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Sedation and delirium

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https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#1
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
#2
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
#3
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...
November 24, 2016: 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
#4
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
#5
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
https://www.readbyqxmd.com/read/27881185/melatonin-and-melatonin-agonists-to-prevent-and-treat-delirium-in-critical-illness-a-systematic-review-protocol
#6
Jennifer Foster, Lisa D Burry, Lehana Thabane, Karen Choong, Kusum Menon, Mark Duffett, Alexandra Cheung, Melanie Guenette, Timothy Chimunda, Louise Rose
BACKGROUND: Delirium is a syndrome characterized by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk, and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged duration of ICU and hospital length of stay, and increased mortality. Melatonin and melatonin agonists (MMA) have the potential to decrease the incidence and severity of delirium through their hypnotic and sedative-sparing effects, thus improving health-related outcomes...
November 24, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27878605/-special-medical-problems-in-end-of-life-care-crisis-at-the-end-of-life-which-therapy-is-adequate-and-when-is-redefining-treatment-goals-appropriate
#7
Gesine Benze, Bernd Alt-Epping, Friedemann Nauck
Crisis at the end of life are exceptional challenges for patients, relatives and therapists. With respect to the individual treatment goals and the patients' autonomy, therapeutic action should be commenced in an adequate manner in order to preserve the patients' quality of life as much as possible. Advance care planning for specific critical scenarios may be helpful in order to treat patients according to their wishes and values even if they are not capable to express themselves. Furthermore, a crisis plan can define the scope of action for therapists in emergency situations...
November 23, 2016: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
https://www.readbyqxmd.com/read/27874185/translating-delirium-prevention-strategies-for-elderly-adults-with-hip-fracture-into-routine-clinical-care-a-pragmatic-clinical-trial
#8
Susan Freter, Katalin Koller, Michael Dunbar, Chris MacKnight, Kenneth Rockwood
OBJECTIVES: To compare the feasibility (adherence) and effectiveness (prevalence of delirium, length of stay, mortality, discharge site) of delirium-friendly preprinted postoperative orders (PPOs) for individuals with hip fracture, administered by regular orthopedic nurses, with routine postoperative orders. DESIGN: Pragmatic clinical trial to evaluate a quality improvement intervention. SETTING: Tertiary care hospital. PARTICIPANTS: Individuals aged 65 and older admitted for hip fracture repair (N = 283)...
November 22, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27871631/-benefit-of-general-anesthesia-monitored-by-bispectral-index-compared-with-monitoring-guided-only-by-clinical-parameters-systematic-review-and-meta-analysis
#9
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...
November 18, 2016: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/27854517/acute-kidney-injury-as-a-risk-factor-for-delirium-and-coma-during-critical-illness
#10
Edward D Siew, William H Fissell, Christina M Tripp, Jeffrey D Blume, Matthew D Wilson, Amanda J Clark, Andrew J Vincz, E Wesley Ely, Pratik P Pandharipande, Timothy D Girard
RATIONALE: Acute kidney injury may contribute to distant organ dysfunction. Few studies have examined kidney injury as a risk factor for delirium and coma. OBJECTIVE: To examine whether acute kidney injury is associated with delirium and coma in critically ill adults. METHODS: In a prospective cohort study of ICU patients with respiratory failure and/or shock, we examined the association between acute kidney injury and daily mental status using multinomial transition models adjusting for demographics, non-renal organ failure, sepsis, prior mental status, and sedative exposure...
November 17, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27850874/1238-a-nursing-survey-of-protocol-based-pain-sedation-and-delirium-management-in-an-intensive-care-unit
#11
Kerra Cissne, Allegra Durrant, Erin Pender, Muhammad Ali Javed
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27850745/1108-improving-the-management-of-pain-sedation-and-delirium-in-ventilated-adult-critical-care-patients
#12
Christy Rooks, Angela Dechand, Austin Jackson, Salah Najm
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27849239/importance-of-the-use-of-protocols-for-the-management-of-analgesia-and-sedation-in-pediatric-intensive-care-unit
#13
Emiliana Motta, Michele Luglio, Artur Figueiredo Delgado, Werther Brunow de Carvalho
Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols...
September 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27822046/clinical-outcomes-with-olanzapine-long-acting-injection-impact-of-the-3-hour-observation-period-on-patient-satisfaction-and-well-being
#14
Ernie Anand, Lovisa Berggren, John Landry, Ágoston Tóth, Holland C Detke
BACKGROUND: The objective of the present analysis is to determine the impact of the 3-hour observation period for olanzapine long-acting injection (LAI) on patient satisfaction and well-being by comparing data collected before and after its implementation. METHODS: This is a post hoc analysis of patients treated with olanzapine LAI in 1) a 6-month fixed-dose randomized controlled trial and/or 2) a 6-year open-label safety study. This analysis was limited to patients with schizophrenia who were treated with olanzapine LAI consistent with the approved indication and dosing recommendations of the European Union Summary of Product Characteristics (N=966)...
2016: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/27802952/detection-of-posttraumatic-stress-symptoms-in-patients-after-discharge-from-intensive-care
#15
Heather Warlan, Lois Howland, Cynthia Connelly
BACKGROUND: Despite emphasis on identifying personal and clinical characteristics that place patients at higher risk for posttraumatic stress syndrome after intensive care, the extent of screening for the syndrome in intensive care patients is unknown. OBJECTIVES: To examine the feasibility and acceptability of a screening tool to detect posttraumatic stress syndrome, screen for the syndrome soon after discharge from intensive care to identify patients at risk for post-traumatic stress disorder, and determine personal and clinical factors related to higher scores on the screening instrument...
November 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27800163/validity-of-the-richmond-agitation-sedation-scale-rass-in-critically-ill-children
#16
Abigail Glicksman Kerson, Rebecca DeMaria, Elizabeth Mauer, Christine Joyce, Linda M Gerber, Bruce M Greenwald, Gabrielle Silver, Chani Traube
BACKGROUND: The Richmond Agitation-Sedation Scale (RASS) is a single tool that is intuitive, is easy to use, and includes both agitation and sedation. The RASS has never been formally validated for pediatric populations. The objective of this study was to assess inter-rater agreement and criterion validity of the RASS in critically ill children. METHODS: To evaluate validity, the RASS score was compared to both a visual analog scale (VAS) scored by the patient's nurse, and the University of Michigan Sedation Scale (UMSS), performed by a researcher...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27797086/risk-factors-for-new-onset-delirium-in-patients-with-bloodstream-infections-independent-and-quantitative-effect-of-catheters-and-drainages-a-four-year-cohort-study
#17
Tolga Dittrich, Sarah Tschudin-Sutter, Andreas F Widmer, Stephan Rüegg, Stephan Marsch, Raoul Sutter
BACKGROUND: Bloodstream infections (BSI) and delirium are frequent in critically ill patients. During systemic inflammatory response to BSI, cytokines may interact with neurotransmitters and neuronal receptors driving acute brain dysfunction. However, prospectively collected data on incidence, prediction and impact of delirium in association with BSI are lacking. This study aimed to determine the incidence and predictors of new-onset delirium and its impact on outcome in critically ill adult patients with BSI...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27776085/patterns-of-postoperative-delirium-in-children
#18
Jochen Meyburg, Mona-Lisa Dill, Chani Traube, Gabrielle Silver, Rebecca von Haken
OBJECTIVE: Intensive care delirium is a substantial problem in adults. Intensive care delirium is increasingly recognized in pediatrics in parallel with the development of specific scoring systems for children. However, little is known about the fluctuating course of intensive care delirium in children after surgery and possible implications on diagnostic and therapeutic strategies. DESIGN: Patients that needed treatment in the PICU following elective surgery were screened for intensive care delirium with the Cornell Assessment of Pediatric Delirium...
October 21, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27765479/etiologies-and-delirium-rates-of-elderly-ed-patients-with-acutely-altered-mental-status-a-multicenter-prospective-study
#19
Mehmet Ali Aslaner, Mustafa Boz, Ali Çelik, Asliddin Ahmedali, Sercan Eroğlu, Nalan Metin Aksu, Serkan Emre Eroğlu
OBJECTIVES: Altered mental status (AMS) is a challenging diagnosis in older patients and has a large range of etiologies. The aim of this study was to investigate the nature of such etiologies for physicians to be better aware of AMS backgrounds and hence improve outcomes and mortality rates. METHODS: This prospective observational study was conducted at 4 emergency departments. Patients 65 years and older who presented to the emergency department with acute AMS (≤1 week), with symptoms ranging from comas and combativeness, were eligible for inclusion in this study...
October 5, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27757003/off-label-use-of-dexmedetomidine-for-the-treatment-of-delirium-in-the-intensive-care-unit
#20
Huan Mark Nguyen, Doreen Pon
OBJECTIVE: Evaluate recent clinical studies involving the use of dexmedetomidine (DEX) infusion for the treatment of delirium in the intensive care unit (ICU). METHODS: A literature search was conducted to identify peer-reviewed articles in MEDLINE (1966-June 2016) using the terms sedation, analgesic, dexmedetomidine, delirium, and critically ill adult patients. RESULTS: Two studies in the ICU setting reported the potential benefits of DEX for managing agitation during weaning from mechanical ventilation...
October 2016: P & T: a Peer-reviewed Journal for Formulary Management
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