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https://www.readbyqxmd.com/read/28101364/hemodynamic-effects-of-electrical-muscle-stimulation-in-the-prophylaxis-of-deep-vein-thrombosis-for-intensive-care-unit-patients-a-randomized-trial
#1
Masahiro Ojima, Ryosuke Takegawa, Tomoya Hirose, Mitsuo Ohnishi, Tadahiko Shiozaki, Takeshi Shimazu
BACKGROUND: Deep vein thrombosis (DVT) is a major complication in critical care. There are various methods of prophylaxis, but none of them fully prevent DVT, and each method has adverse effects. Electrical muscle stimulation (EMS) could be a new effective approach to prevent DVT in intensive care unit (ICU) patients. We hypothesized that EMS increases the venous flow of the lower limbs and has a prophylactic effect against the formation of DVT. METHODS: This study included 26 patients admitted to a single ICU...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28099642/sedation-protocols-versus-daily-sedation-interruption-a-systematic-review-and-meta-analysis
#2
Antonio Paulo Nassar, Marcelo Park
Objective: The aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies. Methods: We searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28099638/risk-factors-for-agitation-in-critically-ill-patients
#3
Thiago Miranda Lopes de Almeida, Luciano Cesar Pontes de Azevedo, Paulo Maurício Garcia Nosé, Flavio Geraldo Resende de Freitas, Flávia Ribeiro Machado
Objective: To evaluate the incidence of agitation in the first 7 days after intensive care unit admission, its risk factors and its associations with clinical outcomes. Methods: This single-center prospective cohort study included all patients older than 18 years with a predicted stay > 48 hours within the first 24 hours of intensive care unit admission. Agitation was defined as a Richmond Agitation Sedation Scale score ≥ +2, an episode of agitation or the use of a specific medication recorded in patient charts...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28098628/the-abcdef-bundle-science-and-philosophy-of-how-icu-liberation-serves-patients-and-families
#4
E Wesley Ely
Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28098590/analgesia-and-sedation-requirements-in-mechanically-ventilated-trauma-patients-with-acute-preinjury-use-of-cocaine-and-or-amphetamines
#5
Bridgette Kram, Shawn J Kram, Michelle L Sharpe, Michael L James, Maragatha Kuchibhatla, Mark L Shapiro
BACKGROUND: The purpose of this study was to determine whether mechanically ventilated trauma patients with a positive urine drug screen (UDS) for cocaine and/or amphetamines have different opioid analgesic and sedative requirements compared with similar patients with a negative drug screen for these stimulants. METHODS: This retrospective, single-center cohort study at a tertiary care, academic medical and level 1 trauma center in the United States included patients ≥16 years of age who were admitted to an adult intensive care unit with a diagnosis of trauma between 2009 and 2013 with a UDS documented within 24 hours of admission, and were mechanically ventilated for >24 hours...
January 16, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28078682/population-pharmacokinetics-of-intravenous-clonidine-for-sedation-during-pediatric-extracorporeal-membrane-oxygenation-ecmo-and-continuous-veno-venous-hemofiltration-cvvh
#6
Niina Kleiber, Ron A A Mathôt, Maurice J Ahsman, Enno D Wildschut, Dick Tibboel, Saskia N de Wildt
AIMS: Clonidine is used for sedation in the pediatric intensive care unit. Extracorporeal membrane oxygenation (ECMO) provides temporary support if respiratory and cardiac function is threatened. ECMO influences the pharmacokinetics of drugs. Clonidine during pediatric ECMO cannot be effectively titrated as PK data are lacking. The aim of this study is to describe clonidine PK in a particular ECMO system and propose dosing guidelines for children on this particular ECMO circuit. METHODS: All children below the age of 18 who received clonidine during ECMO were eligible...
