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ABSTRACT Objective: To perform the translation and adaptation of the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) into Brazilian Portuguese. Methods: Methodological study performed in five recommended stages: initial translations; synthesis of the translations; back translations; assessment of the back translations; expert committee assessment. The expert committee was composed of three registered nurses and two doctors who had a Master’s and/or PhD degree, and an expertise in intravenous therapy and pediatric and neonatal care. To assess the semantic, idiomatic, experiential and conceptual adequacy, a Likert scale was applied, in which 1, “not equivalent”; 2, “inequivalent”; 3, “cannot assess”; 4, “quite equivalent”; 5, “totally equivalent”. The terms mostly analyzed as negative in equivalence and with a lower than 20 score were reviewed and submitted to a new assessment, with the Delphi Technique until consensus was obtained. The results were stored in electronic spreadsheets and treated with concordance index, with a minimum acceptable result of 0.80. Results: The content of all recommendations, named as miniMAGIC-Brasil, was validated by the expert committee after two stages of evaluation. All recommendations had an overall agreement index of 0.91. Conclusions: The miniMAGIC-Brazil guide was validated in respect to the adequacy of the translation after two steps.

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Background Establishing intravenous (IV) access is an essential procedure in surgical patients. External jugular vein (EJV) cannulation can be a good alternative for patients for whom it is difficult to establish peripheral IV access. We aimed to investigate the feasibility and safety of EJV cannulation in surgical patients. Methods We performed a retrospective review of EJV cannulation in patients who underwent anesthesia for surgery at a tertiary hospital between 2010 and 2021. We collected clinical characteristics, including EJV cannulation-related variables, from the anesthetic records. We also investigated the EJV cannulation-related complications, which included any EJV cannulation-related complications (insertion site swelling, infection, thrombophlebitis, pneumothorax, and arterial cannulation) within 7 days after surgery, from the electronic medical records during the hospitalization period for surgery. Results We analyzed 9,482 cases of 9,062 patients for whom EJV cannulation was performed during anesthesia. The most commonly performed surgery was general surgery (49.6%), followed by urologic surgery (17.5%) and obstetric and gynecologic surgery (15.7%). Unplanned EJV cannulation was performed emergently during surgery for 878 (9.3%) cases. The only EJV cannulation-related complication was swelling at the EJV-cannula insertion site (65 cases, 0.7%). There was only one case of unplanned intensive care unit admission due to swelling related to EJV cannulation. Conclusions Our study showed the feasibility and safety of EJV cannulation for surgical patients with difficult IV access or those who need additional large-bore IV access during surgery. EJV cannulation can provide safe and reliable IV access with a low risk of major complications in a surgical patient.

Background/Aim. Septic shock (SS) is a complication that can occur as a consequence of an infection. As the effective circulating blood volume is of great importance in these cases, keeping constant track of the blood volume parameter is essential. The aim of this study was to explore the application value of bedside ultrasound for assessing volume responsiveness (VR) in patients with SS. Methods. A total of 102 patients with SS were selected. The volume load (VL) test was performed, and based on the results of the test, the patients were divided into two groups. The first group was the response (R) group, which had an increase in stroke volume (ΔSV) ≥ 15% after the VL test, and the second was the non-response (NR) group, with ΔSV < 15% after the VL test. There were 54 patients in the R group and 48 in the NR group. Hemodynamic parameters were compared before and after the VL test. The correlation between ΔSV and each hemodynamic index was explored by Pearson’s analysis. The receiver operating characteristic (ROC) curves were plotted for some of the parameters. Results. Before the VL test, retro-hepatic (RH) inferior vena cava (IVC) (RHIVC) distensibility (ΔRHIVC1) index, respiratory variation in RHIVC (ΔRHIVC2) index, respiratory variation in aortic (AO) blood flow peak velocity (ΔVpeakAO) index, respiratory variation in brachial artery (BA) blood flow peak velocity (ΔVpeakBA) index, and respiratory variation in common femoral artery (CFA) blood flow peak velocity (ΔVpeakCFA) index were all higher in the R group than those in the NR group (p < 0.05), while heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) were similar in both groups (p > 0.05). After the VL test, the R group had significantly decreased values of HR and the ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA indices, while the MAP and CVP values (p < 0.05) were increased. The NR group had a significantly decreased value of CVP (p < 0.05), while no significant changes were noticed in the values of other indices. The indices ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA significantly correlated with ΔSV (r = 0.589, r = 0.647, r = 0.697, r = 0.621, r = 0.766, respectively; p < 0.05), but there was no correlation between CVP and ΔSV (r = -0.345; p > 0.05). The areas under the curve (AUC) of ROC graphics for ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA indices, used for the prediction of VR, were 0.839, 0.858, 0.878, 0.916, and 0.921, respectively, and were significantly larger than the AUC of ROC graphic for CVP (0.691), indicating higher sensitivity and specificity of the ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA indices compared to CVP. Conclusion. Bedside ultrasound monitoring of the ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA indices can assess the VR in patients with SS more precisely.

Purpose: Urinary tract infection (UTI) is the second most common infectious disease among older adults. It is important that the treatment strategy used for older patients with UTIs in the emergency department (ED) be adequate. The effectiveness of an initial single dose of intravenous antibiotics in the ED for treating UTIs has not been extensively studied. Therefore, we investigated the clinical outcomes of single-dose intravenous antibiotic administration before discharge from the ED in elderly patients with UTIs. Materials and Methods: This retrospective study was conducted among patients who visited two academic tertiary hospitals in Seoul, South Korea. We included all patients older than 65 years of age with UTI who visited the ED and were directly discharged between 1 January and 31 December 2019 (n = 429). The patients were divided into two groups according to whether they received a single dose of intravenous antibiotics before ED discharge. Results: Patients who received intravenous antibiotics had a higher 72-hour revisit rate (43 [15.4%] vs 10 [6.7%], p = .009) and a longer mean duration of therapy (total days of antibiotics use) (11 [4.00 – 15.00] vs 5 [3.00 – 11.00], p < .001) than patients who received only oral antibiotics. However, the rate of admission after revisits did not differ significantly between the groups (27 [62.8%] vs 5 [50.0%], p = .492). Conclusion: Older patients with severe UTIs were prescribed intravenous antibiotics in the ED. Decisions on admission or discharge should be made carefully for older patients with UTIs who are prescribed intravenous antibiotics in the ED. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of peripheral intravenous catheter insertion failure in children with cancer and its association with demographic, clinical, catheterization and previously used intravenous therapy characteristics. Methods: This is a cross-sectional and exploratory study conducted at the pediatric oncology clinic of a public hospital. Data from the observation of 130 peripheral intravenous catheterizations and medical records of children were used. We analyzed the demographic and clinical characteristics of peripheral intravenous catheterization and intravenous therapy used and its relationship with catheterization failure. Poisson regression with robust variance was used to determine the factors associated with the outcome studied, considering p<0.05. Results: The prevalence of failure was 38.5% and was statistically associated with length of stay (PR=1.6; 95%CI 1.05-2.56), previous prolonged intravenous therapy use (PR=2.1; 95%CI % 1.32-3.20), history of extravasation (PR=1.99; 95%CI 1.15-3.28) and child agitation (PR=1.41; 95%CI 1.02-1.94). Conclusion: There was a high prevalence of peripheral intravenous catheterization failure in children with cancer, associated with length of hospitalization greater than or equal to eight days, previous prolonged IVT use, history of extravasation and child agitation during catheter insertion. [ABSTRACT FROM AUTHOR]

Background: Limb-salvage surgery for malignant bone tumors can be associated with considerable perioperative blood loss. The aim of this randomized controlled trial was to assess the safety and efficacy of the intraoperative infusion of tranexamic acid (TXA) in children and adolescents undergoing limb-salvage surgery., Methods: All participants were <18 years of age at the time of surgery and diagnosed with a malignant bone tumor of the femur that was treated with resection and reconstruction with a megaprosthesis. Exclusion criteria included anatomic locations other than the femur, reconstruction with a vascularized fibular graft, and a previous history of deep venous thrombosis, coagulopathy, or renal dysfunction. Participants were randomly allocated to either the TXA group (a preoperative loading dose infusion of 10 mg/kg of TXA followed by a continuous infusion of 5 mg/kg/hr until the end of surgery) or the placebo group (the same dosage but with TXA substituted with an infusion of normal saline solution). Intraoperative and perioperative blood loss were calculated with use of the hemoglobin balance method. Perioperative blood loss at postoperative day 1 and at discharge from the hospital were calculated. The total volumes of blood transfused intraoperatively and postoperatively were recorded. A statistical comparison between the groups was performed for blood loss and blood transfusion as well as for possible independent variables other than TXA, including age, body mass index, histopathologic diagnosis, tumor volume, preoperative hemoglobin level, type of resection, and the duration of surgery., Results: A total of 48 participants, with a mean age of 12.5 ± 3.44 years (range, 5 to 18 years) and a male-to-female ratio of 1.18, were included. All participants were Egyptians by race and ethnicity. There were no minor or major drug-related adverse events. There was no significant difference between the groups with respect to intraoperative blood loss (p = 0.0616) or transfusion requirements (p = 0.812), but there was a significant difference in perioperative blood loss at postoperative day 1 (p = 0.0144) and at discharge from the hospital (p = 0.0106) and in perioperative blood transfusion (p = 0.023)., Conclusions: TXA can be safely infused intraoperatively in children and adolescents undergoing limb-salvage surgery, and it contributes significantly to the reduction of perioperative blood loss and transfusion requirements., Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: No external funding was received for this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I364 )., (Copyright © 2025 by The Journal of Bone and Joint Surgery, Incorporated.)

