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Sedation and delirium

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https://www.readbyqxmd.com/read/28101764/diazepam-in-the-treatment-of-moderate-to-severe-alcohol-withdrawal
#1
Steven J Weintraub
Benzodiazepines ameliorate or prevent the symptoms and complications of moderate to severe alcohol withdrawal, which can include autonomic hyperactivity, agitation, combativeness, hallucinations, seizures, delirium, and death. The benzodiazepines most commonly used for this purpose are lorazepam, chlordiazepoxide, oxazepam, and diazepam. It is widely asserted that no member of this group is superior to the others for treatment of alcohol withdrawal. However, of these, diazepam has the shortest time to peak effect, which facilitates both rapid control of symptoms and accurate titration to avoid over-sedation...
January 18, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28099642/sedation-protocols-versus-daily-sedation-interruption-a-systematic-review-and-meta-analysis
#2
Antonio Paulo Nassar, Marcelo Park
Objective: The aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies. Methods: We searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28099638/risk-factors-for-agitation-in-critically-ill-patients
#3
Thiago Miranda Lopes de Almeida, Luciano Cesar Pontes de Azevedo, Paulo Maurício Garcia Nosé, Flavio Geraldo Resende de Freitas, Flávia Ribeiro Machado
Objective: To evaluate the incidence of agitation in the first 7 days after intensive care unit admission, its risk factors and its associations with clinical outcomes. Methods: This single-center prospective cohort study included all patients older than 18 years with a predicted stay > 48 hours within the first 24 hours of intensive care unit admission. Agitation was defined as a Richmond Agitation Sedation Scale score ≥ +2, an episode of agitation or the use of a specific medication recorded in patient charts...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28098628/the-abcdef-bundle-science-and-philosophy-of-how-icu-liberation-serves-patients-and-families
#4
E Wesley Ely
Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28074297/-delirium-analgesia-and-sedation-in-intensive-care-medicine-development-of-a-protocol-based-management-approach
#5
A Wolf, R Mörgeli, A Müller, B Weiss, C Spies
Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental...
January 10, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28068834/design-considerations-of-a-randomized-controlled-trial-of-sedation-level-during-hip-fracture-repair-surgery-a-strategy-to-reduce-the-incidence-of-postoperative-delirium-in-elderly-patients
#6
Tianjing Li, L Susan Wieland, Esther Oh, Karin J Neufeld, Nae-Yuh Wang, Kay Dickersin, Frederick E Sieber
Background Delirium is an acute change in mental status characterized by sudden onset, fluctuating course, inattention, disorganized thinking, and abnormal level of consciousness. The objective of the randomized controlled trial "A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" (STRIDE) is to assess the effectiveness of light versus heavy sedation on delirium and other outcomes in elderly patients undergoing hip fracture repair surgery. Our goal is to describe the design considerations and lessons learned in planning and implementing the STRIDE trial...
January 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/28066556/does-the-combination-use-of-two-pain-assessment-tools-have-a-synergistic-effect
#7
EDITORIAL
Takeshi Suzuki
Pain management is a very important aspect in the intensive care unit (ICU), as adequate pain control has been shown to be associated with better clinical outcomes in critically ill patients. A Numerical Rating Scale (NRS) ranging from 0 to 10 (0, no pain; 10, maximum pain), which is based on a patient's self-report, is the gold standard for pain evaluation in patients who can communicate their pain intensity. On the other hand, it is very difficult to evaluate the degree of pain in critically ill patients owing to decreased consciousness level, delirium, and the effect of sedation for mechanical ventilation management...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28017174/benefit-of-general-anesthesia-monitored-by-bispectral-index-compared-with-monitoring-guided-only-by-clinical-parameters-systematic-review-and-meta-analysis
#8
Carlos Rogério Degrandi Oliveira, Wanderley Marques Bernardo, Victor Moisés Nunes
BACKGROUND: The bispectral index parameter is used to guide the titration of general anesthesia; however, many studies have shown conflicting results regarding the benefits of bispectral index monitoring. The objective of this systematic review with meta-analysis is to evaluate the clinical impact of monitoring with the bispectral index parameter. METHODS: The search for evidence in scientific information sources was conducted during December 2013 to January 2015, the following primary databases: Medline/PubMed, LILACS, Cochrane, CINAHL, Ovid, SCOPUS and TESES...
