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Sedation and delirium

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https://www.readbyqxmd.com/read/28910303/the-influence-of-analgesic-based-sedation-protocols-on-delirium-and-outcomes-in-critically-ill-patients-a-randomized-controlled-trial
#1
Dan Liu, Jie Lyu, Huiying Zhao, Youzhong An
OBJECTIVE: To investigate the influence of analgesic-based midazolam sedation on delirium and outcomes in critically ill patients and to analyze the risk factors of delirium. DESIGN: Single center, prospective randomized controlled trial. SETTING: A surgical intensive care unit (ICU) in a tertiary care hospital in China. PATIENTS: Mechanically ventilated patients requiring sedation. MEASUREMENTS AND MAIN RESULTS: Patients admitted to the surgical intensive care unit who required sedation and were undergoing mechanical ventilation for longer than 24 hours were randomly divided into three groups: 1) the remifentanil group received remifentanil and midazolam, 2) the fentanyl group received fentanyl and midazolam, and 3) the control group received only midazolam...
2017: PloS One
https://www.readbyqxmd.com/read/28904966/the-effect-of-oral-dexmedetomidine-premedication-on-preoperative-cooperation-and-emergence-delirium-in-children-undergoing-dental-procedures
#2
Sultan Keles, Ozlem Kocaturk
INTRODUCTION: The aim of this study was to detect the effect of 1 μg/kg of oral dexmedetomidine (DEX) as premedication among children undergoing dental procedures. MATERIALS AND METHODS: The study involved 100 children between 2 and 6 years of age, ASA I, who underwent full-mouth dental rehabilitation. The DEX group (n = 50) received 1 μg/kg DEX in apple juice, and the control group (n = 50) received only apple juice. The patients' scores on the Ramsay Sedation Scale (RSS), parental separation anxiety scale, mask acceptance scale, and pediatric anesthesia emergence delirium scale (PAEDS) and hemodynamic parameters were recorded...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28904548/effect-of-family-patient-communication-on-the-incidence-of-delirium-in-hospitalized-patients-in-cardiovascular-surgery-icu
#3
Maryam Eghbali-Babadi, Nasrin Shokrollahi, Tayebe Mehrabi
BACKGROUND: Cardiovascular diseases are the most important causes of morbidity and mortality in the world, and cardiac surgery is one of the treatments that have complication for patients. One of the most important current psychological complications after cardiac surgery is delirium. For its prevention and treatment, considerable attention should be paid to the role of family. This study has been conducted for assessing the effect of the relationship between the family and patient on the incidence of delirium in hospitalized patients in cardiovascular surgery intensive care unit (ICU) of Isfahan Shahid Chamran hospital...
July 2017: Iranian Journal of Nursing and Midwifery Research
https://www.readbyqxmd.com/read/28880357/-the-use-of-dexmedetomidine-in-extreme-agitation
#4
E Roosens, J P Mulier, G Heylens, J De Fruyt
In clinical practice antipsychotics, benzodiazepines and/or antihistamines are used to calm agitated patients. If agitation persists and patients have contraindications for these substances, then anesthetics, such as propofol, can also be used as well, to serve as a sedative. Our attention was drawn to a particular case in which dexmedetomidine was used as a sedative.<br/> AIM: To study the literature on the use of α2-agonists, such as dexmedetomidine, in the treatment of extreme agitation.<br/> METHOD: We reviewed the relevant scientific literature...
2017: Tijdschrift Voor Psychiatrie
https://www.readbyqxmd.com/read/28869228/symptom-profile-as-assessed-on-delirium-rating-scale-revised-98-of-delirium-in-respiratory-intensive-care-unit-a-study-from-india
#5
Akhilesh Sharma, Savita Malhotra, Sandeep Grover, S K Jindal
AIM: This study aimed to evaluate the phenomenology of delirium in patients admitted in a Respiratory Intensive Care Unit (RICU). METHODS: Consecutive patients admitted to RICU were screened for delirium using Richmond Agitation-Sedation Scale (RASS), Confusion Assessment Method for ICU (CAM-ICU) assessment tool and those found positive for delirium were evaluated by a psychiatrist to confirm the diagnosis. Those with a diagnosis of delirium as per the psychiatrist were evaluated on Delirium Rating Scale-Revised-98 (DRS-R-98) to study phenomenology...