Objectives: This study aimed to predict the impact of different infusion strategies on pharmacokinetic/pharmacodynamic (PK/PD) target attainment and the potential risk for toxicity in an ICU cohort treated with β-lactams., Method: Using collected patient data from 137 adult ICU patients, and applying population PK models, individual PK parameters were estimated and used to predict concentrations and target attainment following cefotaxime 2 g q8h, piperacillin/tazobactam 4.5 g q6h and meropenem 1 g q8h, applying 15 min short infusions (SI), 3 h extended infusions (EI) and 24 h continuous infusion (CI). The MIC level of the most common primary pathogens, and the worst-case scenario (WCS) pathogen, were used in analyses., Results: For primary pathogens, target was reached in 94% (129/137) using SI. For WCS pathogens treated with piperacillin/tazobactam and meropenem, 78% (65/83) and 92% (76/83) reached target using SI and EI, respectively. However, target attainment was lower for cefotaxime [SI: 31% (17/54), EI: 44% (24/54)]. Overall, the number of individuals with potentially toxic concentrations was low, both in EI (n = 7) and SI (n = 5). For CI and WCS, target was reached in 50% (27/54), 96% (54/56) and 93% (25/27) for cefotaxime, piperacillin/tazobactam and meropenem, respectively., Conclusions: In a Swedish ICU cohort target attainment rates for primary pathogens were high regardless of infusion strategy. In WCS pathogens, SI was insufficient, suggesting the benefit of routine use of EI or CI. However, for cefotaxime, target attainment remained low also with EI and CI. The use of CI might lead to unnecessarily high concentrations, but well-established toxicity levels are lacking and future studies are warranted., (© The Author(s) 2025. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Background and Objectives: Cefiderocol approved dosages are based on a prolonged infusion (PI) of 3 h that may not be adequate in all settings The objective of this study was to identify alternative cefiderocol dosage regimens based on short infusion (SI) or continuous infusion (CI)., Methods: We performed 1000-patient pharmacokinetic/pharmacodynamic (PK/PD) simulations based on a reference population model. Drug penetration into the epithelial lining fluid (ELF) was considered for pneumonia. For various stages of creatinine clearance (CLCR), we simulated the recommended PI as well as various SI (1 h-infusion) and CI regimens. The PK/PD targets were set at 75% or 100% of the dosing interval during which the free concentration of cefiderocol was above the MIC (fT > MIC) in plasma and ELF. The PTAs were computed considering the cefiderocol MIC breakpoint (2 mg/L)., Results: In plasma, all recommended PI regimens were associated with a PTA  ≥ 90%. Some SI regimens also showed acceptable PTAs. CI regimens were associated with high PTAs, even for doses as low as 2 g over 24 h and in patients with high CLCR. Recommended dosages failed to achieve acceptable PTAs in ELF for the 100% fT > MIC target in patients with CLCR  ≥ 90 mL/min. CI regimens showed the highest PTAs for the high target, but high doses of 6 to 8 g over 24 h were required in patients with CLCR  ≥ 90 mL/min., Conclusions: We identified SI and CI regimens of cefiderocol that may be useful alternatives to the PI regimens in some patients. Continuous administration of cefiderocol may be especially relevant for patients with pneumonia. However, further clinical evaluation is necessary., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: There have been 2 primary methods of intravenous fluid administration for diabetic ketoacidosis (DKA) treatment described in the literature: the serial bag method and the 2-bag method., Objectives: This study will assess the clinical outcomes and workflow efficiency after a transition in practice from the serial fluid method to the 2-bag method for pediatric DKA., Methods: This was a retrospective chart review of pediatric DKA patients 18 years or younger, 1 year before and after the transition was conducted. After exclusion criteria, 94 patients in the serial bag method group and 100 patients in the 2-bag method group remained. Variables included patient demographics, laboratory values, and duration of therapy., Results: Patients achieving physiologic resolution of DKA had a median duration of 8.7 hours using the serial bag method and 7.5 hours using the 2-bag method (P = .193). Duration of DKA pharmacologic therapy had median values of 11.6 and 12.7 hours, between the serial bag and 2-bag method, respectively (P = .203). The 2-bag method resulted in faster workflow efficiency per bag for intravenous fluids, with a median duration of 35.5 minutes compared with 44.5 minutes using the serial bag (P = .025). Episodes of hypokalemia (P = .010) and hyperchloremia (P = .002) with the 2-bag method were significantly more frequent., Discussion: Duration of DKA pharmacologic therapy and that of physiologic DKA were not statistically different between methods. Workflow efficiency improved with the 2-bag method. Further studies are needed to address potential electrolyte disturbances with the 2-bag method., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Delirium is a common complication observed in intensive care units (ICUs). Propofol is one of the most widely used sedatives and is believed to be closely connected with the incidence of delirium. The study was carried out to explore the relationship between delirium and the average rate of propofol infusion., Methods: Patients who underwent invasive mechanical ventilation (IMV) while receiving propofol from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were included in the study. The primary outcome was to identify the potential risk factors for the incidence of delirium and investigate the relationship between the average rate of propofol infusion and the incidence of delirium. The secondary outcome was to further analyze the relationship by subgroup analysis. Propensity score matching (PSM) was employed to minimize bias., Results: A total of 16,956 patients (delirium: 5805; control: 11,151) were ultimately included in the study after PSM. The median diagnostic time of delirium was 18 h. An average propofol infusion rate ≥ 20 μg/(kg*h) during the initial 18 h was found to be independently significant [OR = 1.84, 95% CI = (1.72, 1.98), p < 0.001], while an average propofol infusion rate ≤ 40 μg/(kg*h) in the first hour showed no statistically significant difference in the incidence of delirium [OR = 0.95, 95% CI = (0.88, 1.02), p = 0.163]. Besides, an average propofol infusion rate ≥ 20 μg/(kg*h) was also found to be statistically significant in all the subgroup analyses., Conclusion: An average propofol infusion rate ≥ 20 μg/(kg*h) during the initial 18 h was identified as an independent risk factor for delirium, suggesting that the accumulation of propofol might be associated with an increased incidence of delirium., (© 2025 The Author(s). CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.)

Background: Although numerous techniques exist for renal blood flow (RBF) estimation, none of the methods have been implemented in routine clinical practice due to their inadequacies and burdensomeness. Previously, we evaluated rubidium-82 ( 82 Rb) positron emission tomography/computed tomography (PET/CT) for renal perfusion determination and found strong indications of method precision and reliability. The aim of this study was to compare renal 82 Rb clearance with renal technetium-99m-mercaptoacetyltriglycine ([ 99m Tc]Tc-MAG3) clearance as a first attempt to validate 82 Rb PET/CT for renal perfusion estimation using a reference method., Methods: Ten subjects with essential hypertension underwent two treatment periods, receiving spironolactone and placebo in random order. At the end of each period, each subject completed a 82 Rb PET/CT scan and a [ 99m Tc]Tc-MAG3 clearance study., Results: 82 Rb clearance correlated positively with [ 99m Tc]Tc-MAG3 clearance in both treatment periods. The [ 99m Tc]Tc-MAG3-to- 82 Rb clearance ratio was 0.83 and 0.86 in the placebo and spironolactone treatment periods, respectively., Conclusion: The correlation between 82 Rb clearance and [ 99m Tc]Tc-MAG3 clearance may indicate that PET/CT determined 82 Rb clearance can act as an estimator of renal perfusion. The [ 99m Tc]Tc-MAG3-to- 82 Rb clearance ratios suggest that the extraction fraction of 82 Rb is higher than that of [ 99m Tc]Tc-MAG3, further suggesting 82 Rb clearance as an estimator of flow. However, further studies are warranted to validate use of 82 Rb PET/CT for flow estimation., (© 2025 The Author(s). Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.)

Hyperglycemia is common in critically ill patients. Due to the complex medical issues of critically ill patients, continuous insulin infusions are often used to treat hyperglycemia in the ICU. This article discusses the benefits and risks of continuous insulin infusions, components of insulin infusion protocols, nursing management while administering insulin infusions, and proper transition off an insulin infusion., Competing Interests: Disclosure The author has nothing to disclose., (Published by Elsevier Inc.)

Purpose: Severe Cushing's syndrome (SCS) is a life-threatening endocrine condition that requires prompt medical intervention. Intravenous etomidate infusion is considered to be the most effective in rapid cortisol overproduction inhibition. This single-center retrospective study aimed to present the safety and effectiveness of intravenous, low-dose, lipid-formulated etomidate infusion in patients with SCS., Methods: Seven patients with complicated SCS related to ectopic ACTH syndrome (n = 6) or Cushing's disease (n = 1) who received low-dose etomidate infusion as a part of their cortisol-lowering treatment between April 2019 and April 2024 in the Department of Internal Medicine, Endocrinology and Diabetes of Medical University of Warsaw were included in the study. A continuous etomidate infusion was initiated at 0.01-0.02 mg/kg/h., Results: In all patients, rapid control of hypercortisolemia was achieved with a median time of 30 h (range: 12-48 h). Median serum cortisol concentration reduced from 101.9 μg/dL (range: 78.2-119.6 μg/dL) before etomidate to 19.5 μg/dL (range: 18.3-22.5) after 72 h of etomidate treatment. Etomidate infusion was followed by etomidate and osilodrostat combined treatment and then osilodrostat monotherapy in four patients; one patient underwent adrenalectomy, and two patients died during etomidate infusion due to complications of advanced malignancy., Conclusions: This study shows that low-dose and short-term lipid formulation etomidate therapy is highly effective in severe hypercortisolemia management. Combined therapy with etomidate and osilodrostat is well tolerated and could serve as a bridge in long-term SCS treatment., Competing Interests: Compliance with ethical standards. Conflict of interest: Authors L.D. and P.W. reports receiving speaker fees and consulting fees from Recordati Rare Diseases. Author J.S., W.R., A.W-L., and P.K. declare no conflict of interest. Ethical approval: The study was approved by the Ethics Committee of Medical University of Warsaw (permission number: AKBE/170/2024) and was performed in accordance with the Declaration of Helsinki. Consent to participate: As this was a retrospective study on medical files and all the procedures being performed were part of the routine care, patient’s informed consent in the opinion of the local bioethics committee was not required. However, before etomidate infusion and after obtaining comprehensive information (including off-label use of etomidate), each patient signed informed consent for etomidate treatment and for the use of data obtained during treatment for scientific purposes, which is included in the patient’s medical history., (© 2024. The Author(s).)

