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Intensive care, critical care, pain

Rosechelle M Ruggiero
The entity of chronic critical illness (CCI) has shown a rise in the past decades for popularity and prevalence. CCI is loosely defined as the group of patients who require the intensive care setting for weeks to months; its hallmark is prolonged mechanical ventilation. The outcomes of chronically critically ill patients have been dismal and have not improved over time; 1-year survival hovers at approximately 50%. Given the high mortality, prognostic variables are important when making medical decisions. CCI encompasses a syndrome that includes altered pathophysiology across a variety of organ systems...
March 2018: American Journal of the Medical Sciences
Toshihiro Fukui
Background: Both acute aortic dissection and ruptured aortic aneurysm are leading causes of death in cardiovascular disease. These life-threatening conditions have recently been categorized as acute aortic syndrome. This review describes the etiology, clinical presentation, and therapeutic options for acute aortic syndrome including acute aortic dissection and ruptured aortic aneurysm. Main body: Several diagnostic tools for detecting these critical conditions have been developed including computed tomography, ultrasonography, magnetic resonance imaging, and laboratory tests...
2018: Journal of Intensive Care
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
Rajesh M Shetty, Antonio Bellini, Dhuleep S Wijayatilake, Mark A Hamilton, Rajesh Jain, Sunil Karanth, ArunKumar Namachivayam
BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools...
February 21, 2018: Cochrane Database of Systematic Reviews
Rima H Bouajram, Christian M Sebat, Dawn Love, Erin L Louie, Machelle D Wilson, Jeremiah J Duby
BACKGROUND: Self-reported and behavioral pain assessment scales are often used interchangeably in critically ill patients due to fluctuations in mental status. The correlation between scales is not well elucidated. The purpose of this study was to describe the correlation between self-reported and behavioral pain scores in critically ill patients. METHODS: Pain was assessed using behavioral and self-reported pain assessment tools. Behavioral pain tools included Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS)...
January 1, 2018: Journal of Intensive Care Medicine
Vivek V Shukla, Satvik Bansal, Archana Nimbalkar, Apurva Chapla, Ajay Phatak, Dipen Patel, Somashekhar Nimbalkar
OBJECTIVE: To compare individual efficacy and additive effects of pain control interventions in preterm neonates. DESIGN: Randomized controlled trial. SETTING: Level-3 University affiliated neonatal intensive care unit. PARTICIPANTS: 200 neonates (26-36 weeks gestational age) requiring heel-stick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions...
February 9, 2018: Indian Pediatrics
Craig M Dale, Orla Smith, Lisa Burry, Louise Rose
BACKGROUND: Oral care of intubated patients is essential to the prevention of infection and patient discomfort. However, barriers to oral access and delivery of oral care have received little attention. OBJECTIVE: To determine prevalence and predictors of oral access difficulty. DESIGN: A prospective, observational, multi-center study. SETTINGS: Four intensive care units in Toronto, Canada. PARTICIPANTS: Adult patients orally intubated for ≥48 h...
December 28, 2017: International Journal of Nursing Studies
Maria Vargas, Yuda Sutherasan, Iole Brunetti, Camilla Micalizzi, Angelo Insorsi, Lorenzo Ball, Marta Folentino, Rosanna Sileo, Arduino DE Lucia, Manuela Cerana, Alessandro Accattatis, Domenico DE Lisi, Angelo Gratarola, Francesco Mora, Giorgio Peretti, Giuseppe Servillo, Paolo Pelosi
BACKGROUND: Quality of life and mortality after percutaneous dilatational tracheotomy (PDT) has been poorly investigated. The aims of this study were to evaluate the independent risk factors for Intensive Care Unit (ICU) mortality and investigate quality of life over the first year after PDT in critically ill patients. METHODS: This was a prospective, single-center, cohort study performed in a tertiary care University Hospital, enrolling consecutive ICU patients requiring elective PDT, collecting data during the tracheotomy procedure and the ICU stay...
