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Sedation interruption

Chenguang Wang, Daniel O Scharfstein, Elizabeth Colantuoni, Timothy D Girard, Ying Yan
In randomized studies involving severely ill patients, functional outcomes are often unobserved due to missed clinic visits, premature withdrawal, or death. It is well known that if these unobserved functional outcomes are not handled properly, biased treatment comparisons can be produced. In this article, we propose a procedure for comparing treatments that is based on a composite endpoint that combines information on both the functional outcome and survival. We further propose a missing data imputation scheme and sensitivity analysis strategy to handle the unobserved functional outcomes not due to death...
October 17, 2016: Biometrics
Tony Chung Tung Lo, Stephen Tung Yeung, Sujin Lee, Kira Skavinski, Solomon Liao
OBJECTIVE: Ehlers-Danlos syndrome frequently causes acute and chronic pain because of joint subluxations and dislocations secondary to hypermobility. Current treatments for pain related to Ehlers-Danlos syndrome and central pain syndrome are inadequate. This case report discusses the therapeutic use of ketamine intravenous infusion as an alternative. CASE REPORT: A 27-year-old Caucasian female with a history of Ehlers-Danlos syndrome and spinal cord ischemic myelopathy resulting in central pain syndrome, presented with severe generalized body pain refractory to multiple pharmacological interventions...
2016: Journal of Pain Research
Sylvain Fazilleau
OBJECTIVE: Early verticalization in ICU is recommended [1] but not documented in brain-damaged people. Using a verticalization table involves risks and stresses in this context. The main objective was to determine the safety and feasibility of in-bed verticalization in neurological intensive care. Secondary objectives were to study the immediate, hemodynamic, and respiratory impacts, as well as the effects on awakening. MATERIAL/PATIENTS AND METHODS: Observational study in a neurological intensive care unit...
September 2016: Annals of Physical and Rehabilitation Medicine
Jean François Ciais, Flora Tremellat, Maud Castelli-Prieto, Caroline Jestin
BACKGROUND: At the end of life, patients may feel refractory pain during care procedures although they receive appropriate analgesia. They can benefit from a short-term sedation. Propofol is used for procedural sedation in emergency or reanimation departments. It may be adapted in a palliative care unit. OBJECTIVE: The main objective was to verify whether propofol could allow us to administer care without causing major pain to patients with refractory pain at the end of life...
September 27, 2016: Journal of Palliative Medicine
Nienke J Vet, Saskia N de Wildt, Carin W M Verlaat, Miriam G Mooij, Dick Tibboel, Matthijs de Hoog, Corinne M P Buysse
OBJECTIVE: Our earlier pediatric daily sedation interruption trial showed that daily sedation interruption in addition to protocolized sedation in critically ill children does not reduce duration of mechanical ventilation, length of stay, or amounts of sedative drugs administered when compared with protocolized sedation only, but undersedation was more frequent in the daily sedation interruption + protocolized sedation group. We now report the preplanned analysis comparing short-term health-related quality of life and posttraumatic stress symptoms between the two groups...
September 22, 2016: Pediatric Critical Care Medicine
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
Nikolas C Vann, Francis D Pham, John A Hayes, Andrew Kottick, Christopher A Del Negro
Interneurons derived from Dbx1-expressing precursors located in the brainstem preBötzinger complex (preBötC) putatively form the core oscillator for inspiratory breathing movements. We tested this Dbx1 core hypothesis by expressing archaerhodopsin in Dbx1-derived interneurons and then transiently hyperpolarizing these neurons while measuring respiratory rhythm in vitro or breathing in vagus-intact adult mice. Transient illumination of the preBötC interrupted inspiratory rhythm in both slice preparations and sedated mice...
2016: PloS One
Masaki Ominami, Yasuaki Nagami, Masatsugu Shiba, Kazunari Tominaga, Hirotsugu Maruyama, Junichi Okamoto, Kunihiro Kato, Hiroaki Minamino, Shusei Fukunaga, Satoshi Sugimori, Hirokazu Yamagami, Tetsuya Tanigawa, Toshio Watanabe, Yasuhiro Fujiwara, Tetsuo Arakawa
BACKGROUND/AIMS: Modified neuroleptanalgesia (m-NLA) with midazolam is often used for sedation and analgesia during endoscopic submucosal dissection (ESD) for gastrointestinal neoplasia. However, interruption due to poor response to midazolam is often experienced during ESD for esophageal squamous cell carcinoma (ESCC) because most patients with ESCC have a history of heavy alcohol intake. We examined the incidence and risk factors for poor response to m-NLA with midazolam and pethidine hydrochloride...
August 20, 2016: Digestion
Milisa Manojlovich, David Ratz, Melissa A Miller, Sarah L Krein
Although the Awakening and Breathing Coordination, Delirium assessment, and Early exercise/mobility (ABCDE) bundle may be effective, individual components of ABCDE may not be implemented as intended. We examined the use of daily interruption of sedation (DIS) and early mobility, looking for an association between these bundle elements. Despite the growing use of DIS and early mobility, the two do not seem to be adopted together, with serious implications for the effectiveness of the ABCDE bundle.
August 1, 2016: Journal of Nursing Care Quality
Sangeeta Mehta, Maureen Meade, Lisa Burry, Ranjeeta Mallick, Christina Katsios, Dean Fergusson, Peter Dodek, Karen Burns, Margaret Herridge, John W Devlin, Maged Tanios, Robert Fowler, Michael Jacka, Yoanna Skrobik, Kendiss Olafson, Deborah Cook
BACKGROUND: Mechanically ventilated patients may receive more sedation during the night than during the day, potentially delaying extubation. We compared nighttime and daytime benzodiazepine and opioid administration in adult patients enrolled in a multicenter sedation trial comparing protocolized sedation alone or protocolized sedation combined with daily sedation interruption; and we evaluated whether nighttime and daytime doses were associated with liberation from mechanical ventilation...