Purpose: Opioids are frequently used to treat pain in neonatal intensive care units (NICU) with fentanyl, morphine and sufentanil being mainly used agents. Equianalgesic potency between opioids is not clearly described in the neonatal population. The aim of this study was to compare theoretical and actual equipotent conversion ratios between morphine, sufentanil and fentanyl based on prescriptions., Methods: In this observational, multicentric, pharmacoepidemiologic study, prescriptions' data (doses, duration of use, patients' characteristics) were collected and analyzed for all neonates hospitalized in one of the 30 Level III French NICUs using the same prescription software (Logipren®) and who received at least one prescription of morphine, sufentanil or fentanyl as continuous infusion during a 6-year period (2014-2020)., Results: Among 65,555 neonates, 8361 (12.8%) received a prescription of continuous opioid infusion in one of the 30 French NICUs: 5054 (60.4%) received sufentanil, 2413 (28.9%) morphine and 894 (10.7%) fentanyl. After conversion to equipotent morphine doses using theoretical conversions ratios of 50:1 for morphine/fentanyl ratio and 500:1 for morphine/sufentanil ratio, prescribed mean maintenance doses of fentanyl and sufentanil were two times and five times higher than morphine doses, respectively. In this cohort, potency conversion ratios between the different opioids were 20:1 for morphine/fentanyl ratio and 100:1 for morphine/sufentanil ratio, and 4:1 for fentanyl/sufentanil ratio (theoretical conversion ratio of 7: 1)., Conclusion: In a large cohort of neonates treated with continuous opioids in NICU, fentanyl and sufentanil doses used were significantly higher than morphine doses when using theoretical conversion ratios., Competing Interests: Declarations. Ethics approval and consent to participate: Authorization to use the data was obtained from the National Commission for Data Protection and Privacy (CNIL: DE-2015–099, DE-2017–410). Parents were informed of data collection and consent is not required for studies on data according to French regulation (MR-004). Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established., Objectives: The main objective of this study was to evaluate the association between the amount of intravenous glucose provided and hospitalization for children with acute gastroenteritis. Another objective was to evaluate practice variation regarding the amount of glucose provided for IV rehydration in a pediatric emergency department (ED)., Method: We conducted a retrospective cohort study from 2019 to 2022 in a Canadian pediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease, or diabetes were excluded. The IV glucose administered during the initial 4 hours of rehydration was quantified. The primary outcome was hospitalization, and return visit within the following week was a secondary outcome. Ten percent of the charts were evaluated in duplicate to assess interrater reliability. We examined glucose distribution at 1 and 4 hours and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions., Results: Among 6939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent interrater reliability. Notable variations existed in glucose quantities provided, both at 1 hour (first quartile, 87 mg/kg; third quartile, 294 mg/kg) and 4 hours (first quartile, 681 mg/kg; third quartile, 1174 mg/kg) of rehydration. Multiple logistic regression showed a negative association between hospitalization and glucose administration during the initial hour (OR for each 100 mg/kg increment, 0.60; 95% CI, 0.42-0.84) and 4 hours (OR, 0.76; 95% CI, 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were less likely of having a return visit (OR for each 100 mg/kg increment: 0.52; 95% CI, 0.35-0.78), as well as during the first 4 hours (OR for each 100 mg/kg increment, 0.83; 95% CI, 0.73-0.94)., Conclusions: There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Diabetic ketoacidosis (DKA) is often treated with intravenous regular insulin infusion (IVRII). Subcutaneous fast-acting insulin analogues (FAIAs); either alone or combined with subcutaneous long-acting insulin (LAI); might be useful to treat DKA. Our meta-analysis updated on their benefits and safety in DKA., Methods: We searched major electronic databases for randomised trials on subcutaneous FAIAs ± subcutaneous LAI vs IVRII in DKA. Primary outcomes were all-cause in-hospital mortality, time to resolution of DKA and hyperglycemia, in-hospital DKA recurrence and hospital readmission for DKA post-discharge. Secondary outcomes included resource utilisation and patient satisfaction. Safety outcomes were adverse events. Reviewers assessed risk of bias and quality of evidence using GRADE. We performed a priori subgroup and trial sequential analyses on primary outcomes., Results: Seven trials enrolled 351 mainly adult patients (255/351) with mild to moderate DKA. No trials studied subcutaneous FAIA and subcutaneous LAI. Their risk of bias was high or unclear in several domains. No all-cause in-hospital mortality and DKA recurrence were reported. No trial investigated hospital readmission for DKA post-discharge. There was no difference in mean time to resolution of DKA (mean difference = -0.70, 95% CI -2.18 to 0.79 h, p = 0.36) or hyperglycemia [blood glucose < 250 mg/dL (13.9 mmol/L)] (mean difference = -0.17, 95% CI -1.10 to 0.76 h, p = 0.72) between subcutaneous FAIA and IVRII groups. There were largely no subgroup effects. Both groups had similar secondary outcomes. Hypoglycemia was the most common adverse event. Quality of evidence was low to very-low for all outcomes. The only possible trial sequential analysis for time to resolution of DKA was inconclusive., Conclusions: There was low- to very-low quality evidence that subcutaneous FAIA did not affect patient-centered outcomes in mainly adult patients with mild to moderate DKA compared to IVRII., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Rationale: The intravenous anesthetic propofol is known to induce positive mood effects during routine clinical use, suggesting it might be repurposed as an antidepressant, but also raising concerns about abuse potential. How propofol's acute effects vary by dose and with repeated infusions is unknown., Objectives: This exploratory analysis aimed to (1) compare the immediate mood effects of propofol administered at two different doses, (2) describe how those mood effects change with repeated infusions, and (3) evaluate whether acute mood improvement predicts later antidepressant response., Methods: Twenty-four adults with moderate-to-severe treatment-resistant depression were randomized into two dosing groups. Six low- or high-dose propofol infusions were administered under blinded conditions over a two-week period. Self-reported mood states were recorded before and after each infusion using the Positive and Negative Affect Schedule (PANAS-X). Abuse potential was evaluated with the Drug Effects Questionnaire (DEQ-5)., Results: At the first infusion, propofol induced acute improvements in PANAS-X Sadness, Fear, Joviality, and Serenity scales (p < 0.002), independent of dose. Over the series of six infusions, acute changes in Sadness, Fear, and Joviality, but not Serenity, diminished with infusion number (p < 0.002). The DEQ-5 "want more" rating decreased across infusions (p = 0.002). Changes in PANAS-X scales with the first infusion did not predict later improvement in depression severity (p > 0.05)., Conclusion: Cumulative changes in mood states observed with repeated infusions suggest that propofol engages adaptive mechanisms in mood circuitry. Subjective responses with repeated infusions do not indicate increasing potential for abuse in this patient population., Competing Interests: Declarations. Conflicts of interest: The authors have no relevant financial or non-financial interests to disclose. BJM reports consulting for Inside Edge and KML, and contracted research support from Health Rhythms, LivaNova, Compass Pathways, and Abbott, for projects unrelated to this work., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Recent randomized controlled trials (RCTs) have studied the potential effect of the topical use of sesame oil (SO), obtained from the sesame plant seeds (Sesamum indicum L., Pedaliaceae family), in preventing or alleviating the symptoms of infusion-related phlebitis (IRP); nevertheless, their data are inconsistent. Thus, this review sought to qualitatively and quantitatively synthesize data from all available RCTs concerning the effect of the topical administration of SO on managing IRP., Methods: The online databases were searched up to July 13, 2024. Studies were eligible if they compared administering standard care plus topical SO to applying an alternative modality and/or standard care. The Cochrane risk-of-bias tool and GRADE framework were employed to appraise the quality of the evidence., Results: Eight studies of 755 records in the initial search met the inclusion criteria, which investigated inpatients and/or outpatients with chemotherapy-induced phlebitis (n = 6) and amiodarone-induced phlebitis (n = 2). According to the quantitative analysis, adults who had received coadministration of standard care and topical SO on the infusion site were significantly less affected by IRP than those who had received a control condition (effect sizes= 5, risk ratio= 0.54; 95 % confidence interval[0.32, 0.92]; P = 0.025). Also, based on the qualitative syntheses, SO can potentially prevent the formation of advanced stages of IRP, delay the appearance of IRP symptoms, and reduce IRP-induced pain severity., Conclusion: Topical SO had a favorable effect on caring for adults with IRP. However, uncertainty remains because the evidence quality was moderate, some RCTs needed better methodological rigor, and most required to address the safety of the intervention or independent verification of SO used in terms of purity and potency. Thus, to build a valid conclusion about the efficacy and safety of SO in managing IRP, more high-quality RCTs must be conducted considering an active placebo control intervention along with a well-designed randomization and blinding approach, as well as a better description of safety parameters and the quality control information of the SO used., Prospero Registration Number: CRD42024542497., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Elderly frailty patients are at particular risk of sedation-related adverse events (SRAEs) during sedation. This study aimed to assess whether intravenous lidocaine could reduce the incidence of SRAEs in elderly frailty patients undergoing endoscopic retrograde cholangiopancreatography (ERCP)., Methods: A total of 210 elderly frailty patients scheduled for ERCP were randomly divided into two groups: lidocaine and control. Patients in the lidocaine group received intravenous lidocaine (1.0 mg/kg) before anesthesia induction, followed by continuous intravenous infusion (2.0 mg/kg/h) during ERCP. The control group received an equal volume of saline solution. The primary endpoint was the composite incidence of SRAEs during ERCP. Secondary endpoints were propofol consumption, VAS score, endoscopists' and patients' satisfaction scores and lidocaine-related adverse events and so on., Results: The composite incidence of SRAEs in the lidocaine group was significantly lower than in the control group (41.05% vs. 21.86%, p < 0.05). The propofol requirement (436.11 ± 118.90, 388.54 ± 149.65. p < 0.001) and VAS score of patients (3.02 ± 1.07, 2.54 ± 1.10. p < 0.05) in the lidocaine group were significantly lower than those in the control group. The endoscopists' satisfaction scores (7.77 ± 1.12, 8.23 ± 1.10. p < 0.05) and patients' satisfaction scores (8.53 ± 0.95, 8.98 ± 0.86. p < 0.05) in lidocaine group were significantly higher than those in the control group., Conclusions: Intravenous lidocaine can significantly decrease the incidence of SRAEs for ERCP procedures in elderly frailty patients, with no increase in lidocaine or other related adverse events., Trial Registration: Chinese Clinical Trial Registry (Trial ID: ChiCTR2300067796, https://www.chictr.org.cn/showproj.html?proj=185763 )., Competing Interests: Declarations. Disclosures: Hao Gao, Zhi-yu Yin, Li-xiao Hao, Jian Wang, Hao-liang Cai, Guo Jun, Xiao-fan Huang, Yue Yong, Yong-qiang Wang, Wen-ting Chen and Jian-gang Song have no conflicts of interest or financial ties to disclose., (© 2025. The Author(s).)

