Abbreviations: (ICU) intensive care unit, (PE) polyethylene, (TGC) tight glycemic controlKeywords: blood glucose, critically ill, insulin, tight glycemic control We aimed to explore the impact of insulin adsorption onto infusion sets in the laboratory and to assess retrospectively if higher insulin doses are required after syringe changes in practice in the ICU. �dsorption is reported to occur �dsorption is reported to occur predominantly during the first hour of infusion, after which binding sites are saturated. 5 There is greater insulin recovery with faster flow rates and higher insulin concentration. 6 The clinical significance of such adsorption in the ICU setting is uncertain. 5In our study-approved by the local ethics committee-adsorption of insulin onto the giving sets used in our adult of insulin onto the giving sets used in our adult ICU was analyzed. The infusion set used was a 5�� ml polypropylene syringe (BD PlastipakThe infusion set used was a 5�� ml polypropylene syringe (BD Plastipak ® ) and 1.6 ml/2���� cm polyethylene (PE) tubing (Cardinal Health, extension set). In the laboratory, the concentration investigated was 1 U/ml (PE) tubing (Cardinal Health, extension set). In the laboratory, the concentration investigated was 1 U/ml In the laboratory, the concentration investigated was 1 U/ml of neutral insulin in sodium chloride ��.9%. The concentrations were determined using a high�performance liquidThe concentrations were determined using a high�performance liquid high�performance liquid chromatography method with a Jupitor 3����, 5 method with a Jupitor 3����, 5 with a Jupitor 3����, 5 μm C18, 25�� mm x 4.6 mm column (Phenomenex), a mobile phase of ), a mobile phase of , a mobile phase of 30% acetonitrile and 0.1% TFA in water, and ultraviolet detection at �10 nm. �ignificant insulin adsorption of 10% ultraviolet detection at �10 nm. �ignificant insulin adsorption of 10% �ignificant insulin adsorption of 10% �ignificant insulin adsorption of 10% occurred during the first hour of an infusion when the infusion rate was 1 ml�h ( of an infusion when the infusion rate was 1 ml/h ( of an infusion when the infusion rate was 1 ml/h (Figure 1). Our experience suggests that this is a common infusion rate used in intensive insulin therapy. �o significant adsorption occurred when the infusion �o significant adsorption occurred when the infusion rate was 4 ml/h, although a trend could be seen with solution leaving the PE tubing at the beginning of the time period having a lower insulin concentration, which increased with time.The infusion rates used before and after an infusion set change were investigated for 1�� ICU patients known to were investigated for 1�� ICU patients known to have been managed with a TGC protocol, aiming for glycemia of 4.4-6.1 mmol/liter, to examine any relationship between the duration of usage of the infusion set and the variation in insulin dosing required. These patients were . These patients were not prescribed drugs known to affect glucose control, such as inotropes and corti...
Advance Access published on July 17 8. No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19 2020. Available from: https:// www.recoverytrial.net/news/statement-from-the-chiefinvestigators-of-the-randomised-evaluation-of-covid-19therapy-recovery-trial-on-hydroxychloroquine-5-june-2020-no-clinical-benefit-from-use-of-hydroxychloroquine-in-hospitalised-patients-with-covid-19. [Accessed 17 May 2020] 9. Baum A, Schwartz MD. Admissions to Veterans Affairs hospitals for emergency conditions during the COVID-19 pandemic. JAMA 2020; 324: 96e9 10. Quilter-Pinner H. The hidden cost of Covid-19 on the NHSand how to 'build back better' 2020.
IntroductionHealthcare-associated infections (HCAIs) are a major cause of morbidity and mortality in critically ill children. In critically ill adults, there are data that suggest the use of Selective Decontamination of the Digestive tract (SDD), alongside standard infection control measures reduce mortality and the incidence of HCAIs. SDD-enhanced infection control has not been compared directly with standard infection prevention strategies in the Paediatric Intensive Care Unit (PICU) population. The aim of this pilot study is to determine the feasibility of conducting a multicentre cluster randomised controlled trial (cRCT) in critically ill children comparing SDD with standard infection control.Methods and analysisPaediatric Intensive Care and Infection Control is a parallel group pilot cRCT, with integrated mixed-methods study, comparing incorporation of SDD into infection control procedures to standard care. After a 1-week pretrial ecology surveillance period, recruitment to the cRCT will run for a period of 18 weeks, comprising: (1) baseline control period (2) pre, mid and post-trial ecology surveillance periods and (3) intervention period. Six PICUs (in England, UK) will begin with usual care in period 1, then will be randomised 1:1 by the trial statistician using computer-based randomisation, to either continue to deliver usual care or commence delivery of the intervention (SDD) in period 2. Outcomes measures include parent and healthcare professionals’ views on trial feasibility, adherence to the SDD intervention, estimation of recruitment rate and understanding of potential patient-centred primary and secondary outcome measures for the definitive trial. The planned recruitment for the cRCT is 324 participants.Ethics and disseminationThe trial received favourable ethical opinion from West Midlands—Black Country Research Ethics Committee (reference: 20/WM/0061) and approval from the Health Research Authority (IRAS number: 239324). Informed consent is not required for SDD intervention or anonymised data collection but is sought for investigations as part of the study, any identifiable data collected and monitoring of medical records. Results will be disseminated via publications in peer-reviewed medical journals.Trial registration numberISRCTN40310490.
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