Comparative Analysis of Intravenous Pumps Relocation for Critically Ill Isolated COVID-19 Patients From Bedside to Outside the Patient Room.

OBJECTIVES: To quantify the impact of IV pump relocation for COVID-19 patients from the bedside to outside the patient room on nurse exposure to COVID-19 and conservation of PPE. DESIGN: Original Article. SETTING: Intensive care units at a single-center teaching hospital. PATIENTS: Critically ill COVID-19 patients under contact and special droplet precautions. INTERVENTIONS: Relocation of intravenous pumps for COVID-19 patients from bedside to outside the patient room using extension tubing. MEASUREMENTS AND MAIN RESULTS: The primary objective of the study was to measure the impact of this strategy on COVID-19 exposure, utilizing the number of nurse entries into the patient room as a surrogate endpoint, and extrapolation of this data to determine the reduction or PPE usage. Secondary endpoints included incidence of extravasation, hyperglycemia, hypotension, and diagnosis of CLABSI/bacteremia. A statistically significant reduction in the primary endpoint of the study was observed as room entries prior to pump relocation averaged 15.36 (± 4.10) as opposed to an average of 7.92 (± 2.19) following pump relocation (p < 0.0001). In both pre- and post-pump relocation groups, there was no incidence of extravasation or CLABSI. No significant differences were noted in number of patients experiencing hyperglycemia, hypotensive episodes, or bacteremia. CONCLUSIONS: There was a significant decrease in COVID-19 exposure based on the number of nurse entries following the relocation of intravenous pumps from inside to outside of the patient room. These results may be cautiously extrapolated to suggest a decrease in personal protective equipment utilization. Future prospective, randomized controlled trials investigating the impact of this strategy are required.

Treatment of Hypertriglyceridemia: A Review of Therapies in the Pipeline.

BackgroundThe 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines and 2021 ACC Expert Consensus Decision Pathway recommend nonpharmacological interventions and initiation of statin therapy for patients with moderate hypertriglyceridemia and addition of fibrates or omega-3 fatty acids in severe hypertriglyceridemia. Although the association between triglyceride (TG) lowering and atherosclerotic cardiovascular disease (ASCVD) risk reduction remains controversial, patients with hypertriglyceridemia may represent a subgroup that require additional therapy to further reduce residual ASCVD risk. Moreover, medications that target novel pathways could provide alternative options for patients who are intolerant of existing therapies or doses needed to provide adequate triglyceride lowering. Objective: Assess recent evidence for TG-lowering agents including omega-3 fatty acid-based therapies, PPARα modulators, apoC-III mRNA antisense inhibitors, angiopoietin-like 3 (ANGPTL3) antibodies, and herbal supplements. Methods: A literature search was performed using PubMed with hypertriglyceridemia specified as a MeSH term or included in the title or abstract of the article along with each individual agent. For inclusion, trials needed to have a primary or secondary outcome of TG levels or TG lowering. Conclusion: Currently, the only US Food and Drug Administration approved medication for CV risk reduction in patients with hypertriglyceridemia is icosapent ethyl. Results from phase 3 trials for CaPre, pemafibrate, and volanesorsen as well as additional evidence for pipeline pharmacotherapies with novel mechanisms of action (e.g., ApoC-III mRNA antisense inhibitors and ANGPTL3 antibodies) will help to guide future pharmacotherapy considerations for patients with hypertriglyceridemia.