January 2017: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/27965224/feasibility-and-effectiveness-of-a-delirium-prevention-bundle-in-critically-ill-patients
#9
Claudia DiSabatino Smith, Petra Grami
BACKGROUND: Strategies for preventing delirium include early identification and avoiding or modifying patient, environmental, and iatrogenic factors. Minimal research exists on a prescriptive delirium prevention bundle that details elements or strategies for each bundle component. Even less research has been focused on nurse-driven interventions or components. OBJECTIVE: To evaluate the effectiveness of a delirium prevention bundle in decreasing delirium incidence in 2 medical-surgical intensive care units in a large Texas medical center...
December 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27956448/delirium-a-guide-for-the-general-physician
#10
Oliver M Todd, Elizabeth A Teale
Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. Certain predisposing factors can make an individual more susceptible to delirium in the face of a stressor. Stressors include direct insults to the brain, insults peripheral to the brain or external changes in the environment of an individual. Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27942054/effect-of-melatonin-on-duration-of-delirium-in-organophosphorus-compound-poisoning-patients-a-double-blind-randomised-placebo-controlled-trial
#11
H N Vijayakumar, K Ramya, Devika Rani Duggappa, Km Veeranna Gowda, K Sudheesh, S S Nethra, R S Raghavendra Rao
BACKGROUND AND AIMS: Organophosphate compound poisoning (OPCP) is associated with high incidence of delirium. Melatonin has been tried in the treatment of delirium and has shown a beneficial effect in OPCP. This study was conducted to know the effect of melatonin on duration of delirium and recovery profile in OPCP patients. METHODS: Double-blind randomised placebo control trial in which 56 patients of OPCP confirmed by history and syndrome of OPCP with low plasma pseudocholinesterase, aged >18 years and weighing between 50 and 100 kg, and Acute Physiology and Chronic Health Evaluation II score of <20 were studied...
November 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/27936404/dexmedetomidine-vs-propofol-sedation-reduces-delirium-in-patients-after-cardiac-surgery-a-meta-analysis-with-trial-sequential-analysis-of-randomized-controlled-trials
#12
Xu Liu, Guohao Xie, Kai Zhang, Shengwen Song, Fang Song, Yue Jin, Xiangming Fang
PURPOSE: It is uncertain whether dexmedetomidine is better than propofol for sedation in postcardiac surgery patients. The purpose of this meta-analysis was to compare the effects of dexmedetomidine and propofol sedation on outcomes in adult patients after cardiac surgery. METHODS: Randomized controlled trials comparing outcomes in cardiac surgery patients sedated with dexmedetomidine or propofol were retrieved from PubMed, Embase, Web of Science, the Cochrane Library, and Clinicaltrials...
November 11, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27924205/risperidone-in-a-child-with-untractable-emergency-delirium-a-case-report
#13
Young Hee Shin, Seung Hyeon Lee, Dae Yoon Kim
A 6-year-old boy was scheduled for thoracic magnetic resonance imaging under deep sedation with midazolam 1.8 mg and propofol 100 µg/kg/min via intravenous injection. He showed emergence delirium in the post-anesthesia care unit. The staff attempted to calm him by administering flumazenil as an antidote for midazolam, propofol for further sedation, and meperidine. However, this was not successful. A psychiatrist recommended the use of antipsychotics. Administration of risperidone led to immediate resolution of the boy's symptoms and relaxed him...
December 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27922747/frailty-and-subsequent-disability-and-mortality-among-patients-with-critical-illness
#14
Nathan E Brummel, Susan P Bell, Timothy D Girard, Pratik P Pandharipande, James C Jackson, Alessandro Morandi, Jennifer L Thompson, Rameela Chandrasekhar, Gordon R Bernard, Robert S Dittus, Thomas M Gill, E Wesley Ely
INTRODUCTION The prevalence of frailty (diminished physiologic reserve) and its effect on outcomes for those ≥18 years old with critical illness is unclear. We hypothesized greater frailty would be associated with subsequent mortality, disability, and cognitive impairment, regardless of age. METHODS At enrollment, we measured frailty using the Clinical Frailty Scale (CFS, range 1 [very fit] to 7 [severely frail]). At 3 and 12 months post-discharge, we assessed vital status, instrumental and basic activities of daily living (IADLs and BADLs), and cognition...
