accuracy 94%]. This study confirmed that the use of an MRI template is an accurate tool in determining whether an obese patient can fit through the MRI bore and be accommodated in the MRI scanner.

Guideline compliance in trauma: evidence-based protocols to improve trauma outcomes?*.

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Inferior vena cava filter placement before ECMO decannulation.

Abstract: Venous thromboembolism (VTE), particularly thrombi in the inferior vena cava (IVC) and pulmonary embolism, can occur after successful extracorporeal membrane oxygenation (ECMO) and can be associated with adverse outcomes including death. VTE is related to the presence of a venous cannula and in some cases inadequate anticoagulation caused by clinical bleeding. We have developed a simple method for guidewire exchange of the femoral venous ECMO cannula to a working catheter for intravascular ultrasound (IVUS) IVC filter placement, and describe the specific methodology.