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https://www.readbyqxmd.com/read/29683053/multidisciplinary-prerounding-meeting-as-a-continuous-quality-improvement-tool-leveraging-to-reduce-continuous-benzodiazepine-use-at-an-academic-medical-center
#1
Alexander H Flannery, Melissa L Thompson Bastin, Ashley Montgomery-Yates, Corrine Hook, Evan Cassity, Phillip M Eaton, Peter E Morris
BACKGROUND: Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. METHODS: This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29680212/impact-of-a-clinical-therapeutic-intervention-on-pain-assessment-management-and-nursing-practices-in-an-intensive-care-unit-a-before-and-after-study
#2
Vincenzo Damico, Flavio Cazzaniga, Liana Murano, Rita Ciceri, Giuseppe Nattino, Alberto Dal Molin
Accurate pain assessment and management constitute a major challenge for medical and nursing staff in intensive care units (ICUs). A distinct recollection of pain is reported by high proportions of ICU patients. A clinical therapeutic intervention directed at improving pain assessment and management in critically ill patients who are unable to communicate was implemented at an Italian ICU. In this before-and-after study, data were collected before (T0 ) and after (T1 ) the adoption of a protocol involving pain assessment with an ad hoc behavioral pain scale and the administration of analgesics, rather than sedatives, to patients with intermediate to high pain scores...
April 18, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29678158/dexmedetomidine-infusion-as-an-analgesic-adjuvant-during-laparoscopic-%C3%B1-holecystectomy-a-randomized-controlled-study
#3
Kateryna Bielka, Iurii Kuchyn, Volodymyr Babych, Kseniia Martycshenko, Oleksii Inozemtsev
BACKGROUND: Dexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC). METHODS: A randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017...
April 20, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29668462/electrodermal-activity-monitoring-during-endotracheal-suction-in-sedated-adult-intensive-care-unit-patients
#4
Theodoros Aslanidis, Vasilios Grosomanidis, Konstantinos Karakoulas, Athanasios Chatzisotiriou
BACKGROUND: Endotracheal suctioning of respiratory secretions is one of the most common causes of pain and discomfort in Intensive Care Unit environment. The electrical properties of the skin, also known as electrodermal activity (EDA), are considered as an indirect measure of autonomous nervous system. AIM: This study explores EDA changes during endotracheal suction in sedated adult critical care patients; and compares these changes to other monitoring parameters...
March 1, 2018: Folia Medica
https://www.readbyqxmd.com/read/29663283/eeg-artifact-versus-subclinical-status-epilepticus-in-a-patient-following-cardiac-arrest
#5
Jean E Cibula, Daniel S Demos, Brenda G Fahy
BACKGROUND: A challenge in ICU EEG interpretation is identifying subclinical status epilepticus versus patterns on the ictal-interictal continuum versus other repetitive patterns. In the electrically noisy intensive care unit, identifying and eliminating interference and artifact allow accurate diagnoses from the EEG, avoiding unnecessary treatment or sedation. METHODS: We present a case during Impella (Abiomed Inc, Danvers, MA) continuous flow left ventricular assist device use where the EEG artifact was initially misinterpreted as seizure by the resident and treated as status epilepticus because of the "focal" sharply contoured repetitive pattern...
April 16, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29657370/delirium-in-the-intensive-care-unit-incidence-risk-factors-and-impact-on-outcome
#6
Nejla Tilouche, Mohamed Fekih Hassen, Habiba Ben Sik Ali, Oussamma Jaoued, Rim Gharbi, S Souheil El Atrous
Background: The incidence and risk factors for delirium vary among studies. Objective: We aimed to determine the incidence, risk factors, and impact on outcome of delirium in a medical Intensive Care Unit (ICU) in Tunisia using a prospective observational study. Patients: All consecutive patients admitted to the ICU between May 2012 and April 2013 were included if they were aged more than 18 years and had an ICU stay of more than 24 h. Patients who had a cardiac arrest or have a history of dementia or psychosis were excluded...
March 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29652686/massive-macroglossia-after-posterior-cranial-fossa-surgery-a-case-report
#7
Jennifer F Ha, Lisa N Vitale, Marie A Pfarr, Yu Kawai, David A Zopf
A 16-year-old boy with Chiari 1 malformation presented for an elective suboccipital craniectomy and C1 laminectomy. His intraoperative course was uneventful. At the conclusion of the procedure, he met extubation criteria and followed commands. After extubation, he developed progressive upper airway obstruction and became obtunded. He was reintubated via videolaryngoscopy, which showed edema not only to the tongue, but also to the posterior pharynx and blisters over the vocal folds and epiglottis. The patient was transferred to the pediatric intensive care unit intubated and sedated...