Background: Ketamine has been used to control refractory cancer pain as an adjuvant to opioids. We conducted a prospective phase II study to investigate the efficacy and safety of 5-day continuous intravenous infusion (CIVI) of Ketamine in terminally ill cancer patients with refractory cancer pain., Methods: Hospitalized terminally ill cancer patients with refractory cancer pain were enrolled. Refractory cancer pain was indicated by requirements for 4 or more rescue opioids or pain intensity using numerical rating scale > personalized pain goal (PPG) despite of intravenous morphine equivalent daily dose (IV MEDD) ≥ 120 mg/day. The CIVI of ketamine was increased from .05 mg/kg/hour to .5 mg/kg/hour by .05 every 8 hours if pain intensity exceeded PPG or if number of rescue opioids ≥2 during prior 8 hours was required. The primary end-point was overall pain response rate, which indicates complete response (both rescue opioid ≤3/day and pain intensity ≤ PPG) plus partial response (rescue opioid ≤3/day), without unacceptable toxicities., Results: Among 21 eligible patients enrolled between September 2019 and January 2023, 20 were analyzed. Most pain mechanisms were mixed type (n = 15, 75%), with neuropathic component (n = 17, 85%). The baseline background opioids were IV MEDD 186 mg/24hour (range, 124-592), number of rescue opioids was 6 (IQR, 5-9), and median PPG was 4 (IQR, 3-4). The overall pain response rate was 50% (n = 10) including 40% (n = 8) for complete pain response and 10% (n = 2) for partial pain response., Conclusion: This study showed efficacy of gradually increasing CIVI of ketamine for terminally ill cancer patients with refractory cancer pain. CIVI of ketamine could be a useful tool in these patients considering the limited treatment options. (NCT03362073, Initial Release: November 15, 2017)., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Esketamine has demonstrated acute antidepressant effects in patients with major depressive disorder (MDD). This study investigated whether these effects associate with reversible white matter fiber integrity recovery using diffusion imaging., Method: Twenty patients with MDD and 20 healthy controls received 2-week esketamine treatment. Patients received 0.25 mg/kg intravenous esketamine. Emotional and cognitive recovery were assessed. Diffusion tensor imaging and tract-based spatial statistics evaluated white matter fiber integrity pre/post-treatment. Correlation analyses examined associations between white matter changes and clinical scales., Results: Compared to controls, patients with MDD exhibited decreased fractional anisotropy (FA) values of cerebral white matter fibers involving the association fibers, the commissural fibers and projection fibers. Esketamine effectively reduced depression, anxiety, and suicidal ideation scores while improving cognitive function. However, no reversible recovery of compromised white matter integrity was observed after 2 weeks of esketamine treatment. FA reductions in projection fibers correlated with anxiety and suicidal ideation severity., Limitations: Concurrent sertraline use and lack of placebo control limited our ability to isolate esketamine's effects. The wide age range may have introduced response variability. We used minimal effective dosages based on previous research. The small sample size limited statistical power. Larger, more controlled studies are needed to validate these preliminary findings., Discussion: This study enhances MDD neuropathological understanding, with widespread white matter impairment and associations between projection fibers and symptom severity. While producing significant antidepressant effects, short-term esketamine did not recover compromised white matter microstructure., Competing Interests: Declaration of competing interest No conflicts of interest were declared by the authors., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: To assess the efficacy and safety of bicarbonate infusion in children with Acute Diarrhea and Severe Dehydration (ADSD) having severe Non-Anion Gap Metabolic Acidemia (sNAGMA)., Methods: Children (aged 1-144 mo) with ADSD and sNAGMA (pH ≤7.2 and/or serum bicarbonate ≤15 mEq/L) were enrolled in an open-label randomized design. Controls (n = 25) received WHO-recommended rehydration therapy with Ringer Lactate, while intervention group (n = 25) received additional bicarbonate deficit correction. Primary outcome was time taken to resolve metabolic acidemia (pH >7.30 and/or bicarbonate >15 mEq/L). Secondary outcome measures were adverse outcome [composite of pediatric intensive care unit (PICU) transfer and deaths], acute care area free days in 5 d (ACAFD 5 ), hospital stay, and adverse effects., Results: Time taken to resolve metabolic acidemia was significantly lesser with intervention [median (IQR); 8 h (4, 12) vs. 12 h (8, 24); p = 0.0067]. Intervention led to acidemia resolution in significantly more children by 8 h and 16 h (17/25 vs. 9/25, p = 0.035 and 23/25 vs. 17/24, p = 0.018, respectively). Patients with fluid refractory shock needed lesser inotropes in intervention group [median Vasoactive Inotrope Score (VIS), 10.5 vs. 34]. Intervention led to significantly lesser adverse outcome (0/25 vs. 5/25, p = 0.049), and noticeably more ACAFD 5 [median (IQR); 2 (1, 2) vs. 1 (1, 2); p = 0.12]. Two patients died in the control group while none in the intervention group. No adverse effect was documented., Conclusions: Additional calculated dose of bicarbonate infusion led to significantly early resolution of metabolic acidemia, lesser utilization of critical care facilities, and lesser adverse outcome in children with ADSD and sNAGMA, compared to standard therapy, with no adverse effect., Competing Interests: Declarations. Conflict of Interest: None., (© 2023. The Author(s), under exclusive licence to Dr. K C Chaudhuri Foundation.)

Objective: Summarize the studies evaluating the use of subcutaneous (SQ) insulin in the management of diabetic ketoacidosis (DKA) in adults and pediatrics., Data Sources: A PubMed literature search was conducted for articles published between 2000 and the end of May 2024 which contained the following terms in their title: (1) subcutaneous, glargine, or basal and (2) ketoa*., Study Selection and Data Extraction: Review articles, guidelines, meta-analysis, commentaries, studies not related to the acute management of DKA, studies evaluating continuous SQ insulin, animal studies, if the time to DKA resolution was not clearly defined, and studies where basal insulin was administered greater than 6 hours after the insulin infusion was started were excluded., Data Synthesis: The electronic search identified 58 articles. Following the initial screening 38 articles were excluded and 3 were added after bibliography review. Of the 23 articles assessed for eligibility, 7 were excluded. Sixteen articles were included. Five studies compared SQ rapid/short-acting insulin and intravenous (IV) insulin infusions in adults, 4 compared SQ rapid/short-acting insulin and IV insulin infusions in pediatrics, 4 evaluated IV insulin infusions with or without SQ basal insulin in adults, and 3 evaluated IV insulin infusions with or without SQ basal insulin in pediatrics., Relevance to Patient Care and Clinical Practice: In comparison with IV insulin infusions, rapid/short-acting SQ insulin regimens were associated with reduced ICU admission rates, hospital length of stay, and hospitalization costs. IV insulin infusion regimens that included a single SQ basal insulin dose upon therapy initiation were associated with reduced concurrent IV insulin infusion durations., Conclusion: Studies reviewed suggest that SQ insulin regimens may be as effective and safe as IV insulin infusions in the management of DKA and are associated with the conservation of resources. Providers may refer to this review when establishing or modifying their DKA management protocols., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Total intravenous anaesthesia guided by electroencephalography and neurophysiological monitoring may be used for carotid endarterectomy. Reduction of brain metabolic demand during cross-clamping of the internal carotid artery with propofol titrated to burst suppression requires effect-site concentrations that may delay emergence and interfere with intraoperative neurophysiological monitoring., Objective: To test the hypothesis that dexmedetomidine decreases the effect-site concentration of propofol required for burst-suppression in patients undergoing carotid endarterectomy., Design: Randomised controlled trial., Participants: Patients undergoing carotid endarterectomy., Setting: University Hospital of Berne, Switzerland, from October 2018 to September 2024., Interventions: Patients were randomised into a control ( n  = 23) and a dexmedetomidine groups ( n  = 22). Total intravenous anaesthesia was administered to both groups. Patients in the dexmedetomidine group received an intravenous bolus of dexmedetomidine (0.4 μg kg -1 over 10 min) before induction, followed by a continuous intravenous infusion (0.4 μg kg -1  h -1 ). The effect-site concentrations of propofol were titrated against frontal electroencephalography parameters. Burst suppression was induced with propofol during cross-clamping of the internal carotid artery., Outcome Measures: The primary outcome was the effect-site concentration of propofol required for burst-suppression. The secondary outcomes were the requirement for vasoactive substances, neurophysiological monitoring parameters, and postoperative delirium., Results: The effect-site concentration of propofol required for burst suppression was 4.0 μg ml -1 [3.50 to 4.90] (median [interquartile range]) in the dexmedetomidine group compared with 6.0 μg ml -1 [5.5 to 7.3] in the control group ( P  < 0.001). Less norepinephrine was required in the dexmedetomidine group (total 454 μg [246 to 818] compared with 1000 μg [444 to 1326] ( P  = 0.015) in the control group). Dexmedetomidine did not affect intraoperative neurophysiological monitoring., Conclusion: Co-administration of dexmedetomidine to total intravenous anaesthesia for carotid endarterectomy decreased the effect-site concentrations of propofol required for burst suppression by 33%. The propofol-sparing effect and peripheral alpha-agonism of dexmedetomidine may explain the reduced requirement for vasopressors., Trial Registration: Clinicaltrials.gov identifier: NCT04662177., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.)

