Interpretation: Our data suggest that the reduction of provider fatigue and production of pediatric-strength solutions or industry-prepared infusions may reduce medication errors. AbstractFrom the Department of Critical
A regimen of gentamicin 6 mg/kg IV every 24 hours for Pediatric Intensive Care Unit/Cardiac Critical Care Unit patients at SickKids weighing ≥5 kg with SCr <20% above age-specific upper normal limit before initiation of gentamicin is proposed.
SUMMARYThe results obtained by an enzyme multiplied immunoassay kit, EMIT, for the measurement of serum digoxin concentration were compared with those from two radioimmunoassay kit methods, Immophase and Dac-Cel, Patients' sera were used to study the correlation between the methods, and three quality control sera with low, intermediate, and high digoxin concentrations were used to study individual method precision. The coefficients of correlation between the three methods varied between 0·915 and 0·951 for serum drug concentrations up to 4·5 nmol/l, There were statistically significant differences between the means of the patients' samples for each method. Precision was acceptable for each method: within-batch percentage coefficient of variation (%CV) < 8, between-batch % CV < 10, except for Dac-Cel at low concentration % CV = 18·6.The time taken for the analysis of a batch of 10 samples was between 1· 5 and 2 hours, depending on the method. Material and methodsimmunoassay in which the enzyme label is glucose-6-phosphate dehydrogenase.A recent interlaboratory study of digoxin analysis by Fast et al. 3 attempted to determine the current quality of digoxin assays in a sample of laboratories in the United States of America. This survey, however, did not mention SYVA EMIT or Wellcome Dac-Cel kits. We have therefore compared within our laboratory (1) the Dac-Cel and EMIT techniques with the established Immophase method in order to assess their suitability for routine and emergency use; and (2) an enzyme immunoassay (EMIT) with the two radioimmunoassays to assess comparability between the different assay principles.
Background: Optimal dose adjustment of milrinone in critically ill children is challenging because of conflicting information about the association between dose and outcomes in this age group.Objectives: To describe the use of milrinone in critically ill children and to explore associations between milrinone dosing and clinical outcomes, specifically effectiveness and adverse events.Methods: This retrospective cohort study was performed in a consecutive sample of children admitted to a university-affiliated critical care unit (January to June 2004). The relations between milrinone dosing and its effectiveness (based on prevention of low cardiac output syndrome, defined as a difference in oxygen saturation between arterial and mixed venous blood of at least 30% or an increase in serum lactate > 2 mmol/L) and its adverse effects (thrombocytopenia, arrhythmia) were evaluated by logistic regression.Results: A total of 197 children from 213 admissions (ranging in age from newborn to 18 years) were included in the study. Milrinone was initiated with a median loading dose of 99.2 µg/kg (range 22.1-162.2 µg/kg). The initial loading dose was higher if given in the operating room rather than the Critical Care Unit (median 99.7 versus 51.0 µg/kg; p < 0.001). Subsequent loading doses, for patients who received them, were lower (median 49 µg/kg). Milrinone was infused at a median rate of 0.64 µg/kg per minute (range 0.13-2.08 µg/kg per minute) for a median of 43.1 h. There was no relation between serum creatinine level and the maintenance dose of milrinone (r 2 ≤ 0.0335). Low cardiac output syndrome was relatively frequent (166 [77.9%] of the 213 admissions). There was a trend for occurrence of this syndrome in patients with greater average milrinone dose rate (odds ratio [OR] 8.21, 95% confidence interval [CI] 0.98-69.15, p = 0.053) and with longer duration of milrinone therapy (OR 1.01, 95% CI 1.01-1.02, p < 0.05). Adverse events were relatively frequent (thrombocytopenia for 27 admissions [12.7%], arrhythmia for 82 admissions [38.5%]) but were not significantly associated with milrinone dosing. Conclusions:A retrospective evaluation of milrinone use in critically ill children revealed variable utilization and frequent occurrence of both low cardiac output syndrome and adverse events. Further prospective research is needed to understand the impact of individual pharmacokinetic differences on pharmacodynamic responses, to guide optimal dose adjustment, improve outcomes, and minimize toxic effects.
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