April 15, 2018: A&A practice
https://www.readbyqxmd.com/read/29629988/early-evidence-of-sepsis-associated-hyperperfusion-a-study-of-cerebral-blood-flow-measured-with-mri-arterial-spin-labeling-in-critically-ill-septic-patients-and-control-subjects
#8
Marie-Hélène Masse, Marie Anne Richard, Frédérick D'Aragon, Charles St-Arnaud, Michael Mayette, Neill K J Adhikari, William Fraser, André Carpentier, Steven Palanchuck, David Gauthier, Luc Lanthier, Matthieu Touchette, Albert Lamontagne, Jean Chénard, Sangeeta Mehta, Yanick Sansoucy, Etienne Croteau, Martin Lepage, François Lamontagne
OBJECTIVES: Mechanisms underlying sepsis-associated encephalopathy remain unclear, but reduced cerebral blood flow, alone or in conjunction with altered autoregulation, is reported as a potential contributor. We compared cerebral blood flow of control subjects and vasopressor-dependent septic patients. DESIGN: Randomized crossover study. SETTING: MRI with arterial spin labeling. PATIENTS: Ten sedated septic patients on mechanical ventilation (four with controlled chronic hypertension) and 12 control subjects (six with controlled chronic hypertension) were enrolled...
April 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29629931/magnetic-resonance-imaging-in-neurocritically-ill-patients-who-fails-and-how
#9
Joong-Goo Kim, Myung-Ah Ko, Han-Bin Lee, Sang-Beom Jeon
OBJECTIVES: Performing magnetic resonance imaging (MRI) in neurocritically ill patients is challenging because it often requires sedation and withholding care in the neurological intensive care unit. This study investigated the incidence of and reasons for failed or complicated MRI (MRI-FC) in such patients. METHODS: A consecutive series of 218 neurocritically ill patients who underwent brain MRI were retrospectively evaluated. Failed or complicated MRI included failure to obtain all ordered sequences, unscheduled sedative administration, decrease in oxygen saturation to less than 90%, hypotension (≥40-mm Hg decrease and/or use of inotropic agents), and cardiac or respiratory arrest...
April 6, 2018: Journal of Patient Safety
https://www.readbyqxmd.com/read/29628833/efficacy-and-safety-of-dexmedetomidine-infusion-for-patients-undergoing-awake-craniotomy-an-observational-study
#10
Charu Mahajan, Girija Prasad Rath, Gyaninder Pal Singh, Nitasha Mishra, Suman Sokhal, Parmod Kumar Bithal
Background: The goal of awake craniotomy is to maintain adequate sedation, analgesia, respiratory, and hemodynamic stability and also to provide a cooperative patient for neurologic testing. An observational study carried out to evaluate the efficacy of dexmedetomidine sedation for awake craniotomy. Materials and Methods: Adult patients with age >18 year who underwent awake craniotomy for intracranial tumor surgery were enrolled. Those who were uncooperative and had difficult airway were excluded from the study...
April 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29628826/dexmedetomidine-vs-morphine-and-midazolam-in-the-prevention-and-treatment-of-delirium-after-adult-cardiac-surgery-a-randomized-double-blinded-clinical-trial
#11
Tamer M Abdel Azeem, Nahed E Yosif, Adel M Alansary, Ibrahim Mamdouh Esmat, Ahmed K Mohamed
Background: The aim of this clinical study was to evaluate the efficacy of neurobehavioral, hemodynamics and sedative characteristics of dexmedetomidine compared with morphine and midazolam-based regimen after cardiac surgery at equivalent levels of sedation and analgesia in improving clinically relevant outcomes such as delirium. Methods: Sixty patients were randomly allocated into one of two equal groups: group A = 30 patients received dexmedetomidine infusion (0...
April 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29628332/patients-lived-experience-of-intensive-care-when-being-on-mechanical-ventilation-during-the-weaning-process-a-hermeneutic-phenomenological-study
#12
Catarina Tingsvik, Fredrik Hammarskjöld, Jan Mårtensson, Maria Henricson
BACKGROUND: The medical and nursing care of the patient on mechanical ventilation has developed and proceeds in terms of ventilator functions, sedation strategies and patient participation. New data are needed to explore the weaning process from the patients' perspective. Therefore, the aim of this study was to explore the meaning of being a patient on mechanical ventilation during the weaning process in the intensive care unit. METHODS: This study used van Manen's hermeneutic phenomenological approach...
April 5, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29625595/psychometric-properties-of-the-arabic-version-of-the-confusion-assessment-method-for-the-intensive-care-unit-cam-icu
#13
Maha H Aljuaid, Ahmad M Deeb, Maamoun Dbsawy, Daniah Alsayegh, Moteb Alotaibi, Yaseen M Arabi
BACKGROUND: It is recommended that critically ill patients undergo routine delirium monitoring with a valid and reliable tool such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). However, the validity and reliability of the Arabic version of the CAM-ICU has not been investigated. Here, we test the validity and reliability of the Arabic CAM-ICU. METHODS: We conducted a psychometric study at ICUs in a tertiary-care hospital in Saudi Arabia...
