Characteristics of Cumulative Annual Radiation Exposure in Young Intensive Care Unit Survivors.

OBJECTIVES: Patients admitted to the intensive care unit (ICU) are at high risk for hazardous medical radiation exposure. However, the cumulative annual radiation exposure in ICU survivors remains unknown. METHODS: This was a single-center retrospective study of all critically ill adult patients admitted to the 64-bed adult medical ICU at a quaternary medical center. The study included patients aged 18 to 39 years admitted through the year 2013 (January 1, 2013-December 31, 2013) who survived their respective ICU admission. RESULTS: A total of 353 patients were included in the study. The median cumulative effective dose (CED) for the calendar year was 9.14 mSv (interquartile range, 1.74-27 mSv). In 11.6% of the patients (n = 41), CED was more than 50 mSv, while 5.1% of the patients (n = 18) exceeded annual CED of 100 mSv. Overall, radiation exposure from ICU-related imaging studies was lower than those from other medical settings (mean difference, -9.2 ± 83.6; P < 0.05). However, there was no statistically significant difference in exposure (ICU versus non-ICU) when restricting the analysis to patients with a CED of greater than 50 and greater than 100 mSv. Eighty-seven percent of the original cohort was alive at the end of the year. CONCLUSIONS: Young ICU survivors are at risk for high annual radiation exposure from both ICU and non-ICU sources. A subset is exposed to hazardous annual radiation exposure in excess of 100 mSv.

Single-Center Experience of Outcomes and Prescribing Patterns of IV Immunoglobulin Use in Critically Ill Patients.

Previous literature has not compared prescribing practices of IV immunoglobulin in medical ICU survivors and nonsurvivors. The objective of this study was to study IV immunoglobulin use in patients admitted to a medical ICU evaluating differences between hospital survivors and nonsurvivors in regards to level of evidence supporting use, prescribing patterns, and cost. DESIGN: Retrospective, observational study. SETTING: Single, academic medical center medical ICU. PATIENTS: Adults who received greater than or equal to 1 dose of IV immunoglobulin during their medical ICU admission from 2011 to 2018. INTERVENTIONS: Prescribing patterns, level of evidence supporting use, and cost. MEASUREMENTS AND MAIN RESULTS: A total of 389 patients received greater than or equal to 1 dose of IV immunoglobulin for 46 discrete indications and 36.5% of indications had low-quality data supporting use of IV immunoglobulin. The primary indication for IV immunoglobulin was hypogammaglobulinemia (35.5%) followed by antibody-mediated lung transplant rejection (15.4%). Nonsurvivors received lower median dosing (g/kg) and number of doses compared with survivors (0.4 g/kg [0.4-1 g/kg] vs 0.5 g/kg [0.4-1 g/kg] [p = 0.0003] and 1.0 [1-2] vs 2 [1-3] doses [p = 0.0001], respectively). Dosing was based on ideal body weight in 258 patients (66%). High-quality data supported IV immunoglobulin use in 15 patients (4%). The median cost per dose of IV immunoglobulin in nonsurvivors was $4,893 ($4,078-$8,155) versus $5,709 ($4,078-$10,602) in survivors (p = 0.04). CONCLUSIONS: IV immunoglobulin is prescribed for many indications in the medical ICU with low-quality evidence supporting its use and dosing regimens are variable. Hospital survivors received a higher dose and greater number of doses of IV immunoglobulin compared with nonsurvivors. National guidelines are needed to help inform IV immunoglobulin utilization and reduce healthcare costs.