September 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/28869145/the-early-diagnosis-and-management-of-mixed-delirium-in-a-patient-placed-on-ecmo-and-with-difficult-sedation-a-case-report
#6
María Acevedo-Nuevo, Maria Teresa González-Gil, Miguel Ángel Romera-Ortega, Ignacio Latorre-Marco, Maria Dolores Rodríguez-Huerta
Delirium represents a serious problem that impacts the physical and cognitive prognosis of patients admitted to intensive care units and requires prompt diagnosis and management. This article describes the case and progress of a patient placed on Extracorporeal Membrane Oxygenation with difficult sedation criteria and an early diagnosis of mixed delirium. During the case report, we reflect on the pharmacological and non-pharmacological strategies employed to cope with delirium paying special attention to the non-use of physical restraint measures in order to preserve vital support devices (endotracheal tube or Extracorporeal Membrane Oxygenation cannula)...
August 28, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28865447/multicenter-assessment-of-sedation-and-delirium-practices-in-the-intensive-care-units-in-poland-is-this-common-practice-in-eastern-europe
#7
Katarzyna Kotfis, Małgorzata Zegan-Barańska, Maciej Żukowski, Krzysztof Kusza, Mariusz Kaczmarczyk, E Wesley Ely
BACKGROUND: The majority of critically ill patients experience distress during their stay in the Intensive Care Unit (ICU), resulting from systemic illness, multiple interventions and environmental factors. Providing humane care should address concomitant treatment of pain, agitation and delirium. The use of sedation and approaches to ICU delirium should be monitored according to structured guidelines. However, it is unknown to what extent these concepts are followed in Eastern European countries like Poland...
September 2, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28865338/impact-of-restarting-home-neuropsychiatric-medications-on-sedation-outcomes-in-medical-intensive-care-unit-patients
#8
Mary K La, Melissa L Thompson Bastin, Jenee T Gisewhite, Carrie A Johnson, Alexander H Flannery
PURPOSE: This single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes. MATERIALS AND METHODS: Subjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated before or on arrival to the intensive care unit (ICU); and were on benzodiazepine-based sedation. The intervention assessed was the timing of the initiation of home NPMs: early (≤5days) vs...
July 29, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28864877/clinical-assessment-and-management-of-delirium-in-the-palliative-care-setting
#9
Shirley Harvey Bush, Sallyanne Tierney, Peter Gerard Lawlor
Delirium is a neurocognitive syndrome arising from acute global brain dysfunction, and is prevalent in up to 42% of patients admitted to palliative care inpatient units. The symptoms of delirium and its associated communicative impediment invariably generate high levels of patient and family distress. Furthermore, delirium is associated with significant patient morbidity and increased mortality in many patient populations, especially palliative care where refractory delirium is common in the dying phase. As the clinical diagnosis of delirium is frequently missed by the healthcare team, the case for regular screening is arguably very compelling...
September 1, 2017: Drugs
https://www.readbyqxmd.com/read/28863011/sedation-and-mobilization-during-venovenous-extracorporeal-membrane-oxygenation-for-acute-respiratory-failure-an-international-survey
#10
Jonathan D Marhong, Julian DeBacker, Julien Viau-Lapointe, Laveena Munshi, Lorenzo Del Sorbo, Lisa Burry, Eddy Fan, Sangeeta Mehta
OBJECTIVES: To characterize sedation, analgesia, delirium, and mobilization practices in patients supported with venovenous extracorporeal membrane oxygenation for severe acute respiratory failure. DESIGN: Cross-sectional electronic survey administered January 2016 to March 2016. SETTING: Three-hundred ninety-four extracorporeal membrane oxygenation centers registered with the Extracorporeal Life Support Organization. SUBJECTS: Extracorporeal membrane oxygenation medical directors and program coordinators...
