Biomedical subjects

Richard M Hackbarth

Publications and source records attributed to Richard M Hackbarth.

3 recordsLinked to original sources

PubMed2006

Medication errors and patient complications with continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) is commonly used for renal support in the intensive care unit. While the risk of medication errors in the intensive care unit has been described, errors related specifically to CRRT are unknown. The purpose of this study is to characterize medication errors related to CRRT and compare medication errors that occur with manually compounded solutions versus commercially available solutions. We surveyed three separate internet-based, pediatric list serves that are commonly used for communications for programs utilizing CRRT. Data regarding CRRT practices and medication errors were recorded. Medication errors were graded for degree of severity and compared between programs using manually compounded dialysis solutions versus commercially available dialysis solutions. In a survey with 31 program responses, 18 reported medication errors. Two of the 18 were related to heparin compounding, while 16/18 were due to solution compounding errors. Half of the medication errors were classified as causing harm, two of which were fatal. All medication errors were reported by programs that manually compounded their dialysis solutions. Medication errors related to CRRT are associated with a high degree of severity, including death. Industry-based, commercially available solutions can decrease the occurrence of medication errors due to CRRT.

Child↗

PubMed2005

Zero balance ultrafiltration (Z-BUF) in blood-primed CRRT circuits achieves electrolyte and acid-base homeostasis prior to patient connection.

Infants requiring CRRT present a unique challenge due to the large circuit volume to blood volume ratio. Blood priming is often used, but some patients can become unstable during the initiation of CRRT due to electrolyte and acid-base imbalance. We postulated that using Z-BUF we could normalize electrolytes and improve the acid base status of the prime prior to patient connection. To test this we set up a circuit using the Baxter BM-25 CRRT pump, a polysulfone or AN-69 membrane, and a three-way stopcock. The circuit was primed with a 60/40 mix of expired autologous donor pRBCs and 5% albumin. The modalities of CVVH, CVVHD, and CVVHDF were compared for relative efficacy. Electrolytes, lactate, pH, cytokines (TNF-alpha, IL-1beta, bradykinin, and IL-6) were measured. Plasma hemoglobin levels were also measured before and after the Z-BUF procedure. Bradykinin production and elimination in AN-69 membrane circuits were assessed. All lab values equilibrated by 35 minutes. All CRRT modalities were equally efficacious for Z-BUF. Cytokine production or significant hemolysis was not found. In addition, no bradykinin accumulation occurred in AN-69 membrane-containing circuits. We conclude that Z-BUF is a simple and effective way to normalize electrolyte and acid-base status in the CRRT circuit when blood priming is required.

Acid-Base Equilibrium↗

PubMed2002

Survival and functional outcome in pediatric traumatic brain injury: a retrospective review and analysis of predictive factors.

OBJECTIVE: The aim of this study was to evaluate the relationship of patient care variables to survival and functional outcome in the pediatric population with traumatic brain injury. DESIGN: Retrospective chart review. SETTING: A 16-bed pediatric critical care unit in an academic community children's hospital. PATIENTS: A total of 320 consecutive pediatric patients with traumatic brain injuries admitted to our pediatric critical care unit between 1992 and 1996. INTERVENTIONS: Patients were managed using our standard traumatic brain injury protocol. MEASUREMENTS AND MAIN RESULTS: A total of 230 patient variables encompassing demographic data, prehospital, emergency department, and pediatric critical care unit care were recorded. A total of 79 patients were severely injured, with admitting Glasgow Coma Scale scores of < or =10. There were 18 deaths. Only two patients survived without cognition. Ninety-five of 302 survivors required inpatient rehabilitation. Of these, 73 were old enough to be compared using FIMTM scores. At the time of discharge from rehabilitation, 52 patients (71%) were functioning independently, 20 (27%) were moderately dependent, and one patient was completely dependent. Analysis of variables with respect to survival revealed that an inability to maintain a cerebral perfusion pressure of > or =50 mm Hg on the first pediatric critical care unit day (p =.0002) and the presence of bradycardia in the emergency department (p =.0139) were the strongest factors associated with mortality. By using the regression equation generated from this model, we could correctly identify survivors and nonsurvivors with a predictive value of 94%. CONCLUSIONS: The ability to maintain a cerebral perfusion pressure of > or =50 mm Hg was the single most important predictor of traumatic brain injury survival in this study. This suggests that monitoring and optimizing cerebral perfusion pressure is critical to the management of these patients. The relationship between cognitive outcome and therapeutic interventions used to optimize cerebral perfusion pressure is unclear and requires further evaluation in a large prospective study.

Adolescent↗