August 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
Julius Z Wermelt, Richard K Ellerkmann
Emergence Delirium in children after general anesthesia is a common and self limitating event. Although it might be seen as being harmless it can cause other serious complications and might leave both parents and other caregivers with a negative impression behind. Although the cause may still not be clear, potential predictors can be named: preschool age, the use of fast acting volatile anesthestics, higher preoperative anxiety levels and postoperative pain.A child-focused approach to reduce preoperative anxiety focusing on distraction methods rather than pharmacological sedation may be the key as well as sufficient postoperative pain control and the use of total intravenous anesthesia...
July 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Salmaan Kanji, Alexandru Mera, Brian Hutton, Lisa Burry, Erin Rosenberg, Erika MacDonald, Vanessa Luks
OBJECTIVES: Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients. SETTING/PARTICIPANTS: We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention...
2016: BMJ Open
Jan Claassen, Angela Velazquez, Emma Meyers, Jens Witsch, M Cristina Falo, Soojin Park, Sachin Agarwal, J Michael Schmidt, Nicholas D Schiff, Jacobo D Sitt, Lionel Naccache, E Sander Connolly, Hans-Peter Frey
OBJECTIVE: Accurate behavioral assessments of consciousness carry tremendous significance in guiding management, but are extremely challenging in acutely brain-injured patients. We evaluated whether electroencephalography (EEG) and multimodality monitoring parameters may facilitate assessment of consciousness in patients with subarachnoid hemorrhage. METHODS: A retrospective analysis was performed of 83 consecutively treated adults with subarachnoid hemorrhage. All patients were initially comatose and had invasive brain monitoring placed...
October 2016: Annals of Neurology
Michael Klompas, Lingling Li, Ken Kleinman, Paul M Szumita, Anthony F Massaro
IMPORTANCE: Ventilator bundles, including head-of-bed elevation, sedative infusion interruptions, spontaneous breathing trials, thromboprophylaxis, stress ulcer prophylaxis, and oral care with chlorhexidine gluconate, are ubiquitous, but the absolute and relative value of each bundle component is unclear. OBJECTIVE: To evaluate associations between individual and collective ventilator bundle components and ventilator-associated events, time to extubation, ventilator mortality, time to hospital discharge, and hospital death...
September 1, 2016: JAMA Internal Medicine
Arvind Palanisamy, Matthew B Friese, Emily Cotran, Ludde Moller, Justin D Boyd, Gregory Crosby, Deborah J Culley
Neurocognitive dysfunction is common in survivors of intensive care. Prolonged sedation has been implicated but the mechanisms are unclear. Neurogenesis continues into adulthood and is implicated in learning. The neural progenitor cells (NPC) that drive neurogenesis have receptors for the major classes of sedatives used clinically, suggesting that interruption of neurogenesis may partly contribute to cognitive decline in ICU survivors. Using an in vitro system, we tested the hypothesis that prolonged exposure to propofol concentration- and duration-dependently kills or markedly decreases the proliferation of NPCs...
2016: PloS One
Daniel A Caroff, Paul M Szumita, Michael Klompas
BACKGROUND Healthcare-associated infections (HAIs) cause significant morbidity in critically ill patients. An underappreciated but potentially modifiable risk factor for infection is sedation strategy. Recent trials suggest that choice of sedative agent, depth of sedation, and sedative management can influence HAI risk in mechanically ventilated patients. OBJECTIVE To better characterize the relationships between sedation strategies and infection. METHODS Systematic literature review. RESULTS We found 500 articles and accepted 70 for review...
October 2016: Infection Control and Hospital Epidemiology
Kiran Godse, Prachi Bhattar, Sharmila Patil, Nitin Nadkarni, Manjyot Gautam
Chronic urticaria (CU) is a persistent, debiliating condition that causes severe impairment on the quality of life (QoL) of patient by interrupting work productivity. Current guidelines recommend second-generation (nonsedating) anti-histamines for the treatment for all forms of urticaria. In patients who do not respond adequately to conventional doses of anti-histamines, it is recommended to increase the dose to up to four times to obtain control. But there are only few controlled studies that have assessed the efficacy and safety of nonsedating anti-histamines...
May 2016: Indian Journal of Dermatology
L Roberts, C Snelson
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
DaiWai M Olson, Kyloni Phillips, Carmelo Graffagnino
The sedation-assessment conundrum is the struggle to balance the need for sedation against the need to awaken the patient and perform a neurologic examination. This article discusses the nuances of the sedation-assessment conundrum as well as approaches to resolve this and reduce the negative impact of abruptly stopping sedative infusions. Both oversedation and undersedation affect critically ill patients. This article discusses methods of assessing sedation and interpreting individualized patient responses to sedation...
June 2016: Critical Care Nursing Clinics of North America
Zoé Thiboutot, Marc M Perreault, David R Williamson, Louise Rose, Sangeeta Mehta, Melanie D Guenette, Deborah Cook, Lisa Burry
BACKGROUND: Critically ill patients frequently experience delirium, and antipsychotic drugs are often used to manage symptoms. OBJECTIVES: To describe the use of antipsychotic drugs and delirium screening tools in mechanically ventilated, critically ill adult patients in Canadian intensive care units (ICUs) and to identify factors associated with the use of antipsychotic drugs. METHODS: Pharmacists from 51 Canadian ICUs prospectively collected data on antipsychotic use and delirium screening in all patients for whom invasive mechanical ventilation was initiated during a chosen 2-week period occurring sometime in 2008 or 2009...
March 2016: Canadian Journal of Hospital Pharmacy
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