August 31, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28851588/do-sedation-and-analgesia-contribute-to-long-term-cognitive-dysfunction-in-critical-care-survivors
#11
S Fernandez-Gonzalo, M Turon, C De Haro, J López-Aguilar, M Jodar, L Blanch
Deep sedation during stay in the Intensive Care Unit (ICU) may have deleterious effects upon the clinical and cognitive outcomes of critically ill patients undergoing mechanical ventilation. Over the last decade a vast body of literature has been generated regarding different sedation strategies, with the aim of reducing the levels of sedation in critically ill patients. There has also been a growing interest in acute brain dysfunction, or delirium, in the ICU. However, the effect of sedation during ICU stay upon long-term cognitive deficits in ICU survivors remains unclear...
August 26, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28845902/persistence-of-delirium-after-cessation-of-sedatives-and-analgesics-and-impact-on-clinical-outcomes-in-critically-ill-patients
#12
Michael T Kenes, Joanna L Stollings, Li Wang, Timothy D Girard, E Wesley Ely, Pratik P Pandharipande
STUDY OBJECTIVE: As delirium is a common manifestation in critically ill patients and is associated with worse clinical outcomes, we sought to characterize the reversibility of delirium after discontinuation of sedation and to determine whether sedation-associated delirium that rapidly reverses impacts clinical outcomes. DESIGN: Post hoc subgroup analysis of prospectively collected data from a previously published study. PATIENTS: Seventy adults admitted to a medical intensive care unit (ICU) between March and July 2012 who required mechanical ventilation with continuous analgesia and/or sedation and underwent a spontaneous awakening trial (SAT)...
August 28, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28843663/risk-factors-and-outcomes-of-critically-ill-patients-with-acute-brain-failure-a-novel-end-point
#13
Tarun D Singh, John C O'Horo, Ognjen Gajic, Amra Sakusic, Courtney N Day, Jay Mandrekar, Rahul Kashyap, Dereddi Raja Shekar Reddy, Alejandro A Rabinstein
OBJECTIVE: To determine the incidence, risk factors and outcomes of acute brain failure (ABF) in a mixed medical and surgical cohort of critically ill patients and its effect on ICU & hospital mortality. DESIGN: Observational electronic medical record (EMR) based retrospective cohort study of critically ill patients admitted to the ICU between 2006 and 2013. SETTING: Tertiary academic medical center. PATIENTS: Consecutive adult (>18years) critically ill patients admitted to medical and surgical ICUs...
August 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28841632/delirium-and-catatonia-in-critically-ill-patients-the-delirium-and-catatonia-prospective-cohort-investigation
#14
Jo E Wilson, Richard Carlson, Maria C Duggan, Pratik Pandharipande, Timothy D Girard, Li Wang, Jennifer L Thompson, Rameela Chandrasekhar, Andrew Francis, Stephen E Nicolson, Robert S Dittus, Stephan Heckers, E Wesley Ely
OBJECTIVES: Catatonia, a condition characterized by motor, behavioral, and emotional changes, can occur during critical illness and appear as clinically similar to delirium, yet its management differs from delirium. Traditional criteria for medical catatonia preclude its diagnosis in delirium. Our objective in this investigation was to understand the overlap and relationship between delirium and catatonia in ICU patients and determine diagnostic thresholds for catatonia. DESIGN: Convenience cohort, nested within two ongoing randomized trials...
August 24, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28828407/delirium-risk-of-dexmedetomidine-and-midazolam-in-patients-treated-with-postoperative-mechanical-ventilation-a-meta-analysis
#15
Wang Peng, Shan Shimin, Wang Hongli, Zhang Yanli, Zhang Ying
OBJECTIVE: To evaluate by meta-analysis the effects of dexmedetomidine versus midazolam on postoperative delirium in patients that received postoperative mechanical ventilation. METHODS: The electronic databases of PubMed, Web of Science, EMbase, CNKI, CBM, Cochrane library and WanFang were searched by two reviewers. All the clinical studies related to dexmedetomidine versus midazolam on postoperative delirium were screened and collected in this meta-analysis. The combined postoperative delirium risk between dexmedetomidine and midazolam groups was pooled by random effect model...
