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Pain ICU

J C Menon, J K Joseph, M P Jose, B L Dhananjaya, O V Oommen
INTRODUCTION: Snakebite is an occupational hazard causing considerable morbidity and mortality worldwide, particularly so in tropical countries like India. OBJECTIVE: The aim of this study is to (i) review the demographic, clinical and laboratory findings in patients (1051) admitted with venomous snakebite (ii) to correlate mortality, morbidity and duration of hospital stay with clinical signs, symptoms and laboratory parameters. METHODS: A retrospective study of 1051 patients treated for snakebite over 10 years (2000 - 2009) in Little Flower Hospital, Angamaly, Kerala...
August 2016: Journal of the Association of Physicians of India
Kathleen A Puntillo, Adeline Max, Marine Chaize, Gerald Chanques, Elie Azoulay
OBJECTIVE: To assess patients' recollections of in-ICU procedural pain and its impact on post-ICU burden. DESIGN: Prospective longitudinal study of patients who underwent ICU procedures. SETTING: Thirty-four ICUs in France and Belgium. PATIENTS: Two hundred thirty-six patients who had undergone ICU procedures. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Patients were interviewed 3-16 months after hospitalization about: 1) recall of procedural pain intensity and pain distress (on 0-10 numeric rating scale); 2) current pain; that is, having pain in the past week that was not present before hospitalization; and 3) presence of traumatic stress (Impact of Events Scale)...
November 2016: Critical Care Medicine
Ahmad Ismail
Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels...
October 15, 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Jennifer B Seaman, Amber E Barnato, Susan M Sereika, Mary Beth Happ, Judith A Erlen
OBJECTIVE: Describe patterns of palliative care service consultation among a sample of ICU patients at high risk of dying. BACKGROUND: Patients receiving mechanical ventilation (MV) face threats to comfort, social connectedness and dignity due to pain, heavy sedation and physical restraint. Palliative care consultation services may mitigate poor outcomes. METHODS: From a dataset of 1440 ICU patients with ≥2 days of MV and ≥12 h of sustained wakefulness, we identified those at high risk of dying and/or who died and assessed patterns of sub-specialty palliative care consultation...
October 4, 2016: Heart & Lung: the Journal of Critical Care
Nicholas G Wysham, Michael J Hochman, Steven P Wolf, Christopher E Cox, Arif H Kamal
CONTEXT: Quality metrics for intensive care unit (ICU)-based palliative care have been proposed but it is unknown how consultative palliative care can contribute to performance on these measures. OBJECTIVES: Assess adherence to proposed quality metrics of intensive care unit (ICU)-based palliative care by palliative care specialists. METHODS: Surrogates for 9/14 patient-level quality metrics were assessed in all patients who received an initial palliative care specialist consult while in an ICU from 10/26/2012 to 1/16/2015 in the Global Palliative Care Quality Alliance, a nationwide palliative care quality registry...
September 30, 2016: Journal of Pain and Symptom Management
Kwadwo Kyeremanteng, Gianni D'Egidio, Cynthia Wan, Alan Baxter, Hans Rosenberg
Objective. To describe a single case of Systemic Capillary Leak Syndrome (SCLS) with a rare complication of compartment syndrome. Patient. Our patient is a 57-year-old male, referred to our hospital due to polycythemia (hemoglobin (Hgb) of 220 g/L), hypotension, acute renal failure, and bilateral calf pain. Measurements and Main Results. The patient required bilateral forearm, thigh, and calf fasciotomies during his ICU stay and continuous renal replacement therapy was instituted following onset of acute renal failure and oliguria...
2016: Case Reports in Critical Care
Ali Sait Kavakli, Nilgun Kavrut Ozturk, Raif Umut Ayoglu, Mustafa Emmiler, Lutfi Ozyurek, Kerem Inanoglu, Sadik Ozmen
OBJECTIVES: Various minimally invasive surgical approaches have been used in mitral valve (MV) surgery. The transapical off-pump mitral valve intervention with NeoChord implantation (TOP-MINI) is a minimally invasive, alternative procedure for the treatment of degenerative mitral regurgitation. There are several special considerations for the anesthesiologist during the TOP-MINI procedure. The main purpose of this study was to present the anesthetic management of the TOP-MINI procedure...
