Publications (2)6.43 Total impact
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Article: Do burn patients cost more? The intensive care unit costs of burn patients compared with controls matched for length of stay and acuity.
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ABSTRACT: Modern intensive care management of burn patients is resource intensive with important ramifications for funding of regional burn services. The aim of this retrospective cohort study was to determine the intensive care unit costs for burn patients compared with nonburn patients matched for length of stay and severity of illness. The patient record was reviewed to compare costs associated with expendables (medications and fluids), investigations (laboratory and radiological tests), and physiotherapy sessions in 13 burn patients and 13 nonburn controls. Medical and nursing staff costs could not be differentially determined between groups. The cost of wound dressings were estimated for burn patients. The mean daily cost of burn patients was Australian dollars (AUD) 700.74 and AUD 697.99 for nonburn controls (P = .97), with an additional AUD 1411 estimated for nursing and medical staffing. There was no significant difference in the cost of expendables or laboratory tests between the groups. The largest drug and laboratory costs in both cases and controls were attributed to the use of meropenem and intravenous antifungals (25% and 30%, respectively) and arterial blood gas analysis (31% and 27%, respectively). Analgesics, anxiolytics, and sedatives costed AUD 21.58 more per day in burn patients than in controls (P = .054). Physiotherapy costs were AUD 18.62 higher per day in burn patients (P = .028), whereas radiology costs were AUD 108.10 higher in the control group (P = .001). Burn dressings costed AUD 120.77 per day. The authors found no significant difference in the mean daily intensive care unit cost of burn patients compared with controls matched for length of stay and acuity. However, physiotherapy and dressing costs were higher in burn patients, and there was a trend to increase costs associated with analgesic/anxiolytic/sedative medications. Antimicrobials accounted for a significant proportion of pharmacy costs in both groups.Journal of burn care & research: official publication of the American Burn Association 05/2010; 31(4):598-602. · 1.37 Impact Factor -
Article: Is continuous infusion ceftriaxone better than once-a-day dosing in intensive care? A randomized controlled pilot study.
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ABSTRACT: To compare the clinical and bacteriological outcome of critically ill patients with sepsis treated by ceftriaxone administered as a once-a-day intermittent bolus dose or by 24 h continuous infusion. We conducted an open-label, randomized controlled pilot study in 57 patients clinically diagnosed with sepsis (suspected/proven infection and systemic inflammatory response syndrome) in a tertiary level intensive care unit. Patients were randomized to receive 2 g of ceftriaxone administered by once-daily intermittent bolus dosing or by 24 h continuous infusion. Clinical and bacteriological outcomes were assessed by blinded clinicians. Fifty-seven patients were enrolled in the study, 50 of whom fulfilled the a priori definition of treatment for 4 or more days. The infusion (n = 29) and bolus groups (n = 28) were similar in terms of demographics, although the median age of those receiving the infusion was younger. Intention-to-treat analysis found no statistically significant differences in the primary outcomes for clinical response (P = 0.17), clinical cure [infusion n = 13/29 versus bolus n = 5/28; adjusted odds ratio (AOR) = 3.74; 95% confidence interval (95% CI) = 1.11-12.57; P = 0.06], bacteriological response (P = 0.41) and bacteriological cure (infusion n = 18/29 versus bolus 14/28; AOR = 1.64; 95% CI = 0.57-4.70; P = 0.52). However, logistic regression in patients that complied with the a priori definitions who received ceftriaxone by continuous infusion (AOR = 22.8; 95% CI = 2.24-232.3; P = 0.008) or patients with a low Acute Physiology and Chronic Health Evaluation (APACHE) II score (AOR = 0.70; 95% CI = 0.54-0.91; P = 0.008) were associated with an improved clinical outcome when age and Sepsis Organ Failure Assessment (SOFA) score at time of study entry were controlled for. This pilot study suggests clinical and bacteriological advantages of continuous infusion of ceftriaxone over bolus administration in critically ill patients in patients requiring 4 or more days of treatment. This sets the scene for a large multicentre double-blind randomized controlled trial to confirm these findings.Journal of Antimicrobial Chemotherapy 03/2007; 59(2):285-91. · 5.07 Impact Factor