December 6, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27918778/efficacy-of-oral-risperidone-haloperidol-or-placebo-for-symptoms-of-delirium-among-patients-in-palliative-care-a-randomized-clinical-trial
#15
Meera R Agar, Peter G Lawlor, Stephen Quinn, Brian Draper, Gideon A Caplan, Debra Rowett, Christine Sanderson, Janet Hardy, Brian Le, Simon Eckermann, Nicola McCaffrey, Linda Devilee, Belinda Fazekas, Mark Hill, David C Currow
Importance: Antipsychotics are widely used for distressing symptoms of delirium, but efficacy has not been established in placebo-controlled trials in palliative care. Objective: To determine efficacy of risperidone or haloperidol relative to placebo in relieving target symptoms of delirium associated with distress among patients receiving palliative care. Design, Setting, and Participants: A double-blind, parallel-arm, dose-titrated randomized clinical trial was conducted at 11 Australian inpatient hospice or hospital palliative care services between August 13, 2008, and April 2, 2014, among participants with life-limiting illness, delirium, and a delirium symptoms score (sum of Nursing Delirium Screening Scale behavioral, communication, and perceptual items) of 1 or more...
January 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#16
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27902947/what-factors-affect-implementation-of-early-rehabilitation-into-intensive-care-unit-practice-a-qualitative-study-with-clinicians
#17
Selina M Parry, Louisa Remedios, Linda Denehy, Laura D Knight, Lisa Beach, Thomas C Rollinson, Sue Berney, Zudin A Puthucheary, Peter Morris, Catherine L Granger
PURPOSE: To identify the barriers and enablers that influence clinicians' implementation of early rehabilitation in critical care. MATERIALS AND METHODS: Qualitative study involving 26 multidisciplinary participants who were recruited using purposive sampling. Four focus groups were conducted using semistructured questions to explore attitudes, beliefs, and experiences. Data were transcribed verbatim and thematic analysis was performed. RESULTS: Six themes emerged, as follows: (1) the clinicians' expectations and knowledge (including rationale for rehabilitation, perceived benefits, and experience), (2) the evidence for and application of rehabilitation (including beliefs regarding when to intervene), (3) patient factors (including prognosis, sedation, delirium, cooperation, motivation, goals, and family), (4) safety considerations (including physiological stability and presence of devices or lines), (5) environmental influences (staffing, resources, equipment, time, and competing priorities), and (6) culture and teamwork...
November 12, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27898439/limiting-sedation-for-patients-with-acute-respiratory-distress-syndrome-time-to-wake-up
#18
Faraaz Ali Shah, Timothy D Girard, Sachin Yende
PURPOSE OF REVIEW: Critically ill patients with acute respiratory distress syndrome (ARDS) may require sedation in their clinical care. The goals of sedation in ARDS patients are to improve patient comfort and tolerance of supportive and therapeutic measures without contributing to adverse outcomes. This review discusses the current evidence for sedation management in patients with ARDS. RECENT FINDINGS: Deep sedation strategies should be avoided in the care of patients with ARDS because deep sedation has been associated with increased time on mechanical ventilation, longer ICU and hospital length of stay, and higher mortality in critically ill patients...
February 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27893294/management-of-multifactorial-infant-delirium-with-intravenous-haloperidol-in-the-setting-of-over-sedation-and-poor-enteral-absorption
#19
Erin F Carlton, Madeline K Mahowald, Nasuh Malas
No abstract text is available yet for this article.
November 28, 2016: Journal of Child and Adolescent Psychopharmacology
https://www.readbyqxmd.com/read/27882039/pediatric-tooth-extractions-under-sedoanalgesia
#20
Ayse Hande Arpaci, Berrin Isik
OBJECTIVE: The present study aims to evaluate intravenous ketamine and inhalation sedation in children, their unwanted side-effects and surgeon satisfaction. METHODS: In this study, data of 922 children aged between 1-18 who underwent tooth extraction under sedoanalgesia in our department between September 2015-January 2016 were gathered and anesthesia approaches, unwanted side effects and surgical satisfaction was investigated. Postoperative recovery emergence agitation or delirium was evaluated with Watcha Behavior Scale (WBS)...
September 2016: Pakistan Journal of Medical Sciences Quarterly
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