June 28, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Janneke G J Hoeijmakers, Catharina G Faber, Carien J Miedema, Ingemar S J Merkies, Johan S H Vles
Small fiber neuropathy (SFN) is a debilitating condition that often leads to pain and autonomic dysfunction. In the last few decades, SFN has been gaining more attention, particularly in adults. However, literature about SFN in children remains limited. The present article reports the cases of 2 adolescent girls diagnosed with SFN. The first patient (14 years of age) complained about painful itch and tingling in her legs, as well as dysautonomia symptoms for years. She also reported a red/purple-type discoloration of her legs aggravated by warmth and standing, compatible with erythromelalgia...
September 22, 2016: Pediatrics
Giovanni Mistraletti, Michele Umbrello, Stefania Anania, Elisa Andrighi, Alessandra Di Carlo, Federica Martinetti, Serena Barello, Giovanni Sabbatini, Paolo Formenti, Tommaso Maraffi, Francesco Marrazzo, Alessandra Palo, Giacomo Bellani, Riccarda Russo, Silvia Francesconi, Federico Valdambrini, Marco Cigada, Francesca Riccardi, Egidio A Moja, Gaetano Iapichino
BACKGROUND: International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice. METHODS: Multicenter, randomized, before and after study...
September 20, 2016: Minerva Anestesiologica
Brian Hutton, Lisa D Burry, Salmaan Kanji, Sangeeta Mehta, Melanie Guenette, Claudio M Martin, Dean A Fergusson, Neill K Adhikari, Ingrid Egerod, David Williamson, Sharon Straus, David Moher, E Wesley Ely, Louise Rose
BACKGROUND: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly compared...
2016: Systematic Reviews
Andrew C Faust, Pearl Rajan, Lyndsay A Sheperd, Carlos A Alvarez, Phyllis McCorstin, Rebecca L Doebele
BACKGROUND: Recent attention to adverse effects of intensive care unit (ICU) sedation has led to the use of strategies that target a "lighter" depth of sedation. Among these strategies are "analgosedation" protocols, which prioritize pain management and preferentially use IV opioids before administration of continuously infused sedatives such as propofol or midazolam. We hypothesized that using an analgosedation protocol would result in a shorter duration of mechanical ventilation than a protocol with greater emphasis on IV sedatives METHODS: : We conducted a retrospective study comparing the duration of mechanical ventilation before and after implementation of an analgosedation protocol in a 24-bed medical ICU...
October 2016: Anesthesia and Analgesia
Tomasz Gaszynski
INTRODUCTION: We report on the anesthetic management using opioid-free method of a patient with Steinert syndrome (myotonic dystrophy, MD), autosomal dominant dystrophy which is characterized by consistent contracture of muscle following stimulation. A myotonic crisis can be induced by numerous factors including hypothermia, shivering, and mechanical or electrical stimulation. In patients with MD, hypersensitivity to anesthetic drugs, especially muscle relaxants and opioids, may complicate postoperative management...
September 2016: Medicine (Baltimore)
Babak Mahshidfar, Azadeh Sameti, Saeed Abbasi, Davood Farsi, Mani Mofidi, Peyman Hafezimoghadam, Popak Rahimzadeh, Mahdi Rezai
AIMS: To evaluate the effect of intravenous (IV) acetaminophen on reducing the need for morphine sulfate in intubated patients admitted to the Intensive Care Unit (ICU). SETTINGS AND DESIGN: Current study was done as a clinical trial on the patients supported by mechanical ventilator. SUBJECTS AND METHODS: Behavioral pain scale (BPS) scoring system was used to measure pain in the patients. All of the patients received 1 g, IV acetaminophen, every 6 h during the 1(st) and 3(rd) days of admission and placebo during the 2(nd) and 4(th) days...
