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https://www.readbyqxmd.com/read/29455032/sevoflurane-for-procedural-sedation-in-critically-ill-patients-a-pharmacokinetic-comparative-study-between-burn-and-non-burn-patients
#1
Sebastien Perbet, Daniel Bourdeaux, Alexandre Lenoire, Claire Biboulet, Bruno Pereira, Malha Sadoune, Benoit Plaud, Jean-Marie Launay, Jean-Etienne Bazin, Valerie Sautou, Alexandre Mebazaa, Pascal Houze, Jean-Michel Constantin, Matthieu Legrand
BACKGROUND: Sevoflurane has anti-inflammatory proprieties and short lasting effects making it of interest for procedural sedation in critically ill patients. We evaluated the pharmacokinetics of sevoflurane and metabolites in severely ill burn patients and controls. The secondary objective was to assess potential kidney injury. METHODS: prospective interventional study in a burn and a surgical intensive care unit 24 mechanically ventilated critically ill patients (12 burns, 12 controls) were included,...
February 15, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29446987/dexmedetomidine-decreases-postoperative-pain-and-narcotic-use-in-children-undergoing-alveolar-bone-graft-surgery
#2
Mariela M Lopez, Derrick Zech, Judith L Linton, Steven J Blackwell
OBJECTIVE: Dexmedetomidine is a parenteral agent that combines the benefits of cooperative sedation, anxiolysis, and analgesia without the risks of respiratory depression. Off-label use has been reported in children. We have introduced dexmedetomidine for use in patients having undergone alveolar bone graft (ABG). The objective is to demonstrate the value and safety of postoperative dexmedetomidine infusion in a non-ICU setting following ABG. DESIGN: A retrospective review was performed on patients who underwent ABG by the senior author...
January 1, 2018: Cleft Palate-craniofacial Journal
https://www.readbyqxmd.com/read/29446066/resource-use-during-the-last-6-months-of-life-of-individuals-dying-with-and-of-alzheimer-s-disease
#3
Kristof Faes, Joachim Cohen, Lieven Annemans
OBJECTIVES: To compare resource use during the last 6 months of life of individuals diagnosed with Alzheimer's disease (AD) but for whom AD was not formally identified as the underlying cause of death (dying with AD) with that of those who had AD as underlying cause of death (dying of AD). DESIGN: Full-population retrospective analysis. SETTING: Belgium. PARTICIPANTS: All Belgian decedents in 2012. MEASUREMENTS: We linked participants' healthcare, population, and death certificate data...
February 15, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29444340/antipsychotics-delirium-and-acute-respiratory-distress-syndrome-what-is-the-link
#4
Heather Torbic, Abhijit Duggal
Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, long-term cognitive impairment, and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidly and mortality...
February 14, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29440801/a-retrospective-study-of-end-of-life-care-decisions-in-the-critically-ill-in-a-surgical-intensive-care-unit
#5
Yi Lin Lee, Yee Yian Ong, Sze Ying Thong, Shin Yi Ng
Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU). The practice of approaching end-of-life (EOL) care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU). The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process...
January 2018: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29437077/delirium-assessment-tools-for-use-in-critically-ill-adults-a-psychometric-analysis-and-systematic-review
#6
Céline Gélinas, Mélanie Bérubé, Annie Chevrier, Brenda T Pun, E Wesley Ely, Yoanna Skrobik, Juliana Barr
BACKGROUND: Delirium is highly prevalent in critically ill patients. Its detection with valid tools is crucial. OBJECTIVE: To analyze the development and psychometric properties of delirium assessment tools for critically ill adults. METHODS: Databases were searched to identify relevant studies. Inclusion criteria were English language, publication before January 2015, 30 or more patients, and patient population of critically ill adults (>18 years old)...
