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https://www.readbyqxmd.com/read/27889726/prolonged-infusion-of-dexmedetomidine-in-critically-ill-children
#1
Cinara Andreolio, Jefferson Pedro Piva, Elisa Baldasso, Roberta Ferlini, Rafaela Piccoli
OBJECTIVE: To describe main indications, doses, length of infusion and side effects related to dexmedetomidine infusion. METHODS: Observational and retrospective study evaluating dexmedetomidine use in pediatric intensive care unit. RESULTS: 77 children received dexmedetomidine infusion longer than 6 hours for mechanical ventilation weaning (32.5%), post- neurosurgery and post-upper airway surgery (24.7%), non-invasive ventilation (13%), refractory tachycardia (6...
November 15, 2016: Indian Pediatrics
https://www.readbyqxmd.com/read/27879954/comparison-of-terminal-extubation-and-terminal-weaning-as-mechanical-ventilation-withdrawal-in-icu-patients
#2
Damien Thellier, Pierre Y Delannoy, Olivier Robineau, Agnès Meybeck, Nicolas Boussekey, Arnaud Chiche, Olivier Leroy, Hugues Georges
BACKGROUND: Terminal extubation (TE) is applied in some intensive care unit (ICU) patients when a decision of withdrawal of mechanical ventilation is decided. Other units prefer terminal weaning (TW) with no removal of the endotracheal tube. We report our experience with these two procedures. METHODS: We conducted a retrospective study analyzing patients deceased in our ICU after a decision of life sustained therapy (LST) during the year 2013. TE was proposed to family members for patients presenting with two medical conditions: lack of vasoactive drugs (VAD) and SaO2 > 95% with a FIO2 < 50%...
November 23, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27878815/interventions-to-reduce-cognitive-impairments-following-critical-illness-a-topical-systematic-review
#3
REVIEW
H K Nedergaard, H I Jensen, P Toft
BACKGROUND: Critical illness is associated with cognitive impairments. Effective treatment or prevention has not been established. The aim of this review was to create a systematic summary of the current evidence concerning clinical interventions during intensive care admission to reduce cognitive impairments after discharge. METHODS: Medline, Embase, Cochrane Central, PsycInfo and Cinahl were searched. Inclusion criteria were studies assessing the effect of interventions during intensive care admission on cognitive function in adult patients...
November 22, 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27850632/994-application-of-a-protocolized-sedation-wean-to-children-post-invasive-mechanical-ventilation
#4
Sangita Basnet, Joseph Dario, Georgia Mueller, Giovanna Caprirolo, Ryan Majcina, David Willman
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27790100/post-weaning-environmental-enrichment-but-not-chronic-maternal-isolation-enhanced-ethanol-intake-during-periadolescence-and-early-adulthood
#5
Luciana R Berardo, María C Fabio, Ricardo M Pautassi
This study analyzed ethanol intake in male and female Wistar rats exposed to maternal separation (MS) during infancy (postnatal days 1-21, PD1-21) and environmental enrichment (EE) during adolescence (PD 21-42). Previous work revealed that MS enhances ethanol consumption during adulthood. It is still unknown if a similar effect is found during adolescence. Several studies, in turn, have revealed that EE reverses stress experiences, and reduces ethanol consumption and reinforcement; although others reported greater ethanol intake after EE...
2016: Frontiers in Behavioral Neuroscience
https://www.readbyqxmd.com/read/27757003/off-label-use-of-dexmedetomidine-for-the-treatment-of-delirium-in-the-intensive-care-unit
#6
Huan Mark Nguyen, Doreen Pon
OBJECTIVE: Evaluate recent clinical studies involving the use of dexmedetomidine (DEX) infusion for the treatment of delirium in the intensive care unit (ICU). METHODS: A literature search was conducted to identify peer-reviewed articles in MEDLINE (1966-June 2016) using the terms sedation, analgesic, dexmedetomidine, delirium, and critically ill adult patients. RESULTS: Two studies in the ICU setting reported the potential benefits of DEX for managing agitation during weaning from mechanical ventilation...
October 2016: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/27718440/an-interesting-case-report-of-vertebral-artery-dissection-following-polytrauma
#7
Vikas Acharya, Suresh Chandrasekaran, Sujit Nair
INTRODUCTION: The authors present an interesting case of a 19-year-old male who presented as a polytrauma patient following a fall from a height. PRESENTATION OF CASE: He was initially managed on the intensive care unit with intracranial pressure bolt monitoring after being intubated and sedated and having his other traumatic injuries stabilized. Upon attempting to wean sedation and extubation a repeat CT scan of the head was undertaken and showed a new area suggested of cerebral infarction, this was a new finding...