2017: Open Medicine (Warsaw, Poland)
https://www.readbyqxmd.com/read/28811926/postinjection-delirium-sedation-syndrome-in-patients-with-schizophrenia-receiving-olanzapine-long-acting-injection-results-from-a-large-observational-study
#16
Kristin J Meyers, Himanshu P Upadhyaya, John L Landry, Rashna Chhabra-Khanna, Deborah M Falk, Balasubramanya Seetharama Rao, Meghan E Jones
BACKGROUND: Postinjection delirium/sedation syndrome (PDSS) has been reported uncommonly during treatment with olanzapine long-acting injection (LAI), a sustained-release formulation of olanzapine. AIMS: The primary aim of the study was to estimate the incidence per injection and per patient of PDSS events in adult patients with schizophrenia who were receiving olanzapine LAI in real-world clinical practice. Secondary aims were to further characterise the clinical presentation of PDSS events, to identify potential risk factors associated with PDSS events and to characterise hospitalisations at baseline and post-baseline...
July 2017: BJPsych Open
https://www.readbyqxmd.com/read/28806561/delirium-and-exposure-to-psychoactive-medications-in-critically-ill-adults-a-multi-centre-observational-study
#17
Lisa D Burry, David R Williamson, Sangeeta Mehta, Marc M Perreault, Ioanna Mantas, Ranjeeta Mallick, Dean A Fergusson, Orla Smith, Eddy Fan, Sebastien Dupuis, Margaret Herridge, Louise Rose
PURPOSE: Investigate the relationship between psychoactive drugs and delirium. MATERIALS AND METHODS: Prospective observational study of 520 critically ill adult patients admitted ≥24h to 6 intensive care units (ICUs). Data were collected on psychoactive drug exposure, use of sedation administration strategies, and incident delirium (Intensive Care Delirium Screening Checklist score≥4). RESULTS: Delirium was detected in 260 (50%) patients, median (IQR) duration 2 (1-5) days, and time to onset 3 (2-5) days...
August 5, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28796769/medication-related-patient-harm-in-new-zealand-hospitals
#18
MULTICENTER STUDY
Gillian Robb, Elizabeth Loe, Ashika Maharaj, Richard Hamblin, Mary E Seddon
AIM: The purpose of this study is to identify patterns of medication-related harm from a national perspective, and to use this information to inform decisions on where to focus medication safety efforts. This study updates a 2013 study using the same methodology. METHOD: District health boards (DHBs) still actively using either the Adverse Drug Event (ADE) Trigger Tool (TT) or the Global Trigger Tool (GTT), submitted two years of anonymised ADE data (1 July 2013-30 June 2015) to the Health Quality & Safety Commission (the Commission) using a standard template...
August 11, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28795670/-analysis-of-the-risk-factors-of-cognitive-impairment-in-post-intensive-care-syndrome-patient
#19
Cong Shao, Lixue Gu, Yongxia Mei, Mingjin Li
OBJECTIVE: To investigate the risk factors of cognitive impairment in post-intensive care syndrome patient (PICS-CI). METHODS: A retrospective study was conducted. The patient who transferred from post-intensive care unit (ICU) to the general ward for more than 7 days, and with the age ≥ 18 years old in the First Affiliated Hospital of Jinzhou Medical University from October 2015 to November 2016 were enrolled. The gender, age, marital status, education, occupation, salary, economic income, smoking, alcohol drinking, previous of history, mechanical ventilation, the length of ICU stay, sedative and delirium, and initial diagnosis were recorded...
August 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28792784/improved-pain-control-in-terminally-ill-cancer-patients-by-introducing-low-dose-oral-methadone-in-addition-to-ongoing-opioid-treatment
#20
Per Fürst, Staffan Lundström, Pål Klepstad, Sara Runesdotter, Peter Strang
BACKGROUND: Cancer pain is often not well controlled and there is a need for improved treatment strategies. Methadone exhibits unique properties among opioids and recent reports show promising results from adding a low dose of methadone to regular opioid therapy. OBJECTIVE: To examine the effects of oral low-dose methadone added to regular scheduled opioids in terminally ill patients with complex cancer-related pain. DESIGN: This was a retrospective chart review...
August 9, 2017: Journal of Palliative Medicine
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