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pain agitation and delirium

Emily Contrada
No abstract text is available yet for this article.
October 2016: American Journal of Nursing
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
Joel Norton, Christine Hymers, Penelope Stein, Joanne May Jenkins, Duncan Bew
BACKGROUND: Acute porphyria is historically known as "the little imitator" in reference to its reputation as a notoriously difficult diagnosis. Variegate porphyria is one of the four acute porphyrias, and can present with both blistering cutaneous lesions and acute neurovisceral attacks involving abdominal pain, neuropsychiatric features, neuropathy, hyponatremia, and a vast array of other nonspecific clinical features. CASE REPORT: A 40-year-old man presented to the Emergency Department (ED) as a major trauma call, having been found in an "acutely confused state" surrounded by broken glass...
September 10, 2016: Journal of Emergency Medicine
Jean P Gelinas, Keith R Walley
Recognition and management of agitation, delirium, and pain are key areas. Reduced use of sedatives is an important measure that must be coupled with increased patient engagement, mobilization, and exercise. Use of low tidal volumes and low mean airway pressures during mechanical ventilation is helpful. A key hemodynamic principle following early aggressive volume resuscitation is subsequent careful assessment to avoid unnecessary additional volume administration and adverse consequences of frank volume overload...
June 2016: Clinics in Chest Medicine
Anna Krupp, Michele C Balas
Critically ill patients experience several severe, distressing, and often life-altering symptoms during their intensive care unit stay. A clinical practice guideline released by the American College of Critical Care Medicine provides a template for improving the care and outcomes of the critically ill through evidence-based pain, agitation, and delirium assessment, prevention, and management. Key strategies include the use of valid and reliable assessment tools, setting a desired sedation level target, a focus on light sedation, choosing appropriate sedative medications, the use of nonpharmacologic symptom management strategies, and engaging and empowering patients and their family to play an active role in their intensive care unit care...
June 2016: Critical Care Nursing Clinics of North America
Tara L Sacco, Brenton LaRiccia
Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial...
May 2016: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Ryan Wiatrowski, Colleen Norton, David Giffen
Sedation practices in the critical care unit have been trending toward lighter sedation since the start of the new millennium, but patients continue to experience inadequate pain management and excessive sedation. This paper includes a brief examination of the problem of pain management in the ICU; trends in sedation practices, including light sedation and the daily interruption of sedation; and a literature review of analgosedation. While the analgosedation literature is relatively sparse, it offers a promising, patient-centered method for managing the triad of pain, agitation, and delirium, while reducing common complications associated with long-term ventilation...
June 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Iwona Otremba, Krzysztof Wilczyński, Jan Szewieczek
BACKGROUND: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. OBJECTIVE: Evaluate specific factors for development of delirium in a geriatric ward setting. METHODS: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission...
2016: Clinical Interventions in Aging
Jean-Louis Vincent, Yahya Shehabi, Timothy S Walsh, Pratik P Pandharipande, Jonathan A Ball, Peter Spronk, Dan Longrois, Thomas Strøm, Giorgio Conti, Georg-Christian Funk, Rafael Badenes, Jean Mantz, Claudia Spies, Jukka Takala
We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical requirements for deeper sedation...
June 2016: Intensive Care Medicine
F Maillot, H Blasco, B Lioger, A Bigot, C Douillard
Urea cycle disorders (UCDs) are inborn errors of metabolism in which the clinical picture is mostly due to ammonia intoxication. UCD onset may be observed at any age. Acute decompensations of UCDs include neuro-psychiatric symptoms such as headache, confusion, convulsions, ataxia, agitation or delirium, as well as digestive symptoms, namely nausea and vomiting along with abdominal pain. Acute decompensations may lead to an irreversible coma in the absence of specific therapy. The first step is to measure promptly ammonemia in such patients, and start appropriate therapy on an emergency basis...
March 28, 2016: La Revue de Médecine Interne
Andrew Kamell, Lauren Kelley Smith
BACKGROUND: Benzodiazepines are commonly used in inpatient hospices internationally. U.S. hospice clinician views toward benzodiazepines are unknown. OBJECTIVES: Study objectives were (1) to assess inpatient hospice clinician attitudes towards the benefits of benzodiazepines for various indications and (2) to compare these attitudes to current clinical recommendations and literature. METHODS: A survey was developed and distributed to hospices with inpatient units nationwide...
May 2016: Journal of Palliative Medicine
Crystal Y Zheng, Caterina P Minniti, Mark H Chaitowitz
We describe a case of delirium occurring in a hospitalized sickle cell patient. Following admission for a typical pain crisis, the patient continued to report unrelieved pain with marked agitation for several days, despite escalating doses of opioid analgesia, and ultimately required intubation following development of acute chest syndrome (ACS). After some delay, it was discovered that he had been using a synthetic cannabinoid (K2) which may have precipitated his pain crisis and, with hindsight, explained his prolonged period of delirium...