January 16, 2018: Minerva Anestesiologica
Marjorie A Bowman, Dean A Seehusen, Anne Victoria Neale
Being realistic while helping our patients is this issue's theme. Given the volume of tasks required in family medicine, recommendations for improvements in direct care or care measurement cannot just be evidence-based but must also be realistic. On the list of realistic: ordering antipsychotics for symptoms of dementia in the elderly, despite recommendations to not do so; ordering antidepressants without fear that the patient could develop hypertension; mental health care providers in primary care offices; forced choice for opioid management; plus agenda setting for visit efficiency...
January 2018: Journal of the American Board of Family Medicine: JABFM
Dawn Perez, Kath Peters, Lesley Wilkes, Gillian Murphy
Critically ill patients admitted to an intensive care unit (ICU) often require many invasive procedures and medical devices (Martin and Mathisen 2005). While these interventions are a necessity, they can potentially cause patients a great amount of pain and discomfort, often leading to restlessness and agitation (Langley et al. 2011).
May 2017: Australian Nursing & Midwifery Journal
Rachel D Havyer, Daniel H Pomerantz, Robert L Jayes, Patricia F Harris, Stephanie M Harman, Aziz A Ansari
BACKGROUND: Updated knowledge of the palliative care (PC) literature is needed to maintain competency and best address the PC needs of hospitalized patients. We critiqued the recent PC literature with the highest potential to impact hospital practice. METHODS: We reviewed articles published between January 2016 and December 2016, which were identified through a handsearch of leading journals and a MEDLINE search. The final 9 articles selected were determined by consensus based on scientific rigor, relevance to hospital medicine, and impact on practice...
December 20, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Andrea Cortegiani, Vincenzo Russotto, Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano, Sebastiano Mercadante
BACKGROUND: The aim of this paper is to collect data on the practice of palliative care, withholding and withdrawal of life-sustaining therapies, and management of end of life (EOL) in Italian intensive care units (ICUs). METHODS: Web-based survey among Italian anesthesiologists endorsed by the Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI). The survey consists of 27 close-ended and 2 open-ended questions. RESULTS: Eight hundred and five persons responded to the full list of questions...
December 15, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Elton Mathias, Madhu Srinivas Murthy
Burn injuries are a devastating critical care problem. In children, burns continue to be a major epidemiologic problem around the globe resulting in significant morbidity and death. Apparently, treating these burn injuries in children and adults remains similar, but there are significant physiological and psychological differences. The dermal layer of the skin is generally thinner in neonates, infants, and children than in adults. Enhanced evaporative loss and need for isotonic fluids increases the risk of hypothermia in the pediatric population...
December 11, 2017: Medicines (Basel, Switzerland)
Brent Herritt, Dipayan Chaudhuri, Kednapa Thavorn, Dalibor Kubelik, Kwadwo Kyeremanteng
INTRODUCTION: Up to 12% of the 800,000 patients who undergo mechanical ventilation in the United States every year require tracheostomies. A recent systematic review showed that early tracheostomy was associated with better outcomes: more ventilator-free days, shorter ICU stays, less sedation and reduced long-term mortality. However, the financial impact of early tracheostomies remain unknown. OBJECTIVES: To conduct a cost-analysis on the timing of tracheostomy in mechanically ventilated patients...
April 2018: Journal of Critical Care
Qingyun Zhu, Xinting Pan, Yongxian Cao, Hongqiao Wang, Ning Yu, Fuguo Liu, Shigang Yang, Yunlong Wang, Yunbo Sun, Zhengbin Wang
BACKGROUND/AIMS: This study aimed to report the clinical efficacy of continuous renal replacement therapy (CRRT) in combination with ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) (CRRT+PTGD) in the treatment of acute severe biliary pancreatitis (ASBP). METHODS: Between January 2010 and January 2016, 40 cases of patients with ASBP who received routine CRRT (CRRT group) and 40 of those who received CRRT+PTGD (CRRT+PTGD group) at the Affiliated Hospital of Qingdao University (Qingdao, China) were retrospectively reviewed...
