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https://www.readbyqxmd.com/read/28721340/post-intensive-care-syndrome-an-overview
#1
Gautam Rawal, Sankalp Yadav, Raj Kumar
Survival of critically unwell patients has improved in the last decade due to advances in critical care medicine. Some of these survivors develop cognitive, psychiatric and /or physical disability after treatment in intensive care unit (ICU), which is now recognized as post intensive care syndrome (PICS). Given the limited awareness about PICS in the medical faculty this aspect is often overlooked which may lead to reduced quality of life and cause a lot of suffering of these patients and their families. Efforts should be directed towards preventing PICS by minimizing sedation and early mobilization during ICU...
June 2017: Journal of Translational Internal Medicine
https://www.readbyqxmd.com/read/28718341/diagnostic-yield-and-outcomes-of-computed-tomography-of-the-head-in-critically-ill-nontrauma-patients
#2
Fabian Finkelmeier, Sophie Walter, Kai-Henrik Peiffer, Anjali Cremer, Andrea Tal, Thomas Vogl, Stefan Zeuzem, Stephan Fichtlscherer, Mireen Friedrich-Rust, Jörg Bojunga, Harald Farnik
BACKGROUND: Computed tomography of the head (HCT) is a widely used diagnostic tool, especially for emergency and trauma patients. However, the diagnostic yield and outcomes of HCT for patients on medical intensive care units (MICUs) are largely unknown. METHODS: We retrospectively evaluated all head CTs from patients admitted to a single-center MICU during a 5-year period for CT indications, diagnostic yield, and therapeutic consequences. Uni- and multivariate analyses for the evaluation of risk factors for positive head CT were conducted...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28715310/discovering-ways-to-mend-growing-bodies-the-bioengineering-of-devices-for-the-youngest-patients-brings-unique-challenges-and-rewards
#3
David L Chandler
Some babies are born with a rare condition known as esophageal atresia, in which part of the connection between the throat and stomach is missing or nonfunctional. While this was once untreatable and fatal, in recent years surgeons have developed a method using traction to stretch the tissues out on each end until, over time, they are long enough to be sewn together and so substitute for the missing portion of the esophagus. The procedure has allowed many infant patients to go home with a full, normal life ahead of them...
July 2017: IEEE Pulse
https://www.readbyqxmd.com/read/28710219/comparison-of-propofol-and-dexmedetomidine-infused-overnight-to-treat-hyperactive-and-mixed-icu-delirium-a-protocol-for-the-basel-prodex-clinical-trial
#4
Alexa Hollinger, Katrin Ledergerber, Stefanie von Felten, Raoul Sutter, Stephan Rüegg, Lukas Gantner, Sibylle Zimmermann, Andrea Blum, Luzius A Steiner, Stephan Marsch, Martin Siegemund
BACKGROUND/OBJECTIVES: Delirium is a neurobehavioural disturbance that frequently develops particularly in the intensive care unit (ICU) population. It was first described more than half a century ago, where it was already discovered as a state that might come along with serious complications such as prolonged ICU and hospital stay, reduced quality of life and increased mortality. However, in most cases, there is still lack of proof for causal relationship. Its presence frequently remains unrecognised due to suggested predominance of the hypoactive form...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28704639/a-sense-of-agency-an-ethnographic-exploration-of-being-awake-during-mechanical-ventilation-in-the-intensive-care-unit
#5
Eva Laerkner, Ingrid Egerod, Finn Olesen, Helle Ploug Hansen
BACKGROUND: There is a current trend towards lighter or no sedation of mechanically ventilated patients in the intensive care unit. The advantages of less sedation have been demonstrated as shorter duration of mechanical ventilation and reduced length of stay in the intensive care unit and hospital. Non-sedated patients are more awake during mechanical ventilation, but little is known about how this affects the intensive care patient. AIM: To explore patients' experiences of being awake during critical illness and mechanical ventilation in the intensive care unit...
June 30, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28701602/to-evaluate-dexmedetomidine-as-an-additive-to-propofol-for-sedation-for-elective-cardioversion-in-a-cardiac-intensive-care-unit-a-double-blind-randomized-controlled-trial
#6
Tanveer Singh Kundra, Parminder Kaur, P S Nagaraja, N Manjunatha
INTRODUCTION: Propofol may lead to patient recall and discomfort when used for sedation in elective cardioversion. The aim of the present study was to evaluate dexmedetomidine as an additive to propofol for sedation in elective cardioversion. MATERIALS AND METHODS: A total of 500 patients undergoing elective cardioversion were randomized into Group 1 (n = 250) and Group 2 (n = 250) on the basis of computer-generated randomization table. Patients in Group 1 were given dexmedetomidine (1 mcg/kg) over 10 min before giving propofol (1 mg/kg), while patients in Group 2 were given only propofol (1 mg/kg)...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28699492/adverse-drug-reactions-in-critical-care-setting-a-systematic-review
#7
Joshua Lisha, Velu Annalakshmi, Jose Maria, Devi Padmini
BACKGROUND: The prevalence of adverse drug reactions (ADRs) is reported to be high in critical care units. We conducted a systematic review to study the prevalence, drugs implicated, preventability, predictability, severity and determinants of ADRs in critical care settings. METHODS: We searched MEDLINE, EMBASE, PROQUEST and OVID (January 1995 to June 2015) using pre-specified appropriate medical subject heading (MeSH) terms. Of 1552 studies, 34 studies were included for data extraction and synthesis...
