The Experts below are selected from a list of 210 Experts worldwide ranked by ideXlab platform
Bertrand Décaudin - One of the best experts on this subject based on the ideXlab platform.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review
European Journal of Clinical Pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Purpose Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients’ venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. Methods This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. Results All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Conclusion Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review.
European journal of clinical pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients' venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Clinical implications of intravenous Drug incompatibilities in critically ill patients.
Anaesthesia critical care & pain medicine, 2018Co-Authors: Malik Benlabed, Christine Barthélémy, Gilles Lebuffe, Pascal Odou, Stéphanie Genay, Maxime Perez, Romain Gaudy, Damien Lannoy, Bertrand DécaudinAbstract:Abstract Objective The aim of this review is to analyse the clinical consequences of intravenous Drug incompatibilities in critically ill patients, especially the incidence of organ dysfunctions and mortality. Methods A review of literature was conducted according to the PRISMA statement in June 2017, using Medline, ISI Web of Science and Clinicaltrials.gov. Data extraction Eligible studies were case reports and randomised controlled trials (RCTs) that assessed the effects of Drug incompatibilities in critically ill patients on morbidity or mortality as primary or secondary outcomes, or adverse events. Two investigators independently reviewed the eligibility of the study from abstracts or manuscript data. Data synthesis Twelve articles met the selection criteria. The six articles reporting RCTs concern only four RCTs. RCTs were single-centre studies comparing infusion with or without filter. One of them included adult patients. The others included paediatric and neonatal intensive care unit patients. Primary endpoints were SIRS, organ failure, overall complication rate, bacteraemia, sepsis, phlebitis and length of stay. The results are mixed with one RCT reporting a reduction in SIRS, organ failure and overall complication rate, two studies in disagreement over the occurrence of sepsis and one study reporting no impact on length of hospital stay. The six articles on case reports show different Drug Incompatibility situations. They report pulmonary toxicity. Conclusion Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to Drug incompatibilities and clinical implication.
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Endothelial cell toxicity of vancomycin infusion combined with other antibiotics
Antimicrobial Agents and Chemotherapy, 2015Co-Authors: Maryline Drouet, Bertrand Décaudin, Catherine Barthélémy, Gilles Lebuffe, Bertrand Debaene, Feng Chai, Pascal OdouAbstract:French guidelines recommend central intravenous (i.v.) infusion for high concentrations of vancomycin, but peripheral intravenous (p.i.v.) infusion is often preferred in intensive care units. Vancomycin infusion has been implicated in cases of phlebitis, with endothelial toxicity depending on the Drug concentration and the duration of the infusion. Vancomycin is frequently infused in combination with other i.v. antibiotics through the same administrative Y site, but the local toxicity of such combinations has been poorly evaluated. Such an assessment could improve vancomycin infusion procedures in hospitals. Human umbilical vein endothelial cells (HUVEC) were challenged with clinical doses of vancomycin over 24 h with or without other i.v. antibiotics. Cell death was measured with the alamarBlue test. We observed an excess cellular death rate without any synergistic effect but dependent on the numbers of combined infusions when vancomycin and erythromycin or gentamicin were infused through the same Y site. Incompatibility between vancomycin and piperacillin-tazobactam was not observed in our study, and rinsing the cells between the two antibiotic infusions did not reduce endothelial toxicity. No endothelial toxicity of imipenem-cilastatin was observed when combined with vancomycin. p.i.v. vancomycin infusion in combination with other medications requires new recommendations to prevent phlebitis, including limiting coinfusion on the same line, reducing the infusion rate, and choosing an intermittent infusion method. Further studies need to be carried out to explore other Drug combinations in long-term vancomycin p.i.v. therapy so as to gain insight into the mechanisms of Drug Incompatibility under multiDrug infusion conditions.