April 6, 2018: BMC Psychiatry
https://www.readbyqxmd.com/read/29623221/efficacy-of-dexmedetomidine-versus-ketofol-for-sedation-of-postoperative-mechanically-ventilated-patients-with-obstructive-sleep-apnea
#14
Hatem Elmoutaz Mahmoud, Doaa Abou Elkassim Rashwan
Patients with sleep apnea are prone to postoperative respiratory complications, requiring restriction of sedatives during perioperative care. We performed a prospective randomized study on 24 patients with obstructive sleep apnea (OSA) who underwent elective surgery under general anesthesia. The patients were equally divided into two groups: Group Dex : received dexmedetomidine loading dose 1 mcg/kg IV over 10 min followed by infusion of 0.2-0.7 mcg/kg/hr; Group KFL : received ketofol as an initial bolus dose 500 mcg/kg IV (ketamine/propofol 1 : 1) and maintenance dose of 5-10 mcg/kg/min...
2018: Critical Care Research and Practice
https://www.readbyqxmd.com/read/29619866/enteral-guanfacine-to-treat-severe-anxiety-and-agitation-complicating-critical-care-after-cardiac-surgery
#15
Habib Srour, Komal Pandya, Alex Flannery, Kevin Hatton
This article is the first reported case describing the off-label use of enteral immediate-release guanfacine, a long-acting α-2 adrenergic agonist most commonly used in the treatment of attention-deficit hyperactivity disorder, for sedation in a patient with severe anxiety and agitation limiting mechanical ventilation weaning several days after cardiac surgery. In this case, after several days of unsuccessful attempts to control his agitation and anxiety with conventional therapies, guanfacine therapy was initiated, and the patient was rapidly weaned from all other sedatives and mechanical ventilation shortly thereafter...
April 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29609546/high-frequency-power-of-heart-rate-variability-can-predict-the-outcome-of-thoracic-surgical-patients-with-acute-respiratory-distress-syndrome-on-admission-to-the-intensive-care-unit-a-prospective-single-centric-case-controlled-study
#16
I-Chen Chen, Chew-Teng Kor, Ching-Hsiung Lin, Jane Kuo, Jang-Zern Tsai, Wen-Je Ko, Cheng-Deng Kuo
BACKGROUND: The morbidity and mortality of acute respiratory distress syndrome (ARDS) remains high, and the strategic focus of ARDS research has shifted toward identifying patients at high risk of mortality early in the course of illness. This study intended to identify the heart rate variability (HRV) measure that can predict the outcome of patients with ARDS on admission to the surgical intensive care unit (SICU). METHODS: Patients who had lung or esophageal cancer surgery were included either in the ARDS group (n = 21) if they developed ARDS after surgery or in the control group (n = 11) if they did not...
April 2, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29607710/comparison-of-ketamine-versus-nonketamine-based-sedation-on-delirium-and-coma-in-the-intensive-care-unit
#17
Vanessa Shurtleff, John J Radosevich, Asad E Patanwala
BACKGROUND: At this time, there are no studies evaluating the risk of delirium or coma with the use of ketamine in mechanically ventilated adult patients, compared to conventional therapies such as propofol or dexmedetomidine. OBJECTIVE: The objective of this study was to evaluate the number of days alive without delirium or coma in mechanically ventilated patients in the intensive care unit receiving analgosedation infusions with ketamine versus without ketamine...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29600048/correlation-of-bispectral-index-and-richmond-agitation-sedation-scale-for-evaluating-sedation-depth-a-retrospective-study
#18
Junbo Zheng, Yang Gao, Xiaoyu Xu, Kai Kang, Haitao Liu, Hongliang Wang, Kaijiang Yu
Background: This study aims to verify the correlation of bispectral index (BIS) and Richmond agitation sedation scale (RASS) for evaluating these and explore possibility of replacing RASS with BIS. Methods: This retrospective cohort study consisted of 74 patients who were collected from the third Intensive Care Unit (ICU) ward of XXX Hospital between May 2012 and June 2015 in this retrospective study. Sedation levels were evaluated using the 10-grade RASS and were continuously monitored with a BIS monitor during the procedure every 5 minutes...
January 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29589416/conscious-sedation-in-critically-ill-patients-is-associated-with-stressors-perception-lower-than-assessed-by-caregivers
#19
Giovanni Mistraletti, Michele Umbrello, Vera Mariani, Elisabetta Carloni, Sara Miori, Martina Taverna, Giovanni Sabbatini, Paolo Formenti, Stefano Terzoni, Anne L Destrebecq, Davide Chiumello, Egidio A Moja, Gaetano Iapichino
BACKGROUND: In ICU, the stay is frequently a stressful experience. Caregivers may help to understand patients' perceptions; however, their reliability is uncertain. Despite the recent recommendations of lighter sedation targets, little is known about the impact of "conscious sedation" on ICU patients memories. Purpose of this prospective, observational study is to analyze the stress perception in consciously-sedated ICU-patients, comparing it to caregivers and staff members...
March 27, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29580965/designing-a-nurse-delivered-delirium-bundle-what-intensive-care-unit-staff-survivors-and-their-families-think
#20
Leona Bannon, Jennifer McGaughey, Mike Clarke, Daniel F McAuley, Bronagh Blackwood
BACKGROUND: Implementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation. OBJECTIVE: The objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation...
March 23, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
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