July 10, 2017: Current Drug Safety
https://www.readbyqxmd.com/read/28698343/protocol-for-an-observational-study-of-delirium-in-the-post-anaesthesia-care-unit-pacu-as-a-potential-predictor-of-subsequent-postoperative-delirium
#8
Victoria Cui, Catherine M Tedeschi, Vanessa L Kronzer, Sherry L McKinnon, Michael S Avidan
INTRODUCTION: Postoperative delirium can be a serious consequence of major surgery, associated with longer hospital stays, readmission, cognitive and functional deterioration and mortality. Delirium is an acute, reversible disorder characterised by fluctuating course, inattention, disorganised thinking and altered level of consciousness. Delirium occurring in the hours immediately following anaesthesia and delirium occurring in the postoperative period of 1-5 days have been described as distinct clinical entities...
July 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28697572/delayed-recall-and-working-memory-mmse-domains-predict-delirium-following-cardiac-surgery
#9
Catherine C Price, Cynthia Garvan, Loren Hizel, Marcos G Lopez, Frederic T Billings
BACKGROUND: Reduced preoperative cognition is a risk factor for postoperative delirium. The significance for type of preoperative cognitive deficit, however, has yet to be explored and could provide important insights into mechanisms and prediction of delirium. OBJECTIVE: Our goal was to determine if certain cognitive domains from the general cognitive screener, the Mini-Mental State Exam (MMSE), predict delirium after cardiac surgery. METHODS: Patients completed a preoperative MMSE prior to undergoing elective cardiac surgery...
July 4, 2017: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/28684012/-high-blood-pressure-during-the-autonomic-crises-in-children-in-intensive-care-unit-etiologic-circumstances-and-modality-therapeutic
#10
D D Batouche, M Benatta, R Okbani, N F Benatta
The dysautonomic (DC) or neurovegetative crisis remains an imperfectly known entity; it associates in a paroxysmal manner a reaction of sympathetic hyperreactivity that can lead to the prognosis. Our objective is to specify the etiological circumstances (DC) and their modality of treatment in pediatric intensive care unit. MATERIALS-METHODS: Descriptive study on files of children admitted in the intensive care unit of 2010-2015 who presented a DC acquired during their hospitalization...
July 3, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/28682859/multidisciplinary-interventions-and-continuous-quality-improvement-to-reduce-unplanned-extubation-in-adult-intensive-care-units-a-15-year-experience
#11
Chien-Ming Chao, Chih-Cheng Lai, Khee-Siang Chan, Kuo-Chen Cheng, Chung-Han Ho, Chin-Ming Chen, Willy Chou
We conduct a retrospective study of patients with unplanned extubation (UE) in adult intensive care units (ICU) at a medical center. In 2001, a multidisciplinary team of intensivists, senior residents, nurses, and respiratory therapists was established at Chi Mei Medical Center. The improvement interventions, implemented between 2001 and 2015, were organized around 8 key areas: standardizing procedures, improving communication skills, revising sedation and weaning protocols, changing strategies for restraints, establishing a task force for identifying and managing high-risk patients, using new quality-improvement models as breakthrough series and team resource management, using the strategy of accountability without assigning blame, and changing a new method to secure endotracheal tube...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28682828/criteria-for-intensive-care-admission-and-monitoring-after-elective-craniotomy
#12
Rafael Badenes, Lara Prisco, Armando Maruenda, Fabio S Taccone
PURPOSE OF REVIEW: The current article revises the recent evidence on ICU admission criteria and postoperative neuromonitoring for patients undergoing elective craniotomy. RECENT FINDINGS: Only a small proportion of elective postoperative neurosurgical patients require specific medical interventions and invasive monitoring. Among these, patients undergoing elective craniotomy are frequently admitted to neuro-ICU, specialist postanaesthesia care units or intermediate-level care unit in the postoperative period...
July 5, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28679200/closed-loop-ventilation-mode-in-intensive-care-unit-a-randomized-controlled-clinical-trial-comparing-the-numbers-of-manual-ventilator-setting-changes
#13
Jean-Michel Arnal, Aude Garnero, Dominik Novotni, Gaëlle Corno, Stéphane Y Donati, Didier Demory, Gabrielle Quintana, Laurent Ducros, Thomas Laubscher, Jacques Durand-Gasselin
BACKGROUND: There is an equipoise regarding closed-loop ventilation modes and the ability to reduce workload for providers. On one hand some settings are managed by the ventilator but on another hand the automatic mode introduces new settings for the user. METHODS: This randomized controlled trial compared the number of manual ventilator setting changes between a full closed loop ventilation and oxygenation mode (INTELLiVENT-ASV®) and conventional ventilation modes (volume assist control and pressure support) in intensive care unit (ICU) patients...