August 2016: Indian Journal of Critical Care Medicine
A Bernas Albeniz, D A Aveiga Valencia, L Etxeberria Zabala, J Zaldibar-Gerrikagoitia Bilbao, L Aguilera Celorrio
Tigecycline is a broad spectrum antimicrobial agent, structurally similar to minocycline and that shares some tetracycline-related side effects. A case report is presented on a 68-year-old female who received tigecycline for a sepsis of unknown origin and who, in the following 5days, developed abdominal pain and elevated pancreatic enzymes, which suggested acute pancreatitis. After ruling out other origins, and according to the Naranjo adverse drug reaction probability scale, tigecycline was the probable cause of the acute pancreatitis, a complication that has been reported 5 times in the database of the Spanish pharmacosurveillance system since 2009...
September 5, 2016: Revista Española de Anestesiología y Reanimación
P Nydahl, R Dubb, S Filipovic, C Hermes, F Jüttner, A Kaltwasser, S Klarmann, H Mende, S Nessizius, C Rottensteiner
Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters...
September 6, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Alen Karic
INTRODUCTION: Degenerative aortic stenosis (AS) is the most frequent cause among aortic valve stenotic changes. Mini Sternotomy Aortic Valve Replacement is a replacement of aortic valve through upper partial sternotomy. AIM: The aim of this approach is to improve postoperative convalescence by leaving pleural spaces closed and do not compromise respiratory function, to decrease bleeding, and reduce post op ventilation time and ICU stay. All these advantages decrease cost during hospital stay by reducing ICU stay, respiration time, bleeding and using blood products, pain killers and shortening hospital stay...
June 2016: Medical Archives
Mehmet Ezelsoy, Kerem Oral, Baris Caynak, Zehra Bayramoglu, Belhhan Akpinar
OBJECTIVE: Minimally invasive bypass grafting is a promising surgical treatment in proximal LAD stenosis procedures. The main goal of this study was to make comparisons between robotically assisted minimally invasive coronary bypass surgery and conventional surgery in isolated proximal LAD lesions in terms of pain and quality of life improvement. METHODS: The study contains patients with proximal LAD lesions who were treated with robotically assisted minimally invasive coronary artery bypass surgery and conventional bypass surgery between June 2005 and November 2012...
2016: Heart Surgery Forum
Courtney D Jensen, Jamie T Stark, Lewis L Jacobson, Jan M Powers, Michael F Joseph, Jeffrey M Kinsella-Shaw, Craig R Denegar
OBJECTIVE: Each year, more than 150,000 patients with rib fractures are admitted to US trauma centers; as many as 10% die. Effective pain control is critical to survival. One way to manage pain is thoracic epidural analgesia. If this treatment reduces mortality, more frequent use may be indicated. METHODS: We analyzed the patient registry of a level II trauma center. All patients admitted with one or more rib fractures (N = 1,347) were considered. Patients who were not candidates for epidural analgesia (N = 382) were eliminated...
August 22, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Thomas Kannampallil, William L Galanter, Suzanne Falck, Michael J Gaunt, Robert D Gibbons, Robert McNutt, Richard Odwazny, Gordon Schiff, Allen J Vaida, Diana J Wilkie, Bruce L Lambert
Pain care for hospitalized patients is often suboptimal. Representing pain scores as a graphical trajectory may provide insights into the understanding and treatment of pain. We describe a 1-year, retrospective, observational study to characterize pain trajectories of hospitalized adults during the first 48 hours after admission at an urban academic medical center. Using a subgroup of patients who presented with significant pain (pain score>4; n=7,762 encounters) we characterized pain trajectories and measured area under the curve, slope of the trajectory for the first two hours after admission, and pain intensity at plateau...
August 19, 2016: Pain
Brita F Olsen, Tone Rustøen, Leiv Sandvik, Morten Jacobsen, Berit T Valeberg
PURPOSE: This study aimed to measure the impact of implementing a pain management algorithm in adult intensive care unit (ICU) patients able to express pain. No controlled study has previously evaluated the impact of a pain management algorithm both at rest and during procedures, including both patients able to self-report and express pain behavior, intubated and nonintubated patients, throughout their ICU stay. MATERIALS AND METHODS: The algorithm instructed nurses to assess pain, guided them in pain treatment, and was implemented in 3 units...
July 17, 2016: Journal of Critical Care
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