January 12, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28072745/safety-and-efficacy-of-chloral-hydrate-for-conscious-sedation-of-infants-in-the-pediatric-cardiovascular-intensive-care-unit
#7
Mei-Lian Chen, Qiang Chen, Fan Xu, Jia-Xin Zhang, Xiao-Ying Su, Xiao-Zhen Tu
This study evaluates the safety and efficacy of chloral hydrate administration for the conscious sedation of infants in the pediatric cardiovascular intensive care unit (PCICU).We conducted a retrospective review of the charts of 165 infants with congenital heart disease who received chloral hydrate in our PCICU between January 2014 and December 2014. Chloral hydrate was administered orally or rectally to infants using doses of 50 mg/kg. We collected and analyzed relevant clinical parameters.The overall length of time to achieve sedation was ranged from 5 to 35 min (10...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28066556/does-the-combination-use-of-two-pain-assessment-tools-have-a-synergistic-effect
#8
EDITORIAL
Takeshi Suzuki
Pain management is a very important aspect in the intensive care unit (ICU), as adequate pain control has been shown to be associated with better clinical outcomes in critically ill patients. A Numerical Rating Scale (NRS) ranging from 0 to 10 (0, no pain; 10, maximum pain), which is based on a patient's self-report, is the gold standard for pain evaluation in patients who can communicate their pain intensity. On the other hand, it is very difficult to evaluate the degree of pain in critically ill patients owing to decreased consciousness level, delirium, and the effect of sedation for mechanical ventilation management...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28049382/use-of-intracranial-pressure-monitoring-in-bacterial-meningitis-a-10-year-follow-up-on-outcome-and-intracranial-pressure-versus-head-ct-scans
#9
Lykke Larsen, Frantz R Poulsen, Troels H Nielsen, Carl-Henrik Nordström, Mette K Schulz, Åse B Andersen
BACKGROUND: The aim of this study was to evaluate the clinical outcome of patients with severe bacterial meningitis where intracranial pressure (ICP) monitoring has been performed. METHODS: A retrospective observational study including patients admitted 1st(.) January 2005 to 31st(.) December 2014. Thirty nine patients age 18-89 years were included. All the patients received intensive care with mechanical ventilation, ICP monitoring, sedation, antibiotics and corticosteroids according to current guidelines...
January 3, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/28042369/oral-baclofen-withdrawal-resulting-in-progressive-weakness-and-sedation-requiring-intensive-care-admission
#10
Bret D Alvis, Christopher M Sobey
Baclofen is a common medication used as a muscle relaxant and antispasmodic. Baclofen-withdrawal syndrome has many symptoms such as sedation, somnolence, and weakness but can include psychological symptoms. We present a 62-year-old female whose oral baclofen was not continued at a skilled nursing facility after discharge following inpatient surgery that led to the development of altered mental status and respiratory insufficiency necessitating intensive care unit admission. Abrupt cessation of baclofen, no matter the mode of administration to the patient, can lead to baclofen-withdrawal syndrome...
January 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28030555/trycycle-a-prospective-study-of-the-safety-and-feasibility-of-early-in-bed-cycling-in-mechanically-ventilated-patients
#11
Michelle E Kho, Alexander J Molloy, France J Clarke, Daana Ajami, Magda McCaughan, Kristy Obrovac, Christina Murphy, Laura Camposilvan, Margaret S Herridge, Karen K Y Koo, Jill Rudkowski, Andrew J E Seely, Jennifer M Zanni, Marina Mourtzakis, Thomas Piraino, Deborah J Cook
INTRODUCTION: The objective of this study was to assess the safety and feasibility of in-bed cycling started within the first 4 days of mechanical ventilation (MV) to inform a future randomized clinical trial. METHODS: We conducted a 33-patient prospective cohort study in a 21-bed adult academic medical-surgical intensive care unit (ICU) in Hamilton, ON, Canada. We included adult patients (≥ 18 years) receiving MV who walked independently pre-ICU. Our intervention was 30 minutes of in-bed supine cycling 6 days/week in the ICU...
2016: PloS One
https://www.readbyqxmd.com/read/28024711/-progressive-hematoma-in-anterior-neck-after-endovascular-treatment-of-middle-cerebral-artery-aneurysm
#12
Aysun Ankay Yilbas, Cigdem Kanburoglu, Filiz Uzumcugil, Coskun Cifci, Ozge Ozen Saralp, Heves Karagoz, Seda Banu Akinci, Anil Arat
BACKGROUND: Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm. CASE REPORT: A 49 year-old woman was scheduled for stent placement under general anesthesia for middle cerebral artery aneurysm. Few days before intervention, acetyl salicylic acid and clopidogrel treatment was started...
December 23, 2016: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28019045/autonomic-modulation-for-the-treatment-of-ventricular-arrhythmias-therapeutic-use-of-percutaneous-stellate-ganglion-blocks
#13
Marat Fudim, Richard Boortz-Marx, Chetan B Patel, Albert Y Sun, Jonathan P Piccini
Ventricular tachycardia (VT), ventricular fibrillation (VF) and electrical storm are commonly encountered emergency conditions in cardiac and surgical intensive care units. In most cases, recurrent ventricular arrhythmias or electrical storm are associated with a heightened sympathetic tone. These arrhythmias can be difficult to treat and may be refractory to beta-blockade, antiarrhythmic therapy, sedation, and mechanical hemodynamic support. While monomorphic ventricular tachycardia and PVC-triggered polymorphic ventricular tachycardia may sometimes be amenable to successful ablation, some patients may be too critically ill to make such an approach feasible...
