A comparison of critical care research funding and the financial burden of critical illness in the United States*

Coopersmith, Craig M.; Wunsch, Hannah; Fink, Mitchell P.; Linde-Zwirble, Walter T.; Olsen, Keith M.; Sommers, Marilyn S.; Anand, K.J.S.; Tchorz, Kathryn M.; Angus, Derek C.; Deutschman, Clifford S.

doi:10.1097/ccm.0b013e31823c8d03

Cited by 124 publications

(78 citation statements)

References 22 publications

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“…Despite progress in antibiotic therapy, ventilator management, resuscitative strategies, and blood glucose maintenance, severe sepsis remains the leading cause of death in the intensive care unit (ICU) (3). Even more alarming is the escalating cost of sepsisassociated medical care, which is estimated at $17 billion annually in the United States (4). Given the expanding elderly population with immune senescence (5), overall sepsis mortality is expected to grow at an alarming rate during the next two decades (6).…”

Section: Introductionmentioning

confidence: 99%

Sepsis-induced immune dysfunction: can immune therapies reduce mortality?

Delano¹,

Ward²

2016

Journal of Clinical Investigation

502

472

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Sepsis affects the immune system by directly altering the lifespan, production, and function of the effector cells responsible for Sepsis is a systemic inflammatory response induced by an infection, leading to organ dysfunction and mortality. Historically, sepsis-induced organ dysfunction and lethality were attributed to the interplay between inflammatory and antiinflammatory responses. With advances in intensive care management and goal-directed interventions, early sepsis mortality has diminished, only to surge later after "recovery" from acute events, prompting a search for sepsis-induced alterations in immune function. Sepsis is well known to alter innate and adaptive immune responses for sustained periods after clinical "recovery," with immunosuppression being a prominent example of such alterations. Recent studies have centered on immune-modulatory therapy. These efforts are focused on defining and reversing the persistent immune cell dysfunction that is associated with mortality long after the acute events of sepsis have resolved.

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Section: Introductionmentioning

confidence: 99%

Sepsis-induced immune dysfunction: can immune therapies reduce mortality?

Delano¹,

Ward²

2016

Journal of Clinical Investigation

502

472

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“…Adult critical care services are the most expensive care in the acute care hospital setting being three times more costly than non-critical care areas (Cooper & Linde-Zwirble, 2004). The cost of adult critical care services ranges from $2,000.00 to $3,000.00 daily with up to 38% of total hospital costs spent on critical care services (Coopersmith et al, 2012;Cypress, 2010;Milbrandt, Kersten, & Rahim, 2008). Family-centered care remains a high priority in adult critical care where family is considered client.…”

Section: Background and Significancementioning

confidence: 99%

“…Many individuals over the age of 65 years depend upon Medicare to cover their healthcare costs. The cost of these services is estimated between $121 and $263 billion dollars on an annual basis accounting for 5.2 to 11.2% of national healthcare expenditures (Coopersmith et al, 2012). Adult critical care services are the most expensive care in the acute care hospital setting being three times more costly than non-critical care areas (Cooper & Linde-Zwirble, 2004).…”

Section: Background and Significancementioning

confidence: 99%

The Process of Death Imminence Awareness by Family Members of Patients in Adult Critical Care

Baumhover

2015

Dimensions of Critical Care Nursing

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“…Despite an emerging trend for improved survival in ICU patients [32,[37][38][39], the mortality rate in critically ill patients remains unacceptably high worldwide, ranging from 30-50% in severe sepsis and 40-87% in patients with septic shock [37,[40][41][42][43][44][45]. As a consequence, huge hospital resources are spent worldwide on septic patients [46,47].…”

Section: Sepsismentioning

confidence: 99%

“…Despite an emerging trend for improved survival over recent years [29,30,32], the mortality rate in this patient cohort remains unacceptably high worldwide [1]. In the context of the financial burden incurred, the United States itself is currently spending between $121 and $263 billion annually on critically ill patients, which represents more than 8% of the country's total healthcare expenditure [46].…”

Section: Introductionmentioning

confidence: 99%

Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

Abdul‐Aziz¹,

Mohd²

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Severe sepsis is a major burden in the intensive care unit (ICU) with persistently high mortality rates. Optimization of antibiotic dosing has been suggested as an intervention to improve clinical outcomes for critically ill patients with severe sepsis. However, current antibiotic dosing guidelines may not be appropriate for these patients, as they rarely consider the altered physiology and illness severity associated with this population. Optimizing antibiotic dosing using pharmacokinetic (PK) and pharmacodynamic (PD) principles can address these critical illness-related changes and promote therapeutic success. Due to their wide spectrum of antibiotic activity and excellent safety profile, beta-lactam antibiotics are commonly used for severe infections in the ICU. Two alternative dosing approaches to traditional intermittent bolus (IB) dosing, namely continuous infusion (CI) and extended infusion (EI), have been suggested to maximize the therapeutic potential of these antibiotics in critically ill patients. Collectively, the two dosing approaches can also be referred as prolonged infusion (PI).This Thesis aims to better characterize the pharmacokinetics/pharmacodynamics (PK/PD) of betalactam antibiotics to determine whether there is any therapeutic advantage associated with PI dosing (CI and/or EI) as compared to IB dosing. This Thesis comprises of eight chapters. Chapter 1 is an introductory chapter which provides an overview of the published literature on the area of research. The discussion in Chapter 1 presents a theoretical framework behind the Thesis objectives. Chapter 1 concludes with the specific aims of this Thesis.Chapter 2 reports the findings of a prospective PK study which aimed to describe the population PK of doripenem in critically ill patients with sepsis and perform dosing simulations to develop clinically relevant dosing guidelines for these patients. Twelve critically ill participants receiving 500 mg of doripenem 8-hourly as a 1-hr infusion were enrolled. The volume of distribution (Vd) and clearance (CL) of doripenem in this patient cohort were substantially different than those usually described in non-critically patients. As current dosing guidelines were mostly derived from the non-critically ill, findings from this study suggest that the licensed "one-dose-fits-all" dosing for doripenem is unlikely to achieve optimal exposures in critically ill patients. Empirical use of PI dosing should be considered to account for PK and illness severity differences, particularly when less-susceptible pathogens are involved.ii Chapter 3 incorporates a published systematic review which compares the PK/PD data and clinical outcomes between CI and IB dosing to describe any potential merits supporting either of the two dosing approaches for critically ill patients. The findings suggest that beta-lactam CI may not be advantageous for all critically ill patients and may be beneficial in patients with severe infections.Chapter 4 describes the findings of a post hoc analysis on the Defining...

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A comparison of critical care research funding and the financial burden of critical illness in the United States*

Abstract: The proportion of research dollars spent on critical care is lower than the percentage of healthcare expenditures related to critical illness.

Cited by 124 publications

References 22 publications

Sepsis-induced immune dysfunction: can immune therapies reduce mortality?

Sepsis-induced immune dysfunction: can immune therapies reduce mortality?

The Process of Death Imminence Awareness by Family Members of Patients in Adult Critical Care

Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

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