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sedation in icu

M Richter, B Seipolt
Pain is a central topic on neonatal intensive care units (NICU). Acute as well as prolonged (continuous and chronic) pain frequently occurs. Due to a lack of validated physiological measurement instruments for pain (e. g. saliva cortisol, skin conductance and heart rate variability) pain in neonatology can only be assessed by external observation through the bedside team with pain scores using a regular, standardized procedure. During this very vulnerable period pain and medications (analgesics/sedatives) can negatively influence the brain development of premature babies and neonates...
March 21, 2018: Der Schmerz
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
Zhipeng Zhu, Hongmei Zhou, Yunjian Ni, Cheng Wu, Caijun Zhang, Xiaoyan Ling
Purpose: Cardiac surgery patients always present with atrial fibrillation (AF) after admission to the intensive care unit, leading to high mortality and lengthy hospitalization. Dexmedetomidine (DEX) is a popular medication used for sedation in the intensive care unit; however, whether it can reduce AF needs to be analyzed. Materials and methods: Three primary databases, Medline, Embase (Ovid SP) and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched...
2018: Drug Design, Development and Therapy
Pedro Taffarel, German Bonetto, Facundo Jorro Barón, Claudia Meregalli
INTRODUCTION: Children in pediatric intensive care units (PICUs) are exposed to experiencing pain, stress and anxiety due to their disease, treatment or care setting. Adequate sedation and analgesia are key to their care, particularly in patients requiring mechanical ventilation (MV). OBJECTIVE: To determine the usual practice in sedation and analgesia management in patients requiring MV in PICUs in Argentina. MATERIAL AND METHODS: Descriptive, crosssectional, multi-center study conducted by means of e-mailed surveys...
April 1, 2018: Archivos Argentinos de Pediatría
Selcuk Kayir, Hulya Ulusoy, Guvenc Dogan
Background/aims Sedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients. Material and methods We made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013...
January 13, 2018: Curēus
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
Verónica Becerra, Daniel Buamscha, Corina Ponce, Carlos Cambaceres, Alejandro Noman, María E Galván, Miriam Lenz
INTRODUCTION: Sedation of patients in pediatric ICU extubated and in weaning of mechanic ventilation is diffcult under regular sedation, because of the tolerance and/or abstinence generated by its sustained use. The objective of this study is to describe the use of Levomepromazine as sedative coadjuvant in these patients. POPULATION AND METHODS: Observational and longitudinal study in intensive care from Juan P. Garrahan Pediatric Hospital. Patients older than 2 years were included, extubated and in weaning of mechanic ventilation with requirements of additional sedation...
November 2017: Vertex: Revista Argentina de Psiquiatriá
Asad A Khawaja, Dmitry Tumin, Ralph J Beltran, Joseph D Tobias, Joshua C Uffman
OBJECTIVES: General anesthesia or sedation can facilitate the completion of diagnostic radiological studies in children. We evaluated the incidence, predictors, and causes of adverse events (AEs) when general anesthesia is provided for diagnostic radiological imaging. METHODS: Deidentified data from 24 pediatric tertiary care hospitals participating in the Wake-Up Safe registry during 2010-2015 were obtained for analysis. Children 18 years or younger receiving general anesthesia for radiological procedures were identified using Current Procedural Terminology codes, and reported AEs were analyzed if they were associated with anesthetic care at magnetic resonance imaging or computed tomography locations...
March 8, 2018: Journal of Patient Safety
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
Karen Trudel, Samara Zavalkoff, Nicholas Winters, Caroline Quach, Jacques Lacroix, Patricia S Fontela
BACKGROUND: Prolonged use of indwelling catheters is associated with hospital-acquired urinary tract infections (UTIs). Literature is scarce about the factors influencing urinary catheter removal and maintenance in children. This study aims to describe the determinants of urinary catheter removal in pediatric intensive care unit (PICU) patients. METHODS: Cross-sectional survey of 171 physicians and nurses working at 2 tertiary PICUs in Montreal, Canada. We used focus groups and literature review to design the survey questions and 3 clinical scenarios...
March 5, 2018: American Journal of Infection Control
Jennifer Yurkovich, Debra S Burns, Tondi Harrison
Background: Although evidence suggests music therapy lowers the heart rate of ill adults undergoing painful procedures and premature infants in the NICU, the effect of music therapy interventions on physiologic response in infants with congenital heart disease (CHD) being cared for in the cardiac intensive care unit (CICU) has not been explored. Objective: The purpose of this study was to explore the effect of the music therapy entrainment on physiologic responses of infants with CHD in the CICU...
March 5, 2018: Journal of Music Therapy
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
Theodoros Aslanidis, Vasilios Grosomanidis, Konstantinos Karakoulas, Athanasios Chatzisotiriou
Electrodermal activity (EDA) is considered a measure of autonomous nervous system activity. This study performed an exploratory analysis of the EDA changes during blood pooling for arterial blood gas analysis in sedated adult critical care patients and correlated the variations to other monitored parameters. EDA, along with other parameters, were monitored during 4 h routine daytime intensive care nursing and treatment in an adult ICU. 4 h measurements were divided into two groups based upon the sedation level...
March 6, 2018: Medical Sciences: Open Access Journal
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
Axel Rand, Peter K Zahn, Thomas A Schildhauer, Christian Waydhas, Uwe Hamsen
BACKGROUND: Inhalative sedation is an emerging method for long-term sedation in intensive care therapy. There is evidence that it is easy to control and may be beneficial compared to intravenous sedation. Yet little is known about the use in patients with compromised lung function. In this retrospective analysis, we searched files of patients receiving inhalative sedation under venovenous extracorporeal membrane oxygenator (vv-ECMO) support due to lung failure. METHODS: After ethical approval, we performed a retrospective analysis of patients receiving vv-ECMO support and inhalative sedation in the surgical ICU in 2015...
March 5, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
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
Gemma Via-Clavero, Marta Sanjuán-Naváis, Marta Romero-García, Laura de la Cueva-Ariza, Gemma Martínez-Estalella, Erika Plata-Menchaca, Pilar Delgado-Hito
BACKGROUND: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses' intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses' beliefs regarding the use of physical restraints would provide additional social information about nurses' intention to perform this practice. AIM: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour...
January 1, 2018: Nursing Ethics
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
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