October 3, 2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27540247/application-of-pharmaceutical-knowledge-to-the-unconventional-use-of-a-rarely-used-anaesthetic-agent
#8
Caroline Cole
CASE SUMMARY: A 6 yr old 45 kg child with severe Cushinoid features was admitted to PICU with probable hypertensive encephalopathy. She presented with increasing headaches, vomiting and seizures becoming unresponsive with a GCS of 3. She was profoundly hypertensive and her cortisol levels were significantly elevated (>2000 nmol/L). Rapid reduction in cortisol levels was required to stabilise her condition prior to surgery. Etomidate is the only readily available intravenous preparation which reliably suppresses adrenocortical function...
September 2016: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/27530768/-severe-exacerbation-of-copd-requiring-ventilation-use-of-vv%C3%A2-ecmo-combined-with-inhalation-anesthetics
#9
M Laufenberg, T Schneider
A 58-year male patient was admitted to the intensive care unit of our hospital due to an exacerbated COPD (GOLD IV) complicated by a pneumonia. The clinical course deteriorated despite of evidence based intensive care treatment and lungprotective ventilation, a vv-ECMO and a volatile sedation were established. After a few days vv-ECMO could be discontinued and the patient was discharged from hospital after 20 days.Our case report suggests that early support with vv-ECMO could reduce the cumulative duration of invasive ventilation in case of severe COPD exacerbation...
August 16, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/27513532/patient-process-and-system-predictors-of-iatrogenic-withdrawal-syndrome-in-critically-ill-children
#10
Kaitlin M Best, David Wypij, Lisa A Asaro, Martha A Q Curley
OBJECTIVE: To generate a multidimensional predictive model of risk factors for iatrogenic withdrawal syndrome in critically ill children. DESIGN: Secondary analysis of prospective data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial. SETTING: PICU. PATIENTS: Children who received greater than or equal to 5 days of sedation during mechanical ventilation for acute respiratory failure...
August 4, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27500981/mitigation-of-ventilator-induced-diaphragm-atrophy-by-transvenous-phrenic-nerve-stimulation
#11
Steven C Reynolds, Ramasamy Meyyappan, Viral Thakkar, Bao D Tran, Marc-André Nolette, Gautam Sadarangani, Rodrigo A Sandoval, Laura Bruulsema, Brett Hannigan, Jason W Li, Elizabeth Rohrs, Jason Zurba, Joaquín Andrés Hoffer
Rationale Ventilator-induced Diaphragm Dysfunction is a significant contributor to weaning difficulty in ventilated critically ill patients. It has been hypothesized that electrically pacing the diaphragm during mechanical ventilation could reduce diaphragm dysfunction. Objectives We tested a novel, central line catheter-based, transvenous phrenic nerve pacing therapy for protecting the diaphragm in sedated and ventilated pigs. Methods Eighteen Yorkshire pigs were studied. Six pigs were sedated and mechanically ventilated for 2...
August 8, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27487756/a-pilot-study-implementing-a-protocol-using-dexmedetomidine-as-a-safe-alternative-to-traditional-sedation-to-decrease-ventilator-days-for-patients-difficult-to-extubate
#12
Susan E Becker
BACKGROUND: Traditional sedation for mechanically ventilated patients causes delirium, which increases the patients' length of stay while hospitalized. When extubation is attempted, these medications must be discontinued because of the side effect of respiratory depression, leaving patients anxious and agitated, delaying extubation and prolonging the need for mechanical ventilation. Dexmedetomidine is a safe alternative sedative that does not cause delirium or respiratory depression. During the weaning process, dexmedetomidine can be continued, allowing the patient to remain calm and successfully extubated...