December 26, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28012962/prolonged-infusion-of-sedatives-and-analgesics-in-adult-intensive-care-patients-a-systematic-review-of-pharmacokinetic-data-reporting-and-quality-of-evidence
#14
REVIEW
Andrew H W Tse, Lowell Ling, Gavin M Joynt, Anna Lee
Although pharmacokinetic (PK) data for prolonged sedative and analgesic agents in intensive care unit (ICU) has been described, the number of publications in this important area appear relatively few, and PK data presented is not comprehensive. Known pathophysiological changes in critically ill patients result in altered drug PK when compared with non-critically ill patients. ClinPK Statement was recently developed to promote consistent reporting in PK studies, however, its applicability to ICU specific PK studies is unclear...
December 21, 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28004964/patient-safety-under-deep-sedation-for-digestive-endoscopic-procedures
#15
Julián Álvarez, Rafael Cabadas, Manuel de la Matta
Deep sedation with Propofol has become popular in recent years. The safety of this technique when administered by non-anaesthesiologists has created much controversy which at times is masked in a contentious debate on the economic sustainability of the health system. In 2011, the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy, along with 20 other organisations from European countries, revoked the recommendations of the European Society of Gastrointestinal Endoscopy on the administration of Propofol by non-anaesthesiologists, citing that it is "extremely dangerous for the safety and quality of endoscopic procedures"...
December 22, 2016: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/27999970/oral-30-glucose-provides-sufficient-sedation-in-newborns-during-mri
#16
H Evren Eker, Oya Yalcin Cok, Bilin Çetinkaya, Anis Aribogan
PURPOSE: Newborns are often sedated during MRI but sedation itself creates adverse events and management is more challenging in this environment. Oral glucose/sucrose administration has been studied in newborns during painful procedures; however, its effectiveness in keeping newborns sleepy and motionlessness during painless procedures has not been demonstrated. The objective of this study was to describe effectiveness of oral 30% glucose administration by comparing with intravenous midazolam sedation for newborns during MRI...
December 20, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27987330/protection-of-dexmedetomidine-against-ischemia-reperfusion-induced-apoptotic-insults-to-neuronal-cells-occurs-via-an-intrinsic-mitochondria-dependent-pathway
#17
Gong-Jhe Wu, Jui-Tai Chen, Hsiao-Chien Tsai, Ta-Liang Chen, Shing-Hwa Liu, Ruei-Ming Chen
Dexmedetomidine, an agonist of alpha2-adrenergic receptors, is used for critically ill patients to induce and maintain sedation and analgesia. Brain ischemia/reperfusion (I/R) usually causes severe neuronal injuries to intensive care unit patients. This study was aimed to evaluate the effects of dexmedetomidine on I/R-induced insults to neuronal cells and the possible mechanisms. Treatment of neuro-2a cells with dexmedetomidine did not affect cell viability but could protect against I/R-induced cell death. Separately, the I/R-triggered cell shrinkage, DNA fragmentation, and apoptosis in neuro-2a cells were alleviated by dexmedetomidine...
December 17, 2016: Journal of Cellular Biochemistry
https://www.readbyqxmd.com/read/27984229/sedation-after-cardiac-surgery-is-one-drug-better-than-another
#18
Hong Liu, Fuhai Ji, Ke Peng, Richard L Applegate, Neal Fleming
The classic high-dose narcotic-based cardiac anesthetic has been modified to facilitate a fast-track, rapid recovery in the intensive care unit (ICU). Postoperative sedation is consequently now an essential component in recovery of the patient undergoing cardiac surgery. It must facilitate the patient's unawareness of the environment as well as reduce the discomfort and anxiety caused by surgery, intubation, mechanical ventilation, suction, and physiotherapy. Benzodiazepines seem well suited for this role, but propofol, opioids, and dexmedetomidine are among other agents commonly used for sedation in the ICU...
December 15, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27976489/improving-the-quality-of-nurse-influenced-patient-care-in-the-intensive-care-unit
#19
Lynsey J Sutton, Rebecca J Jarden
BACKGROUND: Quality of care is a major focus in the intensive care unit (ICU). AIM: To describe a nurse-initiated quality improvement (QI) project that improved the care of critically ill patients in a New Zealand tertiary ICU. DESIGN: A framework for QI was developed and implemented as part of a practice change initiative. METHODS: Audit data were collected, analysed and reported across seven nurse-influenced patient care standards...
December 14, 2016: Nursing in Critical Care
https://www.readbyqxmd.com/read/27966302/cost-analysis-and-evaluation-of-nosocomial-infections-in-intensive-care-units
#20
Uğur Kostakoğlu, Sedat Saylan, Mevlüt Karataş, Serap İskender, Firdevs Aksoy, Gürdal Yılmaz
BACKGROUND/AIM: The purpose of this study was to evaluate nosocomial infections occurring in our hospital intensive care units (ICUs) and the risk factors for these, and to determine the effect of these infections on mortality and cost. MATERIALS AND METHODS: This retrospective study was performed via infection control committee surveillance data, ICU records, and information processing data between 1 January and 31 December 2013 at the Kanuni Education and Research Hospital...
November 17, 2016: Turkish Journal of Medical Sciences
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