February 2018: Critical Care Nurse
https://www.readbyqxmd.com/read/29434539/sleep-and-sedative-states-induced-by-targeting-the-histamine-and-noradrenergic-systems
#7
REVIEW
Xiao Yu, Nicholas P Franks, William Wisden
Sedatives target just a handful of receptors and ion channels. But we have no satisfying explanation for how activating these receptors produces sedation. In particular, do sedatives act at restricted brain locations and circuitries or more widely? Two prominent sedative drugs in clinical use are zolpidem, a GABA A receptor positive allosteric modulator, and dexmedetomidine (DEX), a selective α2 adrenergic receptor agonist. By targeting hypothalamic neuromodulatory systems both drugs induce a sleep-like state, but in different ways: zolpidem primarily reduces the latency to NREM sleep, and is a controlled substance taken by many people to help them sleep; DEX produces prominent slow wave activity in the electroencephalogram (EEG) resembling stage 2 NREM sleep, but with complications of hypothermia and lowered blood pressure-it is used for long term sedation in hospital intensive care units-under DEX-induced sedation patients are arousable and responsive, and this drug reduces the risk of delirium...
2018: Frontiers in Neural Circuits
https://www.readbyqxmd.com/read/29428252/delirium-during-the-first-evaluation-of-children-aged-five-to-14%C3%A2-years-admitted-to-a-paediatric-critical-care-unit
#8
Eliana María Cano Londoño, Isabel Cristina Mejía Gil, Katerine Uribe Hernández, Carmenza Ricardo Ramírez, Matilde Ligia Álvarez Gómez, Ricardo Antonio Consuegra Peña, Camilo Andrés Agudelo Vélez, Susana Zuluaga Penagos, Mussatye Elorza Parra, José G Franco Vásquez
OBJECTIVES: To describe the prevalence and characteristics of delirium during the initial evaluation of critically ill patients aged 5-14 years. METHOD/DESIGN: This is a cross-sectional descriptive study in a critical care unit. For six months, all patients were evaluated within the first 24-72 hours or when sedation permitted the use of the paediatric confusion assessment method for the intensive care unit (PCAM-ICU) and the Delirium Rating Scale-Revised-98 items #7 and #8 to determine motor type...
February 7, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29423967/suvorexant-is-associated-with-a-low-incidence-of-delirium-in-critically-ill-patients-a-retrospective-cohort-study
#9
Tomoyuki Masuyama, Masamitsu Sanui, Naoto Yoshida, Yusuke Iizuka, Kunio Ogi, Satoko Yagihashi, Kanae Nagatomo, Yusuke Sasabuchi, Alan K Lefor
BACKGROUND: Benzodiazepine use is a risk factor for the development of delirium in adult intensive care unit (ICU) patients. Suvorexant is an alternative to benzodiazepines to induce sleep, but the incidence of delirium in critically ill patients is unknown. We undertook this retrospective study to investigate the incidence of delirium in patients who receive suvorexant in the ICU. METHODS: This retrospective cohort study was conducted in a closed 12-bed ICU at a tertiary teaching hospital...
February 8, 2018: Psychogeriatrics: the Official Journal of the Japanese Psychogeriatric Society
https://www.readbyqxmd.com/read/29415773/end-expiratory-occlusion-maneuver-to-predict-fluid-responsiveness-in-the-intensive-care-unit-an-echocardiographic-study
#10
Delphine Georges, Hugues de Courson, Romain Lanchon, Musa Sesay, Karine Nouette-Gaulain, Matthieu Biais
BACKGROUND: In mechanically ventilated patients, an increase in cardiac index during an end-expiratory-occlusion test predicts fluid responsiveness. To identify this rapid increase in cardiac index, continuous and instantaneous cardiac index monitoring is necessary, decreasing its feasibility at the bedside. Our study was designed to investigate whether changes in velocity time integral and in peak velocity obtained using transthoracic echocardiography during an end-expiratory-occlusion maneuver could predict fluid responsiveness...