September 2016: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/27445575/practice-variation-in-spontaneous-breathing-trial-performance-and-reporting
#13
Stephanie Godard, Christophe Herry, Paul Westergaard, Nathan Scales, Samuel M Brown, Karen Burns, Sangeeta Mehta, Frank J Jacono, Dalibor Kubelik, Donna E Maziak, John Marshall, Claudio Martin, Andrew J E Seely
Background. Spontaneous breathing trials (SBTs) are standard of care in assessing extubation readiness; however, there are no universally accepted guidelines regarding their precise performance and reporting. Objective. To investigate variability in SBT practice across centres. Methods. Data from 680 patients undergoing 931 SBTs from eight North American centres from the Weaning and Variability Evaluation (WAVE) observational study were examined. SBT performance was analyzed with respect to ventilatory support, oxygen requirements, and sedation level using the Richmond Agitation Scale Score (RASS)...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/27434115/best-practices-for-intrathecal-baclofen-therapy-screening-test
#14
REVIEW
Aaron L Boster, Susan E Bennett, Gerald S Bilsky, Mark Gudesblatt, Stephen F Koelbel, Maura McManus, Michael Saulino
INTRODUCTION: Intrathecal baclofen (ITB) screening assesses response to a test dose of ITB on spasticity and function and identifies adverse reactions. METHOD: An expert panel consulted on best practices after conducting an extensive literature search and conducting an online survey. RESULTS: A successful trial may confirm predetermined goals, which may include improved mobility/positioning, decreased time/improved independence for activities, less home exercise, better wheelchair tolerance, decreased caregiver time, improved sleep, and reduced pain, or may modify goals and expectations...
August 2016: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/27368279/effects-of-dexmedetomidine-and-propofol-on-patient-ventilator-interaction-in-difficult-to-wean-mechanically-ventilated-patients-a-prospective-open-label-randomised-multicentre-study
#15
Giorgio Conti, Vito Marco Ranieri, Roberta Costa, Chris Garratt, Andrew Wighton, Giorgia Spinazzola, Rosario Urbino, Luciana Mascia, Giuliano Ferrone, Pasi Pohjanjousi, Gabriela Ferreyra, Massimo Antonelli
BACKGROUND: Dexmedetomidine can be used for sedation of mechanically ventilated patients and has minor respiratory effects. The aim of this study was to compare the incidence of patient-ventilator dyssynchronies during sedation with dexmedetomidine or propofol. METHODS: We conducted a multicentre, prospective, open-label, randomised clinical trial, comparing dexmedetomidine with standard propofol sedation at three intensive care units of university hospitals in Italy...
July 2, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27312979/the-relationship-between-sedative-drug-utilization-and-outcomes-in-critically-ill-patients-undergoing-mechanical-ventilation
#16
Kenshi Hayashida, Takeshi Umegaki, Hiroshi Ikai, Genki Murakami, Masaji Nishimura, Yuichi Imanaka
OBJECTIVES: The objectives of this study were to describe current sedative drug utilization patterns in critically ill patients undergoing mechanical ventilation (MV) in intensive care units (ICUs) in Japanese hospitals and to elucidate the relationship of these utilization patterns with patient clinical outcomes. METHOD: Analysis of hospital claims data derived from the Quality Indicator/Improvement Project identified 12,395 critically ill adult patients who had undergone MV while hospitalized in the ICUs of 114 Japanese hospitals and had been discharged between April 2008 and March 2010...
October 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27290526/nurses-practice-concerning-sedation-during-weaning-from-mechanical-ventilation
#17
M Borkowska, S Labeau, S Blot
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/27215354/tolerance-and-withdrawal-issues-with-sedatives-in-the-intensive-care-unit
#18
REVIEW
Gina Riggi, Antonia Zapantis, Simon Leung
Prolonged use of sedative medications continues to be a concern for critical care practitioners, with potential adverse effects including tolerance and withdrawal. The amount of sedatives required in critically ill patients can be lessened and tolerance delayed with the use of pain and/or sedation scales to reach the desired effect. The current recommendation for prolonged sedation is to wean patients from the medications over several days to reduce the risk of drug withdrawal. It is important to identify patients at risk for iatrogenic withdrawal and create a treatment strategy...
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27163223/interprofessional-implementation-of-a-pain-sedation-guideline-on-a-trauma-intensive-care-unit
#19
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
https://www.readbyqxmd.com/read/27140216/clinical-study-of-midazolam-sequential-with-dexmedetomidine-for-agitated-patients-undergoing-weaning-to-implement-light-sedation-in-intensive-care-unit
#20
Xing Lu, Jun Li, Tong Li, Jie Zhang, Zhi-Bo Li, Xin-Jing Gao, Lei Xu
PURPOSE: To evaluate midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in ICU. METHODS: This randomized, prospective study was conducted in Tianjin Third Central Hospital, China. Using a sealed-envelope method, the patients were randomly divided into 2 groups (40 patients per group). Each patient of group A received an initial loading dose of midazolam at 0.3-3mg/kg·h 24 h before extubation, followed by an infusion of dexmedetomidine at a rate of 0...
April 1, 2016: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
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