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OHP-046 Impact of Multi-Lumen Infusion Devices on the Occurrence of Physical Drug Incompatibilities: A Controlled in Vitro Study
European Journal of Hospital Pharmacy, 2013Co-Authors: Maxime Perez, Bertrand Décaudin, Aurélie Foinard, Christine Barthélémy, Bertrand Debaene, Pascal OdouAbstract:Background Drug Incompatibility is a problem when managing patients in intensive care units. Patients receive many Drugs simultaneously but through limited venous accesses. The recent marketing of new multi-lumen infusion access device may open the way to preventing Incompatibility. Purpose To evaluate the impact of multi-lumen infusion access devices connected to single-lumen central venous catheters on the occurrence of known Drug incompatibilities through a controlled in vitro study. Materials and Methods Two infusion devices were studied: 1) a standard set with six-gang-manifolds and its extension line and 2) a multi-lumen infusion access device with nine lumens (Edelvaiss-Multiline, Doran International, France). Six Drugs were selected: three basic Drugs (furosemide, pantoprazole and amoxicillin/clavulanic acid) and three acid Drugs (amiodarone, dobutamine and midazolam). Two, four or six Drugs and an infusion vehicle (saline, Ringer’s or 5% glucose) were infused simultaneously. The infusion rate of the vehicle was initially set at 100 mL/h and decreased stepwise by 10 mL/h until precipitate formation occurred. Physical Incompatibility was assessed by visual inspection and sub-visible particle count test as defined by the European Pharmacopeia according to the European Pharmacopeia. The lowest value of the vehicle infusion rate that satisfied the two tests was reported for each infusion set and for each Drug combination. Results The use of multiline access devices contributed to preventing Drug incompatibilities when simultaneously infusing two and four Drugs. Indeed, infusion vehicle flow rate gains oscillated between 10 and 40 mL per hour, in more than 55% and 25% of cases, respectively for two and four Drugs. When infusing six Drugs simultaneously, no differences were identified. Conclusions Our main hypothesis is that fluid dynamics differ depending on the infusion device resulting in differences in the contact time between Drugs. Under specified infusion conditions, the nine-lumen device prevents physical Drug incompatibilities. No conflict of interest.
Pascal Odou - One of the best experts on this subject based on the ideXlab platform.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review
European Journal of Clinical Pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Purpose Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients’ venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. Methods This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. Results All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Conclusion Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review.
European journal of clinical pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients' venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Clinical implications of intravenous Drug incompatibilities in critically ill patients.
Anaesthesia critical care & pain medicine, 2018Co-Authors: Malik Benlabed, Christine Barthélémy, Gilles Lebuffe, Pascal Odou, Stéphanie Genay, Maxime Perez, Romain Gaudy, Damien Lannoy, Bertrand DécaudinAbstract:Abstract Objective The aim of this review is to analyse the clinical consequences of intravenous Drug incompatibilities in critically ill patients, especially the incidence of organ dysfunctions and mortality. Methods A review of literature was conducted according to the PRISMA statement in June 2017, using Medline, ISI Web of Science and Clinicaltrials.gov. Data extraction Eligible studies were case reports and randomised controlled trials (RCTs) that assessed the effects of Drug incompatibilities in critically ill patients on morbidity or mortality as primary or secondary outcomes, or adverse events. Two investigators independently reviewed the eligibility of the study from abstracts or manuscript data. Data synthesis Twelve articles met the selection criteria. The six articles reporting RCTs concern only four RCTs. RCTs were single-centre studies comparing infusion with or without filter. One of them included adult patients. The others included paediatric and neonatal intensive care unit patients. Primary endpoints were SIRS, organ failure, overall complication rate, bacteraemia, sepsis, phlebitis and length of stay. The results are mixed with one RCT reporting a reduction in SIRS, organ failure and overall complication rate, two studies in disagreement over the occurrence of sepsis and one study reporting no impact on length of hospital stay. The six articles on case reports show different Drug Incompatibility situations. They report pulmonary toxicity. Conclusion Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to Drug incompatibilities and clinical implication.
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Endothelial cell toxicity of vancomycin infusion combined with other antibiotics
Antimicrobial Agents and Chemotherapy, 2015Co-Authors: Maryline Drouet, Bertrand Décaudin, Catherine Barthélémy, Gilles Lebuffe, Bertrand Debaene, Feng Chai, Pascal OdouAbstract:French guidelines recommend central intravenous (i.v.) infusion for high concentrations of vancomycin, but peripheral intravenous (p.i.v.) infusion is often preferred in intensive care units. Vancomycin infusion has been implicated in cases of phlebitis, with endothelial toxicity depending on the Drug concentration and the duration of the infusion. Vancomycin is frequently infused in combination with other i.v. antibiotics through the same administrative Y site, but the local toxicity of such combinations has been poorly evaluated. Such an assessment could improve vancomycin infusion procedures in hospitals. Human umbilical vein endothelial cells (HUVEC) were challenged with clinical doses of vancomycin over 24 h with or without other i.v. antibiotics. Cell death was measured with the alamarBlue test. We observed an excess cellular death rate without any synergistic effect but dependent on the numbers of combined infusions when vancomycin and erythromycin or gentamicin were infused through the same Y site. Incompatibility between vancomycin and piperacillin-tazobactam was not observed in our study, and rinsing the cells between the two antibiotic infusions did not reduce endothelial toxicity. No endothelial toxicity of imipenem-cilastatin was observed when combined with vancomycin. p.i.v. vancomycin infusion in combination with other medications requires new recommendations to prevent phlebitis, including limiting coinfusion on the same line, reducing the infusion rate, and choosing an intermittent infusion method. Further studies need to be carried out to explore other Drug combinations in long-term vancomycin p.i.v. therapy so as to gain insight into the mechanisms of Drug Incompatibility under multiDrug infusion conditions.
