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https://www.readbyqxmd.com/read/28198753/mechanical-ventilation-weaning-practices-and-decision-making-in-european-picus
#1
Lyvonne N Tume, Martin C J Kneyber, Bronagh Blackwood, Louise Rose
OBJECTIVES: This survey had three key objectives: 1) To describe responsibility for key ventilation and weaning decisions in European PICUs and explore variations across Europe; 2) To describe the use of protocols, spontaneous breathing trials, noninvasive ventilation, high-flow nasal cannula use, and automated weaning systems; and 3) To describe nurse-to-patient staffing ratios and perceived nursing autonomy and influence over ventilation decision making. DESIGN: Cross-sectional electronic survey...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28186850/the-use-of-dexmedetomidine-in-pediatric-palliative-care-a-preliminary-study
#2
Jamie Burns, Kevin Jackson, Kathy A Sheehy, Julia C Finkel, Zenaide M Quezado
OBJECTIVE: To evaluate the effect of dexmedetomidine infusions in patients with advanced malignancies, advanced heart disease, or after stem cell transplantation (SCT), who during end-of-life care had pain and/or agitation unresponsive to conventional therapies. BACKGROUND: Pediatric patients with intractable advanced malignancies, end-stage congenital heart diseases, or after SCT can suffer a great deal during end of life. Pain, drowsiness, fatigue, irritability, and worrying are experienced frequently, considered distressing, and are strongly associated with reductions in health-related quality-of-life scores...
February 10, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28179250/impact-of-pharmacist-management-of-pain-agitation-and-delirium-in-the-intensive-care-unit-through-participation-in-multidisciplinary-bundle-rounds
#3
Patricia Louzon, Heath Jennings, Mahmood Ali, Marijo Kraisinger
PURPOSE: A two-phase program to increase pharmacist involvement in management of pain, agitation and delirium (PAD) at a large community teaching hospital is described. SUMMARY: Florida Orlando Hospital implemented a two-phase initiative to decrease intensive care unit (ICU) length of stay (LOS), ventilator use, sedative use, and hospital expenditures while advancing pharmacists' scope of practice. Phase 1 of the initiative involved a pilot project to evaluate pharmacist management of sedative therapy for mechanically ventