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Sedation and delirium

Rimen Lim
Sleep disturbance is a significant issue for patients in intensive care units (ICUs), which can affect their health and recovery from illness. Therefore, it is important to consider ways to address sleep disturbance in these settings. One strategy that has been suggested is the use of 'quiet time' interventions, which involve a defined period where there is a reduction in controllable light and sound, and where interruptions at the patient's bedside are minimised. AIM: To determine the effectiveness of quiet time interventions in improving patients' sleep quality in ICUs; to investigate other potential clinical benefits of quiet time interventions; and to consider the effect of incorporating open visitation when implementing quiet time interventions...
March 21, 2018: Nursing Standard
Stefan J Teipel, Thomas Fritze, Martin Ellenrieder, Britta Haenisch, Wolfram Mittelmeier, Gabriele Doblhammer
BACKGROUND: Cognitive decline is an important complication of joint replacement surgeries in senior people. METHODS: We determined incidence rates of dementia diagnosis following endoprosthetic joint replacement surgery (upper and lower extremities). The observation period covered up to 28 quarters using German claims data comprising 154,604 cases 65 years and older. Effects were controlled for cerebrovascular and vascular risk factors, age, sex, the presence of a diagnosis of delirium, and regular prescription of sedative or analgesic drugs (SAD)...
March 21, 2018: International Psychogeriatrics
Chao-Liang Tang, Juan Li, Zhe-Tao Zhang, Bo Zhao, Shu-Dong Wang, Hua-Ming Zhang, Si Shi, Yang Zhang, Zhong-Yuan Xia
Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1...
February 2018: Neural Regeneration Research
Eva Schildmann, Sebastian Pörnbacher, Helen Kalies, Claudia Bausewein
BACKGROUND: Sedatives are frequently used towards the end of life. However, there is scarce information when their use is labelled as 'palliative sedation'. AIM: To assess the use and labelling of 'continuous administration of sedatives within the last 7 days of life', based on objective operational criteria, on a palliative care unit. DESIGN: Retrospective cohort study, using medical records. Explorative statistical analysis (SPSS 23). SETTING/PARTICIPANTS: Patients who died on a palliative care unit from August 2014 to July 2015...
March 1, 2018: Palliative Medicine
Augusto Caraceni, Raffaella Speranza, Elio Spoldi, Cristina Sonia Ambroset, Stefano Canestrari, Mauro Marinari, Anna Maria Marzi, Luciano Orsi, Laura Piva, Mirta Rocchi, Danila Valenti, Gianluigi Zeppetella, Furio Zucco, Alessandra Raimondi, Leonor Vasconcelos Matos, Cinzia Brunelli
CONTEXT: Few studies regarding palliative sedation (PS) have been carried out in home care (HC) setting. A comparison of PS rate and practices between hospice (HS) and HC is also lacking. OBJECTIVES: Comparing HC and HS settings for PS rate, patient clinical characteristics before and during PS, decision-making process and clinical aspects of PS. METHODS: 38 HC/HS services in Italy participated in a multicenter observational longitudinal study...
March 13, 2018: Journal of Pain and Symptom Management
C Ricardo Ramirez, M L Álvarez Gómez, C A Agudelo Vélez, S Zuluaga Penagos, R A Consuegra Peña, K Uribe Hernández, I C Mejía Gil, E M Cano Londoño, M Elorza Parra, J G Franco Vásquez
OBJECTIVE: To evaluate the clinical characteristics, prevalence and factors associated with delirium in critical patients from 5 to 14 years of age. DESIGN: An analytical, cross-sectional observational study was made. Delirium was assessed with the Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) and motor classification was established with the Delirium Rating Scale Revised-98. SETTING: A pediatric Intensive Care Unit...
March 9, 2018: Medicina Intensiva
Bin Mei, Gaige Meng, Guanghong Xu, Xinqi Cheng, Shishou Chen, Ye Zhang, Ming Zhang, Xuesheng Liu, Erwei Gu
BACKGROUND: Peripheral nerve block is a preferable method for elderly patients receiving hip arthroplasty. Sedation with dexmedetomidine may reduce postoperative delirium. The aim of this study was to investigate whether intraoperative sedation with dexmedetomidine, as a supplementary to peripheral nerve block for elderly patients receiving total hip arthroplasty, can decrease the prevalence of postoperative delirium. METHODS: A prospective, randomized controlled study was conducted with patients 65 years of age or older who underwent total hip arthroplasty between June 2016 and June 2017...
March 9, 2018: Clinical Journal of Pain
Anne L Donovan, J Matthew Aldrich, A Kendall Gross, Denise M Barchas, Kevin C Thornton, Hildy M Schell-Chaple, Michael A Gropper, Angela K M Lipshutz
OBJECTIVES: We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES: Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives...
March 7, 2018: Critical Care Medicine
Hannah Lee, Seung-Young Oh, Je Hyuk Yu, Jeongsoo Kim, Sehee Yoon, Ho Geol Ryu
BACKGROUND: Postoperative delirium after liver transplantation is relatively common, especially due to preexisting conditions such as hepatic encephalopathy. Most studies of delirium after liver transplantation were based on ICU practices using deep hypnosedation. Therefore, risk factors and consequences of postoperative delirium after liver transplantation were evaluated in the light sedation era. METHODS: A total of 253 liver transplantation patients were evaluated for postoperative delirium...
March 6, 2018: World Journal of Surgery
Timothy D Girard, Jennifer L Thompson, Pratik P Pandharipande, Nathan E Brummel, James C Jackson, Mayur B Patel, Christopher G Hughes, Rameela Chandrasekhar, Brenda T Pun, Leanne M Boehm, Mark R Elstad, Richard B Goodman, Gordon R Bernard, Robert S Dittus, E W Ely
BACKGROUND: Delirium during critical illness results from numerous insults, which might be interconnected and yet individually contribute to long-term cognitive impairment. We sought to describe the prevalence and duration of clinical phenotypes of delirium (ie, phenotypes defined by clinical risk factors) and to understand associations between these clinical phenotypes and severity of subsequent long-term cognitive impairment. METHODS: In this multicentre, prospective cohort study, we included adult (≥18 years) medical or surgical ICU patients with respiratory failure, shock, or both as part of two parallel studies: the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors (BRAIN-ICU) study, and the Delirium and Dementia in Veterans Surviving ICU Care (MIND-ICU) study...
March 2018: Lancet Respiratory Medicine
Valerie J Page
No abstract text is available yet for this article.
March 2018: Lancet Respiratory Medicine
Silvia L Nunes, Sune Forsberg, Hans Blomqvist, Lars Berggren, Mikael Sörberg, Toni Sarapohja, Carl-Johan Wickerts
BACKGROUND: Intensive care unit patients undergoing mechanical ventilation have traditionally been sedated to make them comfortable and to avoid pain and anxiety. However, this may lead to prolonged mechanical ventilation and a longer length of stay. OBJECTIVE: The aim of this retrospective study was to explore whether different sedation regimens influence the course and duration of the weaning process. PATIENTS AND METHODS: Intubated adult patients (n = 152) from 15 general intensive care units in Sweden were mechanically ventilated for ≥ 24 h...
March 3, 2018: Clinical Drug Investigation
Yahya Shehabi, Rinaldo Bellomo, Suhaini Kadiman, Lian Kah Ti, Belinda Howe, Michael C Reade, Tien Meng Khoo, Anita Alias, Yu-Lin Wong, Amartya Mukhopadhyay, Colin McArthur, Ian Seppelt, Steven A Webb, Maja Green, Michael J Bailey
OBJECTIVES: In the absence of a universal definition of light or deep sedation, the level of sedation that conveys favorable outcomes is unknown. We quantified the relationship between escalating intensity of sedation in the first 48 hours of mechanical ventilation and 180-day survival, time to extubation, and delirium. DESIGN: Harmonized data from prospective multicenter international longitudinal cohort studies SETTING:: Diverse mix of ICUs. PATIENTS: Critically ill patients expected to be ventilated for longer than 24 hours...
March 1, 2018: Critical Care Medicine
Yoanna Skrobik, Matthew S Duprey, Nicholas S Hill, John W Devlin
RATIONALE: Dexmedetomidine is associated with less delirium than benzodiazepines, and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring sedation remains unclear. OBJECTIVES: To determine if nocturnal dexmedetomidine prevents delirium and improves sleep in critically ill adults. METHODS: This two-center, double-blind, placebo-controlled trial randomized 100 delirium-free critically ill adults receiving sedatives to receive nocturnal (21:30 to 6:15h) intravenous dexmedetomidine (0...
March 2, 2018: American Journal of Respiratory and Critical Care Medicine
Apoorva Upadhyay, Samrat Singh Bhandari, Vatsala Sharma, Shyamanta Das
No abstract text is available yet for this article.
October 2017: Indian Journal of Psychiatry
Yanbin Pan, Zhixia Jiang, Yuan Changrong, Lianhong Wang, Jingjing Zhang, Jing Zhou, Ming Tao, Mingtao Quan, Qiong Wu
AIMS AND OBJECTIVES: To investigate the impact of physical restraint on delirium of adult patients in ICU. BACKGROUND: Delirium is a common clinical syndrome in intensive care unit (ICU), correlated with various adverse clinical outcomes. Physical restraint is a precipitating factor for delirium, however, the effect of physical restraint on delirium, such as duration, number, and appliance, etc., is still unclear. DESIGN: A nested case-control study...
March 1, 2018: Journal of Clinical Nursing
Silvio Simeone, Gianluca Pucciarelli, Marco Perrone, Teresa Rea, Gianpaolo Gargiulo, Assunta Guillari, Gaetano Castellano, Luigi Di Tommaso, Massimo Niola, Gabriele Iannelli
AIMS AND OBJECTIVES: To observe the clinical and structural factors that can be associated with the post-operative onset of delirium in patients who have undergone heart surgery. BACKGROUND: Several risk factors could contribute to the development of delirium, such as the use of some sedative drugs and a patient's history with certain types of acute chronic disease. However, in the literature, there is little knowledge about the association between delirium in patients who have undergone cardio-surgical intervention and their clinical and environmental predictors...
March 1, 2018: Journal of Clinical Nursing
Gérald Chanques, E Wesley Ely, Océane Garnier, Fanny Perrigault, Anaïs Eloi, Julie Carr, Christine M Rowan, Albert Prades, Audrey de Jong, Sylvie Moritz-Gasser, Nicolas Molinari, Samir Jaber
BACKGROUND: One third of patients admitted to an intensive care unit (ICU) will develop delirium. However, delirium is under-recognized by bedside clinicians without the use of delirium screening tools, such as the Intensive Care Delirium Screening Checklist (ICDSC) or the Confusion Assessment Method for the ICU (CAM-ICU). The CAM-ICU was updated in 2014 to improve its use by clinicians throughout the world. It has never been validated compared to the new reference standard, the Diagnostic and Statistical Manual of Mental Disorders 5th version (DSM-5)...
March 1, 2018: Annals of Intensive Care
Dragana Radovanović, Zoran Radovanović, Svetlana Škorić-Jokić, Milanka Tatić, Aljoša Mandić, Tatjana Ivković-Kapicl
The aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. This prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. The secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization...
June 2017: Acta Clinica Croatica
David Hui, Kenneth Hess, Seyedeh S Dibaj, Joseph Arthur, Rony Dev, Shalini Dalal, Suresh Reddy, Eduardo Bruera
BACKGROUND: The Richmond Agitation-Sedation Scale (RASS) is commonly used to assess psychomotor activity; however, to the authors' knowledge, its minimal clinically important difference (MCID) has not been determined to date. The objective of the current study was to identify the MCID for RASS using 2 anchor-based approaches. METHODS: The current study was a secondary analysis of a randomized controlled trial to compare the effect of lorazepam versus placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium...
February 22, 2018: Cancer
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