Aims: The aim of the study is to evaluate the clinical and biochemical response of inflammatory bowel disease patients treated with vedolizumab, 16 weeks after transitioning from intravenous (iv) to subcutaneous (sc)., Methods: An observational, prospective, single-center cohort study was performed. Patients with inflammatory bowel disease and maintenance treatment with vedolizumab, stable for at least 4 months, were offered to switch to sc formulation. At the same time of treatment administration a blood test was performed, with vedolizumab levels and fecal calprotectin., Results: Forty-three patients were included, 12 of them (27.9%) chose to transition to sc formulation. All included patients remained in remission during follow-up. At week 16 no significant differences were found in terms of calprotectin levels in patients on iv treatment (mean 146.6±SD 45.9) vs. sc (159.26±53.9) (p=0.9). Vedolizumab serum levels at week 16 were higher in the sc group (22,364.3±5141.6) vs. iv (11,425.9±1514.2) (p=0.009). At week 16, 9 (75%) of the patients in the sc group were highly satisfied with the medication and 11 (91.7%) considered it easy to administer. Four patients (12.9%) in the iv group and 2 (16.6%) in the sc group presented mild adverse effects. The 2 cases (100%) of the sc group the adverse event was local inflammation at the injection site., Conclusion: In our experience, vedolizumab sc is a convenient alternative to iv administration. Vedolizumab serum levels in patients who transitioned to sc were higher than iv formulation., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Background: The use of human albumin in patients with minimal change disease (MCD) remains controversial. The aim of the current study was to assess whether infusion of human albumin increased the risk of acute kidney injury (AKI) in adult patients with MCD., Materials and Methods: Adult patients who underwent renal biopsy for the diagnosis of MCD at the center between 2017 and 2022 were screened. Logistic regression and Nelson-Aalen cumulative risk curve analysis were used to compare data from patients with and without human albumin infusion., Results: A total of 190 adult patients with MCD diagnosed by renal biopsy were included, of whom 45 received human albumin infusion before MCD diagnosis and 34 developed AKI within 4 weeks of MCD diagnosis. Nelson-Aalen cumulative risk curve analysis showed that patients who received human albumin infusion had a longer time to partial or complete response (p < 0.001), were more likely to develop AKI (p < 0.001), and were more likely to relapse (p = 0.002) than those who did not receive human albumin infusion. Multivariate logistic regression analysis showed that human albumin infusion was an independent risk factor for AKI in adult patients with MCD after adjusting for confounding factors (OR = 3.259, 95% CI, 1.209 - 8.780, p = 0.020)., Conclusion: Receiving human albumin infusions may be associated with the development of AKI in adult patients with MCD. Adult MCD patients who received human albumin infusion had a longer time to achieve partial or complete remission and were more likely to relapse.

Background: Amiodarone is a prophylactic rhythm-regulating drug used to prevent arrhythmia; However, especially during infusion, it has the potential to cause a number of complications, especially phlebitis., Aim: The aim of the study is to determine the effects of sesame oil, which has the potential to prevent phlebitis that may occur during amiodarone infusion administered to patients after cardiac surgery., Design: This prospective, two-arm (1:1), block randomized controlled interventional study., Methods: This study was conducted with 44 patients treated in the coronary intensive care unit of a university hospital, who received parenteral infusion of amiodarone. Sesame oil was applied superficially by applying 10 drops to a 10 cm perimeter of the cannula for 10 min. This application was repeated every 8 h during the 24-h amiodarone infusion. No intervention was made to the patients in the control group. However, standard nursing care measures and a standard transparent dressing were applied to the patients in both groups during the peripheral catheter application phase. Patients in the intervention and control groups were evaluated in terms of phlebitis at the end of every 24 h using the Visual Infusion Phlebitis Scale. The study was reported according to the CONSORT declaration., Results: Phlebitis symptoms occurred in 15/22 (68.2%) of the patients in the intervention group on the first day, 3/22 (13.6%) on the second day and 2/22 (9.1%) of the patients on the third day, while in the control group, 20/22 (90.9%) of the patients had phlebitis on the first day and 2/22 (9.1%) on the second day. The incidence of phlebitis was 20/22 (90.9%) in the intervention group and 22/22 (100%) in the control group. There was no statistically significant difference in phlebitis symptoms between groups., Conclusion: The research results showed that the application of sesame oil did not significantly reduce the frequency of phlebitis. However, a trend indicating delayed onset of phlebitis symptoms was observed in the sesame oil group. Nevertheless, larger sample studies are needed. These studies are expected to assist in determining the effects of sesame oil on phlebitis more precisely and provide stronger support for the results., Relevance to Clinical Practice: Training of nurses on non-pharmacological methods should be supported and opportunities should be given for their application., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Context: Reiki is a biofield therapy from Japan currently used in many US hospitals. Evidence supports Reiki's effectiveness for addressing cancer and treatment-related symptoms such as pain and anxiety. However, no study to date has assessed changes in nausea following Reiki received during infusion treatments or assessed patients from multiple healthcare locations., Objectives: To evaluate a Reiki program for outpatients with cancer and other chronic illnesses receiving infusion treatments (e.g., chemotherapy) at two University Hospitals infusion centers., Methods: Participants in the outpatient infusion clinics completed Edmonton Symptom Assessment System measures of pain, fatigue, anxiety, nausea, and well-being before and after receiving a 15-20-minute Reiki session during their infusion. Data analysis included means and 95% confidence intervals (CI) of single-session effects on measures where the pre-session score was ≥1 and analysis of post-session comments., Results: Between March 2022 and February 2024, 392 Reiki sessions were provided to 268 unique patients (mean age 63.3 ± 13.9, 57.5% female, 71.6% White, 26.5% Black/African American). Participants reported clinically significant mean [95% CI] improvements (≥1 unit) in pain (-1.78 [-2.38, -1.18]), fatigue (-1.33 [-1.85, -0.82]), anxiety (-2.09 [-2.68, -1.50]), nausea (-2.30 [-2.95. -1.62), and wellbeing (1.37 [0.95, 1.79]). Participants also commented that the Reiki session was a positive experience helpful for promoting relaxation and symptom reduction., Conclusions: Outpatients receiving Reiki during infusion reported clinically significant improvements in all symptoms, high levels of satisfaction, and a qualitatively positive healing experience. More research is needed to assess long term changes following Reiki, including with an expanded program at additional healthcare locations., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Sickle cell disease (SCD) vaso-occlusive episode (VOE) pain is treated with opioids, and non-opioid adjuvants may reduce pain severity without opioid side effects. We retrospectively investigated the safety and tolerability of intravenous lidocaine infusions as an adjunct to opioids in children and adolescents during VOE hospitalizations. In 2 years, lidocaine was administered in 64.6% of 260 admissions. There were no serious toxicities; overall, 82.2% of recipients chose to receive lidocaine during subsequent admissions. Lidocaine infusions were associated with longer hospitalizations, potentially reflecting selection bias. The efficacy of adjuvant lidocaine infusions during VOE should be studied prospectively., (© 2024 Wiley Periodicals LLC.)

Background: Electrochemotherapy (ECT) is a local nonsurgical effective tumor treatment in the hand of the clinician for the treatment of patients with liver tumors or metastases. The study aimed to test the technical feasibility and safety of intra-arterial (i.a.) bleomycin administration compared to the established intravenous (i.v.) administration in percutaneous electrochemotherapy (pECT). Furthermore, the equivalence hypothesis was tested between the 2 modalities in terms of local short-term response and progression-free survival., Patients and Methods: Forty-four patients have been recruited and treated by pECT for hepatocellular carcinoma, cholangiocarcinoma and liver metastatic lesions from cancers of different origin: 18 were treated with standard i.v., 26 with bleomycin i.a. administration., Results: The 2 groups were similar for anagraphic and anamnestic data, as well as for most relevant disease specific characteristics. Technical success of the treatment was obtained in 95% and 100% of patients in i.v. and i.a. groups respectively. Short-term local response was similar in the 2 groups with a slightly higher complete remission (CR) rate in the i.a. group. There were 61.9% CR, 23.8% partial remission (PR), 4.8% stable disease (SD) in the i.v. group, and 80.6%, CR 12.9% PR, 3.2% PD (p = 0.3454). One-year progression free survival was 60% (C.I. 33%-88%) in the i.v. group and 67% (C.I. 42%-91%) in the i.a. group (p = 0.5849)., Conclusions: The results of this study confirmed the safety and feasibility of super-selective i.a. bleomycin administration. Analysis of local response and progression free survival confirmed the equivalence hypothesis of the new modality compared to standard i.v. administration in the treatment of primary and secondary liver malignancies by pECT., (© 2025 Tim Wilke et al., published by Sciendo.)