June 2016: Hemoglobin
In-Kyung Song, Yong-Hee Park, Ji-Hyun Lee, Jin-Tae Kim, In Ho Choi, Hee-Soo Kim
BACKGROUND: Preemptive analgesia is an anti-nociceptive treatment that starts before surgery and prevents the establishment of central sensitization. Whether preemptive analgesia is more effective than conventional regimens for managing postoperative pain remains controversial. This study evaluated the efficacy of intravenous preemptive analgesia for acute postoperative pain control in pediatric patients. METHODS: In this prospective randomized controlled trial, 51 children aged 3-7 years, scheduled for corrective osteotomy were randomized into control (group C) or preemptive (group P) group...
April 2016: Paediatric Anaesthesia
Joseph B Haymore, Nikhil Patel
This article reviews current literature regarding the neuro intensive care unit (ICU) and the ICU setting in general regarding delirium, pain, agitation, and evidence-based guidelines and assessment tools. Delirium in the ICU affects as many as 50% to 80% of patients. Delirium is associated with increased burden of illness, higher mortality, and increased suffering. Evidence-based guidelines recommend using validated and reliable assessment tools. We reviewed current national clinical guidelines, validated tools for assessing pain, agitation/sedation, and delirium...
March 2016: Critical Care Nursing Clinics of North America
Michele C Balas, John W Devlin, Avelino C Verceles, Peter Morris, E Wesley Ely
When robust clinical trials are lacking, clinicians are often forced to extrapolate safe and effective evidence-based interventions from one patient care setting to another. This article is about such an extrapolation from the intensive care unit (ICU) to the long-term acute care hospital (LTACH) setting. Chronic critical illness is an emerging, disabling, costly, and yet relatively silent epidemic that is central to both of these settings. The number of chronically critically ill patients requiring prolonged mechanical ventilation is expected to reach unprecedented levels over the next decade...
February 2016: Seminars in Respiratory and Critical Care Medicine
G-C Funk
Avoiding pain, agitation and delirium as well as avoiding unnecessary deep sedation is a powerful yet challenging strategy in critical care medicine. A number of interactions between cerebral function and respiratory function should be regarded in patients with respiratory failure and mechanical ventilation. A cooperative sedation strategy (i.e. patient is awake and free of pain and delirium) is feasible in many patients requiring invasive mechanical ventilation. Especially patients with mild acute respiratory distress syndrome (ARDS) seem to benefit from preserved spontaneous breathing...
February 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Shuangling Li, Dongxin Wang, Baxian Yang
The latest advance of sedation for critically ill adult patients in intensive care unit (ICU) was reviewed in order to provide certain clinical information for the ICU physicians about sedation. Guidelines, clinical research, Meta-analysis, and reviews in recent years were collected using electronic data base. Discussions included: (1) the definition of light sedation, and its effects on clinical outcome, stress, sleep and delirium; (2) light sedation strategies included: the target population, the target sedation strategy and daily sedation interruption, clinical assessment and monitoring of sedation, selection of sedative drugs, light sedation extenuation; (3) light sedation strategies and pain, agitation, delirium control bundles; (4) the problems and prospects of light sedation...
January 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Salmaan Kanji, Heather MacPhee, Avinder Singh, Christel Johanson, Jennifer Fairbairn, Tammy Lloyd, Robert MacLean, Erin Rosenberg
OBJECTIVES: The 2013 clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the ICU suggest that pain be routinely assessed using a validated pain assessment tool. Currently available tools have only been evaluated in nondelirious critically ill patients, yet delirium can affect as many as 80% of ICU patients. The validated pain assessment tool adopted by our institution is the Critical Care Pain Observation Tool, and the objective of this study was to investigate the validity of this tool in patients with evidence of delirium...
May 2016: Critical Care Medicine
Yoonsun Mo, Anthony E Zimmermann, Michael C Thomas
OBJECTIVE: The aim of this study was to determine current delirium practices in the intensive care unit (ICU) setting and evaluate awareness and adoption of the 2013 Pain, Agitation, and Delirium (PAD) guidelines with emphasis on delirium management. DESIGN, SETTING, AND PARTICIPANTS: A large-scale, multidisciplinary, online survey was administered to physician, pharmacist, nurse, and mid-level practitioner members of the Society of Critical Care Medicine (SCCM) between September 2014 and October 2014...
January 13, 2016: Journal of Pharmacy Practice
Gülcin Şenel, Neşe Uysal, Gonca Oguz, Mensure Kaya, Nihal Kadioullari, Nesteren Koçak, Serife Karaca
INTRODUCTION: Delirium is a complex but common disorder in palliative care with a prevalence between 13% and 88% but a particular frequency at the end of life yet often remains insufficiently diagnosed and managed. The aim of our study is to determine the frequency of delirium and identify factors associated with delirium at palliative care unit. METHODS: Two hundred thirteen consecutive inpatients from October 1, 2012, to March 31, 2013, were studied prospectively...
December 31, 2015: American Journal of Hospice & Palliative Care
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