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OHP-046 Impact of Multi-Lumen Infusion Devices on the Occurrence of Physical Drug Incompatibilities: A Controlled in Vitro Study
European Journal of Hospital Pharmacy, 2013Co-Authors: Maxime Perez, Bertrand Décaudin, Aurélie Foinard, Christine Barthélémy, Bertrand Debaene, Pascal OdouAbstract:Background Drug Incompatibility is a problem when managing patients in intensive care units. Patients receive many Drugs simultaneously but through limited venous accesses. The recent marketing of new multi-lumen infusion access device may open the way to preventing Incompatibility. Purpose To evaluate the impact of multi-lumen infusion access devices connected to single-lumen central venous catheters on the occurrence of known Drug incompatibilities through a controlled in vitro study. Materials and Methods Two infusion devices were studied: 1) a standard set with six-gang-manifolds and its extension line and 2) a multi-lumen infusion access device with nine lumens (Edelvaiss-Multiline, Doran International, France). Six Drugs were selected: three basic Drugs (furosemide, pantoprazole and amoxicillin/clavulanic acid) and three acid Drugs (amiodarone, dobutamine and midazolam). Two, four or six Drugs and an infusion vehicle (saline, Ringer’s or 5% glucose) were infused simultaneously. The infusion rate of the vehicle was initially set at 100 mL/h and decreased stepwise by 10 mL/h until precipitate formation occurred. Physical Incompatibility was assessed by visual inspection and sub-visible particle count test as defined by the European Pharmacopeia according to the European Pharmacopeia. The lowest value of the vehicle infusion rate that satisfied the two tests was reported for each infusion set and for each Drug combination. Results The use of multiline access devices contributed to preventing Drug incompatibilities when simultaneously infusing two and four Drugs. Indeed, infusion vehicle flow rate gains oscillated between 10 and 40 mL per hour, in more than 55% and 25% of cases, respectively for two and four Drugs. When infusing six Drugs simultaneously, no differences were identified. Conclusions Our main hypothesis is that fluid dynamics differ depending on the infusion device resulting in differences in the contact time between Drugs. Under specified infusion conditions, the nine-lumen device prevents physical Drug incompatibilities. No conflict of interest.
Gilles Lebuffe - One of the best experts on this subject based on the ideXlab platform.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review.
European journal of clinical pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients' venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review
European Journal of Clinical Pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Purpose Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients’ venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. Methods This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. Results All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Conclusion Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Clinical implications of intravenous Drug incompatibilities in critically ill patients.
Anaesthesia critical care & pain medicine, 2018Co-Authors: Malik Benlabed, Christine Barthélémy, Gilles Lebuffe, Pascal Odou, Stéphanie Genay, Maxime Perez, Romain Gaudy, Damien Lannoy, Bertrand DécaudinAbstract:Abstract Objective The aim of this review is to analyse the clinical consequences of intravenous Drug incompatibilities in critically ill patients, especially the incidence of organ dysfunctions and mortality. Methods A review of literature was conducted according to the PRISMA statement in June 2017, using Medline, ISI Web of Science and Clinicaltrials.gov. Data extraction Eligible studies were case reports and randomised controlled trials (RCTs) that assessed the effects of Drug incompatibilities in critically ill patients on morbidity or mortality as primary or secondary outcomes, or adverse events. Two investigators independently reviewed the eligibility of the study from abstracts or manuscript data. Data synthesis Twelve articles met the selection criteria. The six articles reporting RCTs concern only four RCTs. RCTs were single-centre studies comparing infusion with or without filter. One of them included adult patients. The others included paediatric and neonatal intensive care unit patients. Primary endpoints were SIRS, organ failure, overall complication rate, bacteraemia, sepsis, phlebitis and length of stay. The results are mixed with one RCT reporting a reduction in SIRS, organ failure and overall complication rate, two studies in disagreement over the occurrence of sepsis and one study reporting no impact on length of hospital stay. The six articles on case reports show different Drug Incompatibility situations. They report pulmonary toxicity. Conclusion Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to Drug incompatibilities and clinical implication.