Objective: This study aims to assess the impact of intravenous infusion of fospropofol disodium on lipid metabolism and the inflammatory response in individuals with hyperlipidemia., Methods: A total of 360 preoperative individuals with hyperlipidemia were selected and randomly assigned to either the treatment group or the control group, with 180 participants in each group. The treatment group received an induction dose of fospropofol disodium at 10 mg/kg intravenously, followed by maintenance at a rate of 10 mg/(kg·h). The control group was administered propofol intravenously at 2 mg/kg for induction and maintained at 4 mg/(kg·h). All other medications were consistent between the two groups. Blood samples (3 ml of venous blood) were collected from patients at four-time points: 1 day before surgery (T 0 ), 3 h after anesthesia induction (T 1 ), 4 h post-surgery (T 2 ), and 24 h post-surgery (T3), to measure levels of triglycerides (TG), cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB). C-reactive protein (CRP) and interleukin-6 (IL-6) levels were assessed at T 0 and T 3 . Sedation onset time and adverse reactions were recorded for both groups., Results: At T 0 , the control group exhibited increased TG, CHOL, LDL-C, ApoB, and the ApoB/ApoA1 ratio, while the ApoA1 level had decreased. The LDL-C level and the ApoB/ApoA1 ratio showed significant increases (P < 0.01). Both groups showed elevated CRP and IL-6 levels at T 3 (P < 0.01). Compared to the control group, the treatment group demonstrated reduced levels of TG, CHOL, LDL-C, ApoB, and the ApoB/ApoA1 ratio at T 1 -T 3 , while ApoA1 levels were higher at T1-T2 (P < 0.01 or P < 0.05). The sedation onset time was notably longer in the treatment group, and the incidence of injection-related pain, respiratory depression, hypotension, and other adverse reactions was significantly lower (P < 0.01)., Conclusion: Compared with propofol, intravenous infusion of fospropofol disodium for more than 3 h during anesthesia has lesser impact on lipid metabolism in patients with hyperlipidemia and does not increase inflammatory factors levels., Competing Interests: Declarations. Ethics approval and consent to participate: This controlled trial was approved by the Ethics Committee of Guangyuan First People’s Hospital (Approval Number: GYYYKY20220102901) and registered in the Chinese Clinical Trial Register website ( www.chictr.org.cn , ChiCTR2400088910). This study was conducted in accordance with the declaration of Helsinki. Written informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: The objective of this study was to investigate the efficacy and safety of tranexamic acid (TXA) in hepatectomy when administered as per the standardized protocol of controlled low central venous pressure (CLCVP)., Methods: This study was a randomized, double-blind, controlled study. Patients who fulfilled the inclusion criteria were randomly assigned to the TXA group (group T) or the placebo group (group N). The central venous pressure (CVP) was maintained at below 5 cmH2O before complete dissection of the liver parenchyma. Patients in group T received an intravenous infusion of 10 mg/kg of TXA 30 min before surgery, and it was continuously pumped intravenously at a rate of 1 mg/(kg.h) until the end of surgery. Patients in group N were infused with 1 mL/kg of normal saline 30 min before surgery, and it was continuously pumped intravenously at a rate of 0.1 mL/(kg.h) until the end of surgery. The primary outcome indicators were intraoperative blood loss, blood transfusion rate, intraperitoneal drainage at 24 h after surgery, and the occurrence of compound bleeding within 30 days., Results: The baseline indicators were similar (P > 0.05), and there was no significant difference in intraoperative blood loss between the two groups, but the red blood cell transfusion rate was lower in the T group than in the N group (P < 0.05). The infusion volume, surgical field grade, and surgery duration were comparable between the two groups (P > 0.05). Patients in group T had a shorter hilar occlusion time, lower D-dimer and fibrinogen degradation products (FDPs) on the day of surgery, and significantly less intraperitoneal drainage at 24 h after surgery (all P < 0.05). There were two cases of compound bleeding and three cases of thromboembolism among patients in group N, but there were no such complications in group T., Conclusion: The use of TXA in hepatectomy under CLCVP reduced the intraoperative blood transfusion rate and improved the postoperative bleeding outcome without increasing the risk of adverse events such as hepatic and renal insufficiency and thrombosis., Competing Interests: Declarations. Human ethics and consent to participate: This study was conducted with approval from the Ethics Committee of Second Affiliated Hospital of Kunming Medical University (Approval Number: shen-YJ-2023-159). This study was conducted in accordance with the declaration of Helsinki. Written informed consent was obtained from all participants. Clinical registration: This study was registered in registered in the Chinese Clinical Trial Registration Center (No. ChiCTR2300076300) on September 29, 2023. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: A case of successful transition from high-dose epoprostenol to high-dose subcutaneous treprostinil for treatment of pulmonary arterial hypertension (PAH) is reported., Summary: PAH is a chronically progressive disease characterized by pulmonary artery luminal narrowing that causes increased pulmonary artery pressures leading to right ventricular failure. Parenteral prostacyclin analogues, such as epoprostenol and treprostinil, are direct vasodilators and are cornerstones of therapy for patients with severe disease that have been proven to reduce mortality and increase exercise tolerance. These agents must be administered continuously via intravenous or subcutaneous devices and are high-risk medications due to their potent vasodilatory actions. Chronic use of these medications requires constant attention from both providers and patients because of potential complications including central venous catheter infection, thromboembolism, therapy interruptions, and other undesirable consequences. This case report describes management of a 35-year-old male patient on high-dose outpatient intravenous epoprostenol (101 ng/kg/min; dosing weight, 47 kg) for treatment of PAH who was admitted to the hospital with a malfunctioning central venous catheter. Surrounding manipulation of the central catheter, the patient experienced an ischemic stroke that led to cognitive disability resulting in a lack of ability to manage his previously used home infusion device. The patient was successfully transitioned from intravenous epoprostenol to subcutaneous treprostinil (discharge dose, 200 ng/kg/min) over 5 days by infusing both medications simultaneously and adjusting doses based upon patient-reported symptoms., Conclusion: This successful transition from high-dose epoprostenol to high-dose subcutaneous treprostinil demonstrates the importance in considering patient-specific factors during high-risk medication transitions, the value of a patient-directed flexible prostacyclin transition plan, and the benefit of institutional training and education in ensuring the safe use of parenteral prostacyclin analogues., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: Etoposide is an antineoplastic agent widely used to treat pediatric and adult cancers. Critically ill patients are expected to receive several intravenous pharmaceutical drugs while admitted to hospitals. When compatibility data are available, intravenous drugs may be administered simultaneously through the Y-site. This study aimed to determine the compatibility of etoposide during simulated Y-site administration with 45 continuous-infusion drugs that are commonly administered in tumor critical care units., Methods: Etoposide was diluted to a concentration of 0.25 mg/mL in 0.9% sodium chloride (NS) and other intravenously tested drugs were reconstituted according to the manufacturer's recommendations to the final clinical desired concentrations. Y-site administration was simulated in vitro by mixing 5 mL etoposide with other diluted intravenous medications under aseptic conditions in a 1:1 ratio. Compatible solutions were withdrawn at certain time intervals (0, 1, 2, 4 hours) after mixing and tested visually, using a Tyndall beam, pH, turbidity, insoluble particles, and UV absorption as measures of compatibility., Results: Etoposide was compatible with 38 (84%) of the 45 drugs tested within four hours. Glutathione and human granulocyte colony-stimulating factor immediately showed incompatibility with etoposide. Within 1 h, four medications (cefuroxime sodium, ilaprazole sodium, mycophenolate, and xuebijing) were incompatible. Within 4 h, one medications (ceftazidime) were also found to be incompatible with etoposide under observation., Conclusion: Seven of the 45 common medications in tumor critical care tested with etoposide were incompatible within 4 h. If co administration is inevitable and the drug is infused through a port catheter, a larger volume of saline (NS) or dextrose 5% in water (D5W) should be used to flush the port catheter before and after the etoposide infusion to clean the lumen of the port catheter., Competing Interests: The authors declare no conflicts of interest in this work., (© 2025 Ding et al.)

Objective: Extended meropenem infusion is increasingly employed to enhance clinical outcomes in critically ill patients. Nonetheless, investigations into such dosing regimens in renal-impaired patients undergoing continuous renal replacement therapy (CRRT) are scarce. This study aims to perform a population pharmacokinetic (PK) analysis of prolonged meropenem infusion in critically ill CRRT patients to inform optimal dosing regimens., Methods: Ninety-four concentrations from 21 Chinese critically ill CRRT patients receiving 1 g meropenem every 8-12 hours infused over 2-3 hours were utilized to construct the population PK model. Monte Carlo simulations were employed to assess the efficacy based on PK/PD targets (100% f T >MIC or 100% f T >4×MIC ) and the risk of nephrotoxicity (trough concentration ≥45 mg/L) for extended meropenem dosing regimens (0.5-2 g with a 3-hour infusion administered every 6-12 hours)., Results: Meropenem concentration data was adequately described by a one-compartment model with linear elimination, and creatinine clearance (CLCR) significantly influenced meropenem's endogenous clearance. 0.5 g q6h and 1 g q8h could achieve desirable attainment of 100% f T >MIC target against an MIC≤4 mg/L, with negligible risk of toxicity for CRRT patients across a CLCR range of 10-50 mL/min. 2 g q6h and 2 g q8h is required for targeting 100% f T >4×MIC for the patients, but the associated risk of toxicity is very high (>20%)., Conclusion: A population PK model was developed for prolonged meropenem infusion in Chinese CRRT patients, and 0.5 g q6h and 1 g q8h may be the optimal regimen for prolonged infusion., Competing Interests: The authors declare no conflicts of interest., (© 2025 Peng et al.)

Objectives: To evaluate the effect of 25% albumin in addition to standard treatment (ST) in children with fluid refractory severe dengue on morbidity and mortality compared with ST alone., Methods: This was a comparative study that enrolled children aged 2 months to 18 years with severe dengue who presented to emergency between 2021-2023. Patients who were in circulatory shock after 40 mL per kg of crystalloid/colloid bolus within 1-2 hours of admission were equally categorized into two groups. ST-plus albumin group enrolled patients prospectively and received an albumin infusion (0.5-1 g/kg) in addition to ST as per WHO guidelines. ST-only group enrolled patients retrospectively who had received only ST. Demographic data, clinical course, laboratory parameters and outcomes were compared., Results: Baseline characteristics were comparable between the two groups. Survival was significantly higher in the ST-plus albumin group (97.1%) than in the ST-only group (77.1%); P = 0.043. The need for inotropic support was significantly lower in ST-plus albumin group (60%) than ST-only group (94.3%); P < 0.001. The incidence of bleeding (P = 0.008), AKI (P = 0.065), need for diuretics (P = 0.029) and renal replacement therapy (P = 0.028) were significantly lower in children in the ST-plus albumin group than ST-only group., Conclusion: The addition of 25% albumin to fluid refractory severe dengue early in the disease course led to better survival, less fluid accumulation and bleeding, and lesser incidence of complications.