February 8, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29413725/current-practices-and-safety-of-medication-use-during-rapid-sequence-intubation
#11
Christine M Groth, Nicole M Acquisto, Tina Khadem
PURPOSE: Characterize medication practices during and immediately after rapid sequence intubation (RSI) by provider/location and evaluate adverse drug events. MATERIALS AND METHODS: This was a multicenter, observational, cross-sectional study of adult and pediatric intensive care unit and emergency department patients over a 24-h period surrounding first intubation. RESULTS: A total of 404 patients from 34 geographically diverse institutions were included (mean age 58 ± 22 years, males 59%, pediatric 8%)...
January 30, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29413721/isoflurane-or-propofol-sedation-in-patients-with-targeted-temperature-management-after-cardiopulmonary-resuscitation-a-single-center-study
#12
Dawid Leander Staudacher, Sarah-Kristin Hamilton, Daniel Duerschmied, Paul Marc Biever, Manfred Zehender, Christoph Bode, Tobias Wengenmayer
PROPOSE: Targeted temperature management improves outcomes in comatose patients after cardiac arrest. Short lasting sedatives might enable rapid awakening after targeted temperature management and therefore early prognostication and extubation. Aim of the present study was to compare sedation with volatile isoflurane to intravenous propofol. MATERIALS AND METHODS: All patients after cardiopulmonary resuscitation undergoing targeted temperature management treated between 01/2014 and 02/2017 at a single tertiary referral hospital were screened...
February 2, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29413207/gastroesophageal-reflux-in-the-intensive-care-unit-patient
#13
REVIEW
Cathy A Cooper, Patti P Urso
The incidence of gastroesophageal reflux disease (GERD) in the critically ill patient in the intensive care unit is unknown. Interventions used in critically ill patients, such as sedation, tracheal tubes, mechanical ventilation, enteral feedings, positioning, and medications, along with specific patient characteristics and comorbid conditions contribute to an increased risk for gastroesophageal reflux (GER) in this population. Critical care nurses have an integral role in helping identify critically ill patients at risk for GER or with known GERD, in preventing complications associated with these conditions...
March 2018: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/29411494/post-pyloric-feeding-tube-placement-in-critically-ill-patients-extending-the-scope-of-practice-for-australian-dietitians
#14
Rosalie Yandell, Marianne Chapman, Stephanie O'Connor, Alison Shanks, Kylie Lange, Adam Deane
AIM: To determine whether the placement of a post-pyloric feeding tube (PPFT) can be taught safely and effectively to a critical care dietitian. METHODS: This is a prospective observational study conducted in an adult intensive care unit (ICU). The intervention consisted of 19 attempts at post-pyloric intubation by the dietitian. The 10 'learning' attempts were performed by the dietitian under the direction of an experienced (having completed in excess of 50 successful tube placements) user...
February 2018: Nutrition & Dietetics: the Journal of the Dietitians Association of Australia
https://www.readbyqxmd.com/read/29405671/light-sedation-with-dexmedetomidine-a-practical-approach-for-the-intensivist-in-different-icu-patients
#15
Stefano Romagnoli, Angela Amigoni, Ilaria Blangetti, Giampaolo Casella, Cosimo Chelazzi, Francesco Forfori, Cristiana Garisto, Maria C Mondardini, Marco Moltrasio, Daniela Pasero, Tiziana Principi, Zaccaria Ricci, Fabio Tarantino, Giorgio Conti
Light sedation, corresponding to a Richmond AgitationSedation Scale between 0 and 1 is a priority of modern critical care practice. Dexmedetomidine, a highly selective, central, 2adrenoceptor agonist, is increasingly administered in the intensive care units (ICUs) as an effective drug to induce light sedation, analgesia and a quasiphysiological sleep in critically ill patients. Although in general dexmedetomidine is well tolerated, side effects as bradycardia, hypertension, and hypotension may occur. Although a general dosing range is suggested, different ICU patients may require different and highly precise titration that may significantly vary due to neurological status, cardiorespiratory function, baseline blood pressure, heart rate, liver efficiency, age and coadministration of other sedatives...