July 5, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28675113/low-levels-of-physical-activity-during-critical-illness-and-weaning-the-evidence-reality-gap
#14
Bronwen A Connolly, Jessica L Mortimore, Abdel Douiri, Joleen W Rose, Nicholas Hart, Susan C Berney
BACKGROUND: Physical rehabilitation can benefit critically ill patients during intensive care unit (ICU) admission, but routine clinical practice remains inconsistent nor examined in prolonged mechanical ventilation patients transferred to a specialist ventilator weaning unit (VWU). Behavioral mapping is a sampling approach that allows detailed reporting of physical activity profiles. The objective of this study was to characterize the physical activity profile of critically ill patients in a UK ICU and VWU...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28668927/delirium-after-transcatheter-aortic-valve-replacement
#15
Jennifer L Giuseffi, Nyal E Borges, Leanne M Boehm, Li Wang, John A McPherson, Joseph L Fredi, Rashid M Ahmad, E Wesley Ely, Pratik P Pandharipande
BACKGROUND: Postoperative delirium is associated with increased mortality. Patients undergoing transcatheter aortic valve replacement are at risk for delirium because of comorbid conditions. OBJECTIVE: To compare the incidence, odds, and mortality implications of delirium between patients undergoing transcatheter replacement and patients undergoing surgical replacement. METHODS: The Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit were used to assess arousal level and delirium prospectively in all patients with severe aortic stenosis who had transcatheter or surgical aortic valve replacement at an academic medical center...
July 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28668914/safety-and-acceptability-of-patient-administered-sedatives-during-mechanical-ventilation
#16
Linda L Chlan, Debra J Skaar, Mary F Tracy, Sarah M Hayes, Breanna D Hetland, Kay Savik, Craig R Weinert
BACKGROUND: Safety and acceptability of sedative self-administration by patients receiving mechanical ventilation is unknown. OBJECTIVES: To determine if self-administration of dexmedetomidine by patients is safe and acceptable for self-management of anxiety during ventilatory support. METHODS: In a pilot trial in 3 intensive care units, 17 intubated patients were randomly assigned to dexmedetomidine and 20 to usual care. Dexmedetomidine was administered via standard pumps for patient-controlled analgesia, with a basal infusion (0...
July 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28666781/evaluation-of-sedation-related-medication-errors-in-contact-isolation-patients-in-the-icu
#17
Randi Searcy, Donald Johnson, Christopher Jankowski, Jason Ferreira
BACKGROUND: Patients in the intensive care unit (ICU), may be placed in contact isolation (CI) for meticillin-resistant Staphylococcus aureus (MRSA) colonization to prevent transmission. Prior studies suggest that isolated patients may receive substandard care compared to patients not on isolation. An optimal level of sedation is required to facilitate mechanical ventilation (MV) and to minimize adverse outcomes. AIM: To determine if patients on MV and isolated for MRSA colonization are at an increased risk of inappropriate over-sedation compared to patients not on CI...
June 27, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28661920/is-etomidate-sedation-associated-with-excess-mortality-in-intensive-care-unit-patients-what-is-the-evidence
#18
T Andrew Bowdle
No abstract text is available yet for this article.
June 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28656829/use-of-dexmedetomidine-infusion-as-a-sedative-drug-for-patients-in-the-intensive-care-unit
#19
Nelson Selvaraj
The administration of sedatives may present several challenges for critical care nurses. Evidence-based practice requires critical care nurses to remain up to date with developments in sedation management and ensure safe and effective use of sedative agents in their practice. Dexmedetomidine is a sedative drug that has been increasingly used in the intensive care setting in recent years. This article provides an overview of the pharmacological properties of dexmedetomidine and discusses nurses' responsibilities in caring for patients receiving dexmedetomidine infusion...
June 28, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28654569/maintaining-interrater-agreement-of-core-assessment-instruments-in-a-multisite-randomized-controlled-clinical-trial-the-randomized-evaluation-of-sedation-titration-for-respiratory-failure-restore-trial
#20
Ruth Lebet, Jennifer Hayakawa, Tracy B Chamblee, Joana A Tala, Nakul Singh, David Wypij, Martha A Q Curley
BACKGROUND: RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) was a cluster randomized clinical trial evaluating a sedation strategy in children 2 weeks to <18 years of age with acute respiratory failure supported on mechanical ventilation. A total of 31 U.S. pediatric intensive care units (PICUs) participated in the trial. Staff nurse rater agreement on measures used to assess a critical component of treatment fidelity was essential throughout the 4-year data collection period...
July 2017: Nursing Research
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