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Catherine Duclos, Marie Dumont, Marie-Julie Potvin, Alex Desautels, Danielle Gilbert, David K Menon, Francis Bernard, Nadia Gosselin
BACKGROUND: Sleep-wake disturbances are frequently reported following traumatic brain injury (TBI), but they remain poorly documented in the acute stage of injury. Little is known about their origin and evolution. CASE PRESENTATION: This study presents the case of a patient in the acute phase of a severe TBI. The patient was injured at work when falling 12 m into a mine and was hospitalized in the regular wards of a level I trauma centre. From days 31 to 45 post-injury, once he had reached a level of medical stability and continuous analgosedation had been ceased, his sleep-wake cycle was monitored using actigraphy...
September 27, 2016: BMC Neurology
Andrew C Faust, Pearl Rajan, Lyndsay A Sheperd, Carlos A Alvarez, Phyllis McCorstin, Rebecca L Doebele
BACKGROUND: Recent attention to adverse effects of intensive care unit (ICU) sedation has led to the use of strategies that target a "lighter" depth of sedation. Among these strategies are "analgosedation" protocols, which prioritize pain management and preferentially use IV opioids before administration of continuously infused sedatives such as propofol or midazolam. We hypothesized that using an analgosedation protocol would result in a shorter duration of mechanical ventilation than a protocol with greater emphasis on IV sedatives METHODS: : We conducted a retrospective study comparing the duration of mechanical ventilation before and after implementation of an analgosedation protocol in a 24-bed medical ICU...
October 2016: Anesthesia and Analgesia
Dan Bieler, Axel Franke, Rolf Lefering, Sebastian Hentsch, Arnulf Willms, Martin Kulla, Erwin Kollig
PURPOSE: The role of emergency physicians in the pre-hospital management of severely injured patients remains controversial. In Germany and Austria, an emergency physician is present at the scene of an emergency situation or is called to such a scene in order to provide pre-hospital care to severely injured patients in approximately 95% of all cases. By contrast, in the United States and the United Kingdom, paramedics, i.e. non-physician teams, usually provide care to an injured person both at the scene of an incident and en route to an appropriate hospital...
August 28, 2016: Injury
Monique van Dijk, Erwin Ista, Dick Tibboel
No abstract text is available yet for this article.
September 2016: Pediatric Critical Care Medicine
Karel Balihar, Eva Janská, Lucie Zdrhová, Jan Kotyza, Václav Hejda, Jana Koželuhová
INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive routine procedure used to provide long-term enteral nutrition in selected patients with impaired oral intake. The knowledge of clinical, technical and safety features of PEG is an important issue in clinical practice.The aim of this study was to evaluate the popu-lation of patients selected for PEG insertion, describe certain aspects of the insertion procedure, assess the service life of PEG, as well as account for the number of complications and patient mortality in the six-month period following the procedure...
2016: Vnitr̆ní Lékar̆ství
Anne Smits, John N van den Anker, Karel Allegaert
OBJECTIVES: To propose approaches tailored to the specific needs of neonates, such as structured product development programmes, with the ultimate goal to improve the safe and effective use of analgosedatives in these fragile patients. KEY FINDINGS: The feasibility and relevance of a structured product development programme in neonates (optimal study design based on preliminary data; model development; internal, external and prospective evaluation; an individualized dosing regimen; long-term safety; pharmacogenetics) are illustrated for the use of morphine...
June 30, 2016: Journal of Pharmacy and Pharmacology
Yasuhiro Kuroda
This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the complicated pathophysiology of the condition...
2016: Journal of Intensive Care
Tara L Sacco, Brenton LaRiccia
Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial...
May 2016: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Ryan Wiatrowski, Colleen Norton, David Giffen
Sedation practices in the critical care unit have been trending toward lighter sedation since the start of the new millennium, but patients continue to experience inadequate pain management and excessive sedation. This paper includes a brief examination of the problem of pain management in the ICU; trends in sedation practices, including light sedation and the daily interruption of sedation; and a literature review of analgosedation. While the analgosedation literature is relatively sparse, it offers a promising, patient-centered method for managing the triad of pain, agitation, and delirium, while reducing common complications associated with long-term ventilation...
June 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Julie Stephens, Michael Wright
Pain and agitation may be difficult to assess in a critically ill patient. Pain is best assessed by self-reporting pain scales; but in patients who are unable to communicate, behavioral pain scales seem to have benefit. Patients' sedation level should be assessed each shift and preferably by a validated ICU tool, such as the RASS or SAS scale. Pain is most appropriately treated with the use of opiates, and careful consideration should be given to the pharmacokinetic and pharmacodynamic properties of various analgesics to determine the optimal agent for each individual patient...
March 2016: Nursing Clinics of North America
H Lemm, M Janusch, M Buerke
Patients with cardiogenic shock pose a challenge to physicians due to cardiorespiratory instability in addition to the underlying medical condition. If analgosedation and ventilation are indicated, commonly administered drugs themselves often influence hemodynamics and oxygenation. The present article provides an overview of the available substances with consideration of the patients' condition, then monitoring and optimization of analgosedation.
