Internal medicine patients are frequently prescribed PIMs. PIM-Check's PIM detection rate was three times higher than STOPP/START's, and its screening time was shorter thanks to its electronic interface. Nearly half of the PIMs detected were judged to be non-clinically relevant, however, potentially overalerting the prescriber. These tools can, nevertheless, be considered useful in daily practice. Furthermore, the relevance of any PIM detected by these tools should always be carefully evaluated within the clinical context surrounding the individual patient.
COVID-19 patients often present with rapidly progressing acute hypoxemic respiratory failure, requiring orotracheal intubation with different prognostic issues. However, ICU specialists lack predictive tools to stratify these patients. We conducted a single-center cross-sectional retrospective study to evaluate if the ROX index, measured under non-invasive oxygenation support, can predict ICU mortality in a COVID-19 intubated patient cohort. This study took place in the division of intensive care at the Geneva University Hospitals (Geneva, Switzerland). We included all consecutive adult patients treated by non-invasive oxygenation support and requiring intubation for acute respiratory failure due to COVID-19 between 9 September 2020 and 30 March 2021, corresponding to the second local surge of COVID-19 cases. Baseline demographic data, comorbidities, median ROX between H0 and H8, and clinical outcomes were collected. Overall, 82 patients were intubated after failing a non-invasive oxygenation procedure. Women represented 25.6% of the whole cohort. Median age and median BMI were 70 (60–75) years and 28 (25–33), respectively. Before intubation, the median ROX between H0 and H8 was 6.3 (5.0–8.2). In a multivariate analysis, the median ROX H0–H8 was associated with ICU mortality as a protective factor with an odds ratio (95% CI) = 0.77 (0.60–0.99); p < 0.05. In intubated COVID-19 patients treated initially by non-invasive oxygenation support for acute respiratory failure, the median ROX H0–H8 could be an interesting predictive factor associated with ICU mortality.
Lung ultrasonography (LUS) is an accurate method of estimating lung congestion but there is ongoing debate on the optimal number of scanning points. The aim of the present study was to compare the reproducibility (i.e. interobserver agreement) and the feasibility (i.e. time consumption) of the two most practiced protocols in patients hospitalized for acute heart failure (AHF). This prospective trial compared 8- and 28-point LUS protocols. Both were performed by an expert–novice pair of sonographers at admission and after 4 to 6 days on patients admitted for AHF. A structured bio-clinical evaluation was simultaneously carried out by the treating physician. The primary outcome was expert-novice interobserver agreement estimated by kappa statistics. Secondary outcomes included time spent on image acquisition and interpretation. During the study period, 43 patients underwent a total of 319 LUS exams. Expert–novice interobserver agreement was moderate at admission and substantial at follow-up for 8-point protocol (weighted kappa of 0.54 and 0.62, respectively) with no significant difference for 28-point protocol (weighted kappa of 0.51 and 0.41; P value for comparison 0.74 at admission and 0.13 at follow-up). The 8-point protocol required significantly less time for image acquisition at admission (mean time difference − 3.6 min for experts, − 5.1 min for novices) and interpretation (− 6.0 min for experts and − 6.3 min for novices; P value < 0.001 for all time comparisons). Similar differences were observed at follow-up. In conclusion, an 8-point LUS protocol was shown to be timesaving with similar reproducibility when compared with a 28-point protocol. It should be preferred for evaluating lung congestion in AHF inpatients.
Magnesiocard® (formes orales)C: Magnesii aspartatis hydrochloridum trihydricum. I: Carence en magnésium, troubles du rythme cardiaque, besoins accrus liés à la pratique sportive de haut niveau et pendant la grossesse, éclampsie et pré-éclampsie, tétanie, crampes dans les mollets, myoclonies, jambes sans repos (restless legs). P: De 4.5 mg (= 0.185 mmol) à 9 mg (= 0.37 mmol) de magnésium par kg de poids corporel / 10 -20 mmol de magnésium par jour, en 1 -3 prises orales selon la forme d'administration (granulés, comprimés effervescents, comprimés pelliculés). CI: Hypersensibilité à l'un des composants du médicament. P: Insuffisance rénale. Il est indispensable de surveiller la concentration sérique de magnésium chez les insuffisants rénaux. Magnesiocard 7.5 mmol: ne pas utiliser en cas de phénylcétonurie. IA: Les tétracyclines et Magnesiocard devraient être pris à 3 -4 heures d'intervalle (inhibition mutuelle au niveau de l'absorption). Tendance à l'hypercalcémie lors de l'administration concomitante de magnésium et de cholécalciférol. G/A: Peut être administré. EI: Occasionnellement: troubles gastro-intestinaux. E: Comprimés pelliculés (2.5 mmol) 50, 100; granulés (5 mmol) citron et granulés (5 mmol) orange 20*, 50*; comprimés effervescents (7.5 mmol) 20*, 60*; granulés (10 mmol) grapefruit et granulés (10 mmol) orange 20*, 50*. Cat. B. Pour des informations détaillées, voir www.swissmedicinfo.ch. *admis par les caisses-maladie V030820 Références: 1: www.swissmedicinfo.ch, consulté le 15.10.2020.
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