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Endothelial cell toxicity of vancomycin infusion combined with other antibiotics
Antimicrobial Agents and Chemotherapy, 2015Co-Authors: Maryline Drouet, Bertrand Décaudin, Catherine Barthélémy, Gilles Lebuffe, Bertrand Debaene, Feng Chai, Pascal OdouAbstract:French guidelines recommend central intravenous (i.v.) infusion for high concentrations of vancomycin, but peripheral intravenous (p.i.v.) infusion is often preferred in intensive care units. Vancomycin infusion has been implicated in cases of phlebitis, with endothelial toxicity depending on the Drug concentration and the duration of the infusion. Vancomycin is frequently infused in combination with other i.v. antibiotics through the same administrative Y site, but the local toxicity of such combinations has been poorly evaluated. Such an assessment could improve vancomycin infusion procedures in hospitals. Human umbilical vein endothelial cells (HUVEC) were challenged with clinical doses of vancomycin over 24 h with or without other i.v. antibiotics. Cell death was measured with the alamarBlue test. We observed an excess cellular death rate without any synergistic effect but dependent on the numbers of combined infusions when vancomycin and erythromycin or gentamicin were infused through the same Y site. Incompatibility between vancomycin and piperacillin-tazobactam was not observed in our study, and rinsing the cells between the two antibiotic infusions did not reduce endothelial toxicity. No endothelial toxicity of imipenem-cilastatin was observed when combined with vancomycin. p.i.v. vancomycin infusion in combination with other medications requires new recommendations to prevent phlebitis, including limiting coinfusion on the same line, reducing the infusion rate, and choosing an intermittent infusion method. Further studies need to be carried out to explore other Drug combinations in long-term vancomycin p.i.v. therapy so as to gain insight into the mechanisms of Drug Incompatibility under multiDrug infusion conditions.
Laura Négrier - One of the best experts on this subject based on the ideXlab platform.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review
European Journal of Clinical Pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Purpose Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients’ venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. Methods This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. Results All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Conclusion Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review.
European journal of clinical pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients' venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
Stéphanie Genay - One of the best experts on this subject based on the ideXlab platform.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review
European Journal of Clinical Pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Purpose Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients’ venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. Methods This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. Results All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Conclusion Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Strategies to prevent Drug Incompatibility during simultaneous multi-Drug infusion in intensive care units: a literature review.
European journal of clinical pharmacology, 2021Co-Authors: Laura Négrier, Gilles Lebuffe, Pascal Odou, Anthony Martin Mena, Stéphanie Genay, Bertrand DécaudinAbstract:Drug protocols in intensive care units may require the concomitant administration of many Drugs as patients' venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible Drugs. Incompatibilities can lead to the formation of particles and inactivation of Drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, Incompatibility tables and databases, and the use of standard operating procedures. Although many strategies have been developed in recent years to address Drug Incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
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Clinical implications of intravenous Drug incompatibilities in critically ill patients.
Anaesthesia critical care & pain medicine, 2018Co-Authors: Malik Benlabed, Christine Barthélémy, Gilles Lebuffe, Pascal Odou, Stéphanie Genay, Maxime Perez, Romain Gaudy, Damien Lannoy, Bertrand DécaudinAbstract:Abstract Objective The aim of this review is to analyse the clinical consequences of intravenous Drug incompatibilities in critically ill patients, especially the incidence of organ dysfunctions and mortality. Methods A review of literature was conducted according to the PRISMA statement in June 2017, using Medline, ISI Web of Science and Clinicaltrials.gov. Data extraction Eligible studies were case reports and randomised controlled trials (RCTs) that assessed the effects of Drug incompatibilities in critically ill patients on morbidity or mortality as primary or secondary outcomes, or adverse events. Two investigators independently reviewed the eligibility of the study from abstracts or manuscript data. Data synthesis Twelve articles met the selection criteria. The six articles reporting RCTs concern only four RCTs. RCTs were single-centre studies comparing infusion with or without filter. One of them included adult patients. The others included paediatric and neonatal intensive care unit patients. Primary endpoints were SIRS, organ failure, overall complication rate, bacteraemia, sepsis, phlebitis and length of stay. The results are mixed with one RCT reporting a reduction in SIRS, organ failure and overall complication rate, two studies in disagreement over the occurrence of sepsis and one study reporting no impact on length of hospital stay. The six articles on case reports show different Drug Incompatibility situations. They report pulmonary toxicity. Conclusion Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to Drug incompatibilities and clinical implication.