February 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Ulrike Flierl, Philipp Röntgen, Florian Zauner, Jörn Tongers, Dominik Berliner, Johann Bauersachs, Andreas Schäfer
Acute myocardial infarction (AMI) is the leading cause for out-of-hospital cardiac arrest. Therapeutic hypothermia improves neurological outcome in combination with early revascularisation, but seems to affect clopidogrel responsiveness. The more potent thienopyridine prasugrel has not yet been sufficiently evaluated during therapeutic hypothermia. We investigated 23 consecutive AMI patients (61 ± 11 years) following out-of-hospital resuscitation undergoing revascularisation and therapeutic hypothermia. Prasugrel efficacy was assessed by the platelet-reactivity-index (PRI) before and 2, 4, 6, 12, 24, 48, and 72 hours (h) following a loading dose of 60 mg via a gastric tube...
May 2, 2016: Thrombosis and Haemostasis
Asad E Patanwala, Jennifer R Martin, Brian L Erstad
OBJECTIVE: To evaluate the evidence for the use of intravenous ketamine for analgosedation in the intensive care unit. METHODS: MEDLINE and EMBASE were queried from inception until July 2015. Search terms used included ketamine, intensive care, and critical care. The search retrieved 584 articles to be screened for inclusion. The intent was to include randomized controlled studies using sustained intravenous infusions (>24 hours) of ketamine in the critically ill patients...
December 8, 2015: Journal of Intensive Care Medicine
Harald Sauer, Laura Grünzinger, Jochen Pfeifer, Ulla Lieser, Hashim Abdul-Khaliq
BACKGROUND: (Analgo-) sedations for diagnostic and/or therapeutic procedures form part of the daily clinical routine for pediatric patients. National and international medical specialist associations have published guidelines indicating the general conditions of these procedures, yet the recommendations are not always consistent. Since anesthesiological activities are increasingly performed by nonanesthesiologists at our hospital, the Pediatric Clinic of the University Hospital of Saarland considered it necessary to develop an in-house standard...
February 2016: Wiener Medizinische Wochenschrift
Y Oberländer, K Demuth, B Eifert, A Lindner, M Kellerer
This article describes a case report on a rare cause of acute respiratory failure. The patient suffered from a rapidly progressing respiratory insufficiency due to intoxication with a neurotoxin (botulism). A rapid diagnosis proved to be very difficult due to the rarity of the disease itself and the difficulties encountered in the clinical examination caused by early initiation of intubation, artificial ventilation and analgosedation.
November 18, 2015: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Christian Bohris, Christian G Stief, Frank Strittmatter
BACKGROUND AND PURPOSE: In extracorporeal shockwave lithotripsy (SWL), respiratory-induced motion of the upper urinary tract may hamper stone targeting and disintegration. The objective of this study is to analyze the effect of abdominal compression (AC) to kidney motion and to shock wave efficacy. SUBJECTS AND METHODS: The study included 10 volunteers and 10 kidney stone patients. AC was achieved by a wedge-shaped compression plate. Patients underwent a routine ultrasound-guided SWL...
April 2016: Journal of Endourology
Massimo Girardis, Cosetta Cantaroni, Gennaro Savoia, Rita Melotti, Giorgio Conti
BACKGROUND: The management of analgesia and sedation in critically ill patients is still a challenge due to the shortage of evidence-based treatments. The main objectives of the present study were to critically evaluate the quality of current clinical practice guidelines (CPGL) published on this matter and to identify the contrasting positions and unsolved questions. METHODS: Four members of the Italian Society of Anesthesia and Intensive Care (SIAARTI) council, with an extensive background in the management of critically ill patients and practice guidelines, evaluated CPGL on sedation and analgesia in critically ill patients published from January 2006 to December 2013...
February 2016: Minerva Anestesiologica
Anna Andrychiewicz, Katarzyna Konarska, Karolina Gorka, Sylwia Bartyzel, Marta Salek, Grzegorz Biedron, Aleksandra Surowiec, Krzysztof Sladek, Jerzy Soja, Wojciech Szczeklik
Introduction Bronchofiberoscopy (BF) is a key tool used in the management of patients with respiratory diseases. Describing factors that contribute to patient anxiety surrounding BF has the potential to influence patient management and willingness to undergo the procedure again in the future if needed. Objectives This study sought to understand what factors influence anxiety and satisfaction experienced by patients undergoing BF under conscious sedation. Methods This study had a prospective observational character, and evaluated 463 consecutive patients undergoing BF...
September 14, 2015: Clinical Respiratory Journal
F Schmidt, T Jack, M Sasse, T Kaussen, H Bertram, A Horke, K Seidemann, P Beerbaum, H Koeditz
In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients...
December 2015: Pediatric Cardiology
S Harf, J Marschke, A Lippkowski, K Beilecke, R Tunn
Formation of a haematoma after placement of retropubic tapes for stress incontinence is a rare but typical complication potentially requiring a subsequent operation. Under certain circumstances, haematoma removal by a vaginal approach represents a milder alternative to the subperitoneal laparotomy approach under general anaesthesia. We present two cases of vaginal haematoma revision after placement of retropubic tapes. By means of this gentle alternative to the standard laparotomy approach we could avoid general anaesthesia in one case and perform the operation under analgosedative local anaesthesia...
March 2015: Geburtshilfe und Frauenheilkunde
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