Background: Ciprofol (CIP) for procedural sedation and analgesia (PSA) for painless gastrointestinal endoscopy (GE) can cause respiratory or cardiovascular complications. The literature suggests that intravenous (IV) lidocaine infusion can alleviate visceral pain and enhance humans' ventilator response to CO 2 . Therefore, it was hypothesized that IV lidocaine could reduce the CIP dose for painless GE and improve recovery time., Methods: This randomized placebo-controlled trial included 40 patients undergoing GE. After CIP titration for unconsciousness, patients in group L were given IV lidocaine (1.5 mg/kg bolus dose, then a 2 mg/kg/h continuous infusion); the same volume saline as placebo was given for N group patients. The primary endpoint was the required CIP dose. Secondary endpoints were: endoscopic examination time, awakening time, post-anesthesia care unit (PACU) discharge time, pain and fatigue after awakening, adverse events, and endoscopist's and patient's satisfaction., Results: Both cohorts had comparable demographic characteristics. Group L's CIP consumption was decreased by 23.0% than the N group (47.38 ± 7.45 mg vs. 61.50 ± 9.44 mg, respectively, p < 0.001). Awakening time (P=0.002), PACU discharge time (P < 0.001), pain (P = 0.008), and fatigue (P = 0.004) after awakening were also reduced in group L. Furthermore, group L had higher satisfaction scores than group N (P = 0.017). No marked difference was identified in the incidence of unfavorable effects (P > 0.05 for all)., Conclusions: Lidocaine IV infusion caused a 23.0% reduction in CIP requirements during GE. Furthermore, post-endoscopic pain and fatigue were also improved, thus suggesting that lidocaine is an efficient therapeutic option., Trial Registration: This trial has been submitted to the Chinese Clinical Trial Registry (registration number: ChiCTR2300069868, registration date: 28/03/2023)., Competing Interests: Declarations. Ethics approval and consent to participate: The ethical board of Jinling hospital authorized this trial (2023DZKY-010-01), which was then submitted to the Chinese Clinical Trial Registry (registration number: ChiCTR2300069868, registration date: 28/03/2023).The protocol of the study was performed in accordance with the Declaration of Helsinki. The quality control of this study was conducted by GCP guidelines. Written informed consent was obtained from all patients before enrollment. Consent for publication: Not application. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: This randomized controlled trial was performed to explore efficacy of continuous intravenous infusion of lidocaine on postoperative sore throat after laryngeal mask insertion., Methods: In this prospective trial one hundred and sixty general anesthesia surgery patients (20 to 60 years) using laryngeal mask airway were randomly divided into control group (Group C, saline as placebo), lidocaine gel group (Group LG, lidocaine gel applied to the surface of the laryngeal mask), single intravenous lidocaine group (Group SL, intravenous lidocaine 1.5 mg/kg at induction of anesthesia) and continuous infusion of lidocaine group (Group CL, a bolus of 1.5 mg/kg, followed by an infusion of 2 mg/kg/h until the end of the surgical). The primary outcomes were the incidence and severity of POST at the time of laryngeal mask removal (T1), 2 h (T2), 6 h (T3), and 24 h (T4) after removal. The secondary outcomes included the incidence of adverse events such as hoarseness, cough, and tongue numbness., Result: Within 24 h after extubation, the incidence and severity of POST was significantly lower in group CL than that in group C at all time points. In contrast, compared with group C, the incidence and severity of POST in group SL was lower only at T1. The incidence of hoarseness and cough in group CL were significantly lower than that in group C at T1 and T2. In group SL, the incidence of hoarseness and cough was lower than that in the group C only at T1. In group LG, the incidence of tongue numbness was significantly higher than that in group C only at T1, and there were no significant difference in the four groups at the other time points., Conclusion: Continuous infusion of lidocaine is effective in reducing the incidence and severity of POST after laryngeal mask ventilation, as well as reducing the incidence of adverse effects such as hoarseness and cough., Trial Registration: Chinese Clinical Trial Registry (ChiCTR2300070339,04/10/2023)., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Medical Ethics Committee of Lishui City People’s Hospital in Lishui, China (LLW-FO-403) and was registered at the Chinese Clinical Trial Registry (ChiCTR2300070339, on April 10th, 2023). It adheres to the principles outlined in the Declaration of Helsinki and the CONSORT 2010 guidelines. Informed consent regarding study enrollment and anonymized data collection and publication was obtained from all patients. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Aims: Landiolol, an ultra-fast acting super-selective beta-blocker, was investigated for the first time in Europe in a prospective clinical study for the management of supraventricular tachycardia (SVT) among paediatric patients., Methods and Results: The LANDI-PED study was a prospective, multicentre, open-label, uncontrolled phase III study aiming to investigate the efficacy, safety, and pharmacokinetics (PK) of landiolol in paediatric patients. Sixty patients in surgical and non-surgical settings aged ≥1 day to <18 years with SVTs of various aetiologies received landiolol as a continuous intravenous infusion starting with 5 μg/kg/min titrated up to 40 μg/kg/min depending on heart rate (HR) reduction for up to a maximum of 24 h. The primary endpoint was restoration of normal sinus rhythm (NSR) within 210 min of infusion start. The primary endpoint was achieved in 15 (25.0%) patients. A total of 24 (40.0%) patients achieved a HR reduction of at least 20% within 210 min of landiolol infusion. A significant HR reduction was observed within minutes post-infusion, with a mean (±SD) reduction after 210 min of -13.2 (±11.5)% (P < 0.0001) in the overall population. By infusion end, 51.7% of patients achieved HR reduction of at least 20% from baseline and/or NSR conversion. The PK characteristics were consistent with the known profile of landiolol among adults. The most common adverse drug reaction was hypotension (10%)., Conclusion: Landiolol is effective and safe in the treatment of SVTs in the paediatric population as demonstrated by reduction of HR and/or restoring NSR. Landiolol was well tolerated with no novel safety concerns reported., Clinical Trial Registration: EU Clinical Trial Register; EudraCT Number: 2015-001129-17., Competing Interests: Conflict of interest: M.U., S.S, C.C., C.K., K.K., and J.A. are employees of AOP Orphan Pharmaceuticals GmbH. G.K. is a board director of AOP Health International Management AG. All other authors declare no conflicts of interest regarding this publication., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objectives: In cardiac surgery patients, acute kidney injury (AKI) frequently occurs in the setting of haemodynamic instability and treatment with temporary mechanical circulatory support (tMCS). Recent evidence suggests amino acids (AA) infusion may reduce AKI rate. However, the effect of AA infusion in patients requiring tMCS may be less effective., Methods: We performed a secondary analysis of the PROTECTION multicentre randomized controlled trial including all patients treated with tMCS. Patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomized to receive 2 g/kg ideal body weight/day of intravenous AA to a maximum of 100 g/day or matching placebo from operating room admission until up to 3 days, receipt of renal-replacement therapy, discharge from ICU or death. The primary outcome of the PROTECTION study was the rate of AKI, as in this secondary analysis. A total of 3511 patients were randomized in the study., Results: We studied 232 patients who received tMCS, 112 randomized to AA infusion and 120 to placebo. The median preoperative serum creatinine value was significantly higher among AA group patients (AA: 1.08, interquartile range 0.90-1.26; placebo: 0.98, interquartile range 0.85-1.15; P = 0.02). The rate of AKI, however, was lower in patients randomized to AA (44.6% vs 60.8%; relative risk 0.73; 95% confidence interval (0.57-0.94); P = 0.01; number needed to treat = 6). We found no significant differences in secondary outcomes., Conclusions: Short-term AA infusion appears to reduce rate of AKI among patients requiring tMCS. Use of AA in this population at high-risk for renal failure appears justified., Clinical Trial Registration Number: ClinicalTrials.gov NCT03709264., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

High-risk pulmonary thromboembolism (PTE) is a form of venous thromboembolism that refers to severe obstruction of pulmonary vessels, which causes right ventricular failure and hemodynamic instability. High-risk PTE has a high mortality rate unless immediate reperfusion treatment is done. Systemic thrombolysis is recommended for patients with high-risk PTE. The approved regimen for high-risk PTE is the accelerated intravenous administration of recombinant tissue-type plasminogen activator (rtPA) 100 mg over 2 hours. Herein, we present a case of high-risk PTE in a 74-year-old woman with a high risk of bleeding due to a recent pelvic fracture and head trauma who was successfully treated with a slower infusion of 100 mg rtPA over 4 hours. The modified infusion rate of 100 mg rtPA over 4 hours is an effective regimen for thrombolysis in acute high-risk PTE. It might have a lower risk of bleeding complications, which makes it a good option for patients with high bleeding risk.

Study Objective: VVZ-149 is a small molecule that inhibits the glycine transporter type 2 and the serotonin receptor 5-hydroxytryptamine 2 A. In this Phase 3 study, we investigated the efficacy and safety of VVZ-149 as a single-use injectable analgesic for treating moderate to severe postoperative pain after laparoscopic colectomy., Design: Randomized, parallel group, double-blind, Phase 3 clinical trial (Trial no. NCT05764525)., Setting: 5 tertiary referral centers in South Korea., Patients: 284 patients undergoing laparoscopic colectomy., Interventions: A continuous 10-h intravenous infusion of VVZ-149 (n = 141) or placebo (n = 143) administered after emergence from anesthesia., Measurements: Pain intensity was assessed using a numeric rating scale (NRS) from the start of infusion for 48 h. The primary efficacy measure was the Sum of Pain Intensity Difference (SPID) for the first 12 h after the start of drug infusion. Other efficacy measures included SPID at other time points, opioid consumption via on-demand patient-controlled analgesia (PCA) and rescue medication, and proportion of patients who did not require rescue opioids for 48 h post-dose., Main Results: Pain relief as measured by SPID was significantly improved by 35 % in the VVZ-149 group compared to the placebo group at 6 h (p = 0.0193) and 12 h (p = 0.0047) after the start of infusion. Significantly lower pain intensity scores were observed between 4-10 h in the VVZ-149 group compared to the placebo group (p = 0.0007), reaching mild pain (mean NRS <4) at 8 h. VVZ-149 alleviated pain during the first 12 h post-dose with 30.8 % less opioid consumption and 60.2 % fewer PCA requests when compared with placebo. A higher proportion of patients receiving VVZ-149 were rescue opioid-free during 2-6 h (p = 0.0026) and 6-12 h (p = 0.0024) compared with the placebo group. VVZ-149 administration in post-colectomy patients was generally safe and well tolerated., Conclusions: When compared to placebo, VVZ-149 infusion demonstrated a significant reduction of pain within the first 12 h after surgery with a substantial decrease in opioid use. VVZ-149 rapidly lowers the pain intensity starting at as early as 4 h post-dose, allowing subjects to experience mild pain levels from 8 h through 48 h. Therefore, the analgesic effect of VVZ-149 was shown to effectively relieve pain and reduce opioid use for treating moderate to severe pain in the early postoperative care setting., Registration Number: Trial Number NCT05764525., Competing Interests: Declaration of competing interest Jae-Hyon Bahk reports financial support was provided by Vivozon Inc. Ho-Jin Lee reports financial support was provided by Vivozon Inc. Ji-Yeon Sim reports financial support was provided by Vivozon Inc. Duk Kyung Kim reports financial support was provided by Vivozon Inc. Ah-Young Oh reports financial support was provided by Vivozon Inc. Seung Zhoo Yoon reports financial support was provided by Vivozon Inc. Young-Jin Moon reports financial support was provided by Vivozon Inc. Mi-Hye Park reports financial support was provided by Vivozon Inc. In Sun Park reports financial support was provided by Vivozon Inc. Inkyung Song reports financial support was provided by Vivozon Inc. Jina Kim reports financial support was provided by Vivozon Inc. Sang Rim Lee reports financial support was provided by Vivozon Inc. Sunyoung Cho reports financial support was provided by Vivozon Inc. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Current guidelines recommend the use of glycoprotein IIb/IIIa (GpIIb/IIIa) inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) only as a bail-out therapy. However, drug penetration to the jeopardised area may not be achieved due to impeded blood flow and increased microvascular resistance. Aim of our study is to investigate the impact of distal intracoronary GpIIb/IIIa inhibitor agent infusion in STEMI patients. Primary endpoints were microvascular obstruction (MVO) and infarct size., Methods: Patients with STEMI who have high thrombus burden or slow-flow/NR phenomenon and undergoing primary percutaneous coronary intervention (pPCI) were enrolled. Tirofiban was the preferred GpIIb/IIIa inhibitor. Patients were assigned to the systemic intravenous infusion group and intracoronary infusion group in whom bolus dose of tirofiban was distally infused to the infarct related artery. MVO and size of the infarct size were assessed via cardiac MRI., Results: We prospectively included 75 patients and mean follow-up duration was 383 days. Baseline characteristics were similar between groups except a lower rate of diabetes in distal intracoronary infusion group ( p  = .006). There was no significant difference in localisation of myocardial infarction, ischaemia duration and preloading of P2Y12 inhibitor between groups. MVO ( p  = .048) and infarct size ( p  = .030) were significantly lower in distal intracoronary infusion group., Conclusions: Cardiac MRI based assessment revealed that intracoronary administration of GpIIb/IIIa inhibitors distal to the culprit lesion was associated with reduced MVO and infarct size in high thrombotic risk STEMI patients undergoing pPCI.