2017: Kidney & Blood Pressure Research
Felipe Martínez, Ana María Donoso, Carla Marquez, Eduardo Labarca
BACKGROUND: Delirium is common among the critically ill. Nonpharmacologic interventions are reportedly effective in reducing incident delirium, but limited data specific to this population exist. OBJECTIVES: To assess the efficacy and describe the implementation strategy of a multicomponent intervention to prevent delirium in an intensive care unit. METHODS: A before-and-after study was conducted in an intensive care unit between May 2014 through August 2015...
December 2017: Critical Care Nurse
Alan Rozycki, Andrew S Jarrell, Rachel M Kruer, Samantha Young, Pedro A Mendez-Tellez
BACKGROUND: Society of Critical Care Medicine guidelines recommend the use of pain, agitation, and delirium protocols in the intensive care unit. The feasibility of nurse management of such protocols in the surgical intensive care unit has not been well assessed. OBJECTIVES: To evaluate the percentage of adherent medication interventions for patients assessed by using a pain, sedation, and delirium protocol. METHODS: Data on all adult patients admitted to a surgical intensive care unit from January 2013 through September 2013 who were assessed at least once by using a pain, sedation, and delirium protocol were retrospectively reviewed...
December 2017: Critical Care Nurse
Francesco Sulla, Nilson De Souza Ramos, Noemi Terzi, Tania Trenta, Mariella Uneddu, Melanny Alessandra Zaldivar Cruces, Leopoldo Sarli
BACKGROUND AND AIM: Pain in intensive care units (ICUs) is a frequent and often undermanaged problem. Brain-injured patients are often unable to reliably self-report their pain, calling forth the need to use behavioural scales such as the Critical-Care Pain Observation Tool (CPOT). This study aimed to test the reliability and validity of the Italian CPOT use with brain-injured ICU adults. METHOD: A sample of 50 adults critical care patients was included. Each patient was assessed by two independent observers at three predefined times - at rest; during mobilization for hygiene; 20 minutes later - using the CPOT, PAINAD, and NRS...
November 30, 2017: Acta Bio-medica: Atenei Parmensis
Natalie Moryl, Vinnidhy Dave, Paul Glare, Ali Bokhari, Vivek T Malhotra, Amitabh Gulati, Joseph Hung, Vinay Puttanniah, Yvona Griffo, Roma Tickoo, Alison Wiesenthal, Susan D Horn, Charles E Inturrisi
The Memorial Sloan Kettering Pain Registry contains patient characteristics, treatments, and outcomes for a prospective cohort of 1,534 chronic pain cancer patients who were seen at outpatient pain service clinics. Average pain intensity (Brief Pain Inventory) was reported as mild by 24.6% of patients, moderate by 41.5%, and severe by 33.9%. The patient's report of average percent pain relief and health state (EuroQOL 5 dimensions) was inversely related to average pain intensity category, whereas measures of pain interference, number of worst pain locations, and physical and psychological distress were directly related to pain intensity category...
March 2018: Journal of Pain: Official Journal of the American Pain Society
Céline Gélinas, Kathleen A Puntillo, Madalina Boitor, Mélanie Bérubé, Jane Topolovec-Vranic, Anne-Sylvie Ramelet, Aaron M Joffe, Melissa Richard-Lalonde, Francis Bernard, David L Streiner
BACKGROUND: The evidence shows that brain-injured patients express behaviours that are related to their level of consciousness (LOC), and different from other patients in the intensive care unit (ICU). Therefore, existing behavioural scales should be revised to enhance their content and validity for use in these patients. OBJECTIVES: The aim was to evaluate the content relevance of behaviours and autonomic responses for pain assessment of brain-injured ICU patients from the perspective of critical care clinicians...
November 13, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
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