February 5, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29405600/conscious-sedation-for-tavr-a-wave-of-the-future
#16
EDITORIAL
Christina Tan, Larry S Dean
As indications for TAVR continue to grow, experienced centers strive to adopt further minimally invasive techniques and continue to improve outcomes. Meta-analysis of the available data demonstrate that conscious sedation is associated with decreased ICU and hospitalization time, and is not associated with decreased procedural efficacy or safety. Randomized Controlled clinical Trial data will be needed to confirm observational findings suggesting decreased mortality with conscious sedation versus general anesthesia...
February 1, 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29402365/-effect-and-mechanism-of-dexmedetomidine-on-lungs-in-patients-of-sepsis-complicated-with-acute-respiratory-distress-syndrome
#17
Xianfeng Chen, Juntao Hu, Chi Zhang, Yiping Pan, Diansheng Tian, Fafa Kuang, Zhanhong Tang
OBJECTIVE: To investigate the mechanisms of protective effects of dexmedetomidine on lungs in patients of sepsis complicated with acute respiratory distress syndrome (ARDS). METHODS: The adult patients with sepsis complicated with ARDS, the oxygenation index (PaO2/FiO2) was 150-200 mmHg (1 mmHg = 0.133 kPa), acute physiology and chronic health evaluation II (APACHE II) score was 10-20, need mechanical ventilation (MV) treatment > 72 hours, and admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from September 2013 to June 2017 were enrolled...
February 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29402358/-effect-of-early-mobilization-on-diaphragmatic-function-in-patients-with-mechanical-ventilation-a-prospective-randomized-controlled-study
#18
Shengqiang Yang, Jinggang Liu, Wenbao Yang, Jiyin Yuan, Suqiu Meng, Maoling Liang, Qibiao Shi
OBJECTIVE: To investigate the effect of early mobilization on diaphragmatic function in patients with mechanical ventilation (MV). METHODS: Sixty chronic obstructive pulmonary disease with acute exacerbation (AECOPD) patients with respiratory failure (RF) and underwent MV admitted to intensive care unit (ICU) of Huxi Affiliated Hospital of Jining Medical College from January 2016 to January 2017 were enrolled. The patients were divided into treatment group (n = 30) and control group (n = 30) by randomly number table method...
February 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29392967/sedation-in-the-coronary-intensive-care-unit-an-adapted-algorithm-for-critically-ill-cardiovascular-patient
#19
A L Schenone, K Chen, K Andress, M Militello, L Cho
In the current era, cardiovascular intensive care units care for more complex patients who are far sicker than historical post-myocardial infarction patients, and sedation has become a common intervention in these units. Current sedation best practices derive mainly from non-cardiac units which limits their generalization to the critically ill cardiac patient. Thus, a great variability in sedation protocols, especially the selection of sedative agents, is commonly seen in daily practice across cardiac units...
February 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29389771/early-electroencephalography-findings-in-cardiogenic-shock-patients-treated-by-venoarterial-extracorporeal-membrane-oxygenation
#20
Fabrice Sinnah, Marie-Amélie Dalloz, Eric Magalhaes, Ruben Wanono, Mathilde Neuville, Roland Smonig, Aguila Radjou, Bruno Mourvillier, Lila Bouadma, Jean-François Timsit, Marie-Pia d'Ortho, Any Rouvel-Tallec, Romain Sonneville
OBJECTIVES: We aimed to assess early electroencephalography findings in patients treated by venoarterial extracorporeal membrane oxygenation and their association with neurologic outcome. DESIGN: Single-center observational study. SETTING: Medical ICU of a university hospital. PATIENTS: An early standardized electroencephalography assessment, that is, standard electroencephalography followed by continuous electroencephalography, was performed in consecutive cardiogenic shock patients requiring venoarterial extracorporeal membrane oxygenation...
January 31, 2018: Critical Care Medicine
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