There is accumulating evidence that cerebrospinal fluid (CSF) concentrations of nimodipine correlate with long-term outcome of patients after subarachnoidal hemorrhage (aSAH) by impeding cerebral ischemia. However, pharmacological data on simultaneous serum vs. CSF and intraparenchymal nimodipine values are rarely reported in larger patient groups. Nimodipine concentrations were determined in plasma, CSF, and cerebral interstitial fluid (ISF), at steady state after oral (6 × 60 mg/day) and intravenous (0.5, 1, 1.5 and 2 mg/h) administrations in 10 patients after aSAH. Area under the concentration time curve (AUC 0-24 ) for intravenous nimodipine was highest at an infusion rate of 2 mg/h in plasma (1335.87 ± 591.09 mg*h/L), followed by CSF (39.53 ± 23.07 mg*h/L), resulting in an overall CSF penetration ratio of 3.8% (±1.5) (AUC CSF /AUC plasma ). In contrast, nimodipine levels were significantly lower in both plasma (AUC 0-24 298.32 ± 206.52 mg*h/L) and CSF (AUC 0-24 34.8 ± 16.56 mg*h/L) after oral administration. In cerebral ISF, low amounts of nimodipine were detectable in only 4 patients at an infusion rate of 1.5 and 2 mg/h as well as following oral administration. We found significantly higher CSF nimodipine levels in patients during intravenous compared to oral administration. In contrast, only low amounts of nimodipine were detected in the ISF after both oral and intravenous administration. Our findings strongly suggest that the main clinical nimodipine effect of impeding life threatening cerebral ischemia is mediated through significant higher CSF levels after intravenous administration, more likely effective than oral administration., (© 2024 The Author(s). Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

Purpose: Down syndrome regression disorder (DSRD) is a rare neuropsychiatric condition affecting otherwise healthy individuals with Down syndrome. Multiple studies on DSRD have revealed that immunotherapy with intravenous immunoglobulin (IVIg) is both safe and effective, although site of infusion has never been studied. This study sought to evaluate the safety and tolerability of IVIg in individuals with DSRD receiving home-based infusions., Methods: A single-center, retrospective chart review evaluating infusion reactions was performed for individuals meeting criteria for DSRD and having received IVIg infusions between 2019 and 2024. Adverse events (AEs) were evaluated for severity and need for alterations in infusion plan. A cohort of individuals receiving home-based infusions was compared with a cohort of individuals receiving infusions at an academic medical center., Findings: A total of 315 individuals (162 institutional infusions [51%] and 153 home infusions [49%]) met the inclusion criteria. There were no statistical differences between the demographic and clinical features of the cohorts. Individuals receiving home infusions had the same rate of AE during an infusion (P = 0.14), although they did have a lower number of total AEs (P < 0.001). Individuals receiving home infusions experienced a lower number of behavioral issues with infusions (P = 0.03) and had significantly lower discontinuations of infusions secondary to behavioral issues (P = 0.04)., Implications: Rates of AEs and serious AEs in those with DSRD were the same regardless of site of infusion. These data should be considered in policy regarding the appropriateness of home-based infusions as a safe alternative, when suitable for patients and caregivers, for individuals with DSRD., Competing Interests: Declaration of competing interest None, (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Perioperative intravenous lidocaine infusion can improve the quality of recovery (QoR) in patients undergoing functional endoscopic sinus surgery (FESS), but the effect of esmolol on recovery has been rarely studied. The aim of this study to compare the effects of esmolol and lidocaine on the QoR in patients with FESS., Methods: A total of 60 patients were randomly divided into Group E: intravenous esmolol (0.5 mg/kg for 1 min, followed by 3.0 mg/kg/h); Group L: intravenous lidocaine (2.0 mg/ kg for 10 min, followed by 2 mg/kg/h). The quality of recovery-15 (QoR-15) score was compared. Other parameters compared were the numeric rating pain scale (NRS), haemodynamic data, Surgical field conditions, intraoperative drug dosages, number of cases of remedial analgesia, time to awakening and incidence of postoperative sore throat (POST) as well as postoperative nausea and vomiting (PONV)., Results: The mean difference in the QoR-15 score between Group E and Group L on postoperative day 1 (POD1) was - 1.37 (95% CI - 2.75 to 0.01; P < 0.001 for noninferiority), indicating the noninferiority of esmolol. Haemodynamic changes and intraoperative nitroglycerine dosages were significantly lower in Group E than in Group L (P < 0.05). The scores of surgical field quality (SSFQ) was higher in Group E than in Group L (P < 0.05)., Conclusion: Intravenous infusion of esmolol is not inferior to lidocaine in the quality of postoperative recovery in patients with FESS, and is more advantageous in terms of the quality of the surgical field, attenuation of intraoperative haemodynamic fluctuations, and postoperative awakening., Competing Interests: Declarations. Conflict of interest: The author declare that they have no conflict of interest. Presentation: none., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Changes in hydration status may affect myocardial native T1 and T2 values and influence the clinical interpretation. We aimed to assess the impact of acute preload augmentation on native T1 and T2. Cardiovascular magnetic resonance (CMR) native T1 and T2 mapping were performed twice on the same day in 20 healthy participants before and after an acute preload augmentation by a 2-liter intravenous infusion of isotonic sodium chloride (0.9%). Test-retest reproducibility was evaluated in 30 healthy participants with two consecutive CMR examinations on the same day. Sixteen participants were included in both substudies. In the 20 healthy participants undergoing acute preload augmentation (55% males, mean age (interquartile range [IQR]) 43 [29-51] years), native T1 increased with 17 ms (95% confidence interval [CI] 7 to 26; p = 0.001), T2 with 1.7 ms (95% CI 0.8 to 2.4; p < 0.001), and blood T1 with 46 ms (95% CI 28 to 65; p < 0.001). Test-retest variability in 30 healthy participants (47% males, median age 43 [28-52] years) showed 95% limits of agreement (LOA) of ± 26 ms for native T1, ± 2.1 ms for T2, and ± 57 ms for blood T1. In the 16 participants included in both substudies, the mean differences in changes post-infusion versus test-retest were 22 ms (95% CI 8 to 36; p = 0.01) for native T1, 1.9 ms (95% CI 0.9 to 2.9; p = 0.001) for T2, and 62 ms (95% CI 32 to 91; p < 0.001) for blood T1. Native T1 and T2 values increased following acute preload augmentation. However, the changes were within the 95% LOA of the test-retest reproducibility., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Inappropriate use of intravenous (IV) fluids results in fluid overload, electrolyte disturbances, and increased costs., Aim: To describe IV fluid prescribing and its appropriateness in hospitalised patients., Method: A point prevalence study was conducted at two sites (academic and general) of a tertiary care hospital in Belgium. All inpatients (except those in the operating theatre) and all IV fluids prescribed during a 24-h period were analysed. Data collected included type, rate and volume administered. Each IV fluid was classified by indication (i.e., resuscitation/replacement, maintenance, catheter patency management, drug administration). Appropriateness was assessed using predefined criteria and validation by attending clinicians., Results: IV fluids were administered to 60% (297) of patients, with a median of 3 [IQR 0.5-6] IV fluid bags per patient and a median daily volume of 1000 ml [IQR 100-1550]. Amongst the 1162 IV fluid prescribed bags, 61.2% (712) were for drug administration, 22.1% (257) for catheter patency, 9.7% (112) for maintenance and 7.1% (82) for replacement/resuscitation. Inappropriate use was found for 56.9% (169) of patients with an IV fluid, representing a median volume of 300 ml per patient [IQR 10-500], and median costs of 4.60 € per patient [IQR 0.4-6.7]., Conclusion: Inappropriate IV fluid use is frequent in hospitalised patients, and results in significant costs. Optimisation strategies are needed., Competing Interests: Conflicts of interest: The authors declare there are no conflicts of interest regarding the present work., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: Voriconazole, a second-generation triazole, is used to prevent and treat invasive fungal infections. This study aimed to assess the bioequivalence and safety of test and reference voriconazole intravenous infusion under the fasting conditions., Methods: The study employed a randomized, open-label, single-dose, two-period, crossover trial design. Eligible subjects randomly assigned for screening, receiving either the test or reference voriconazole for intravenous infusion during the first period, with alternative products administered during the second period. The washout period lasted 7 days. The single administration dosage was fixed at 6 mg/kg. Nineteen blood samples were collected at pre-dose and up to 46 h post-dose for each subject. The validated LC-MS/MS method was used to determine the concentration of voriconazole in plasma., Results: Twenty-four subjects were enrolled in the study, comprising 20 males and 4 females. The primary pharmacokinetic parameters (mean ± SD) were as follows: C max was 4631.20 ± 744.80 and 5008.09 ± 1020.77 ng/mL, AUC 0-t was 27,121.07 ± 12,658.03 and 28,674.08 ± 13,118.05 ng*h/mL, and AUC 0-∞ was 28,056.10 ± 14,428.76 and 29,616.29 ± 14,783.70 ng*h/mL for the test and reference formulations, respectively. The 90 % confidence intervals of geometric mean ratios for C max , AUC 0-t , and AUC 0-∞ fell within the range of 80.00 % to 125.00 %. Both products were well tolerated and no serious adverse event was observed., Conclusion: The test and reference voriconazole intravenous infusion demonstrated bioequivalence and good tolerability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 American Pharmacists Association. Published by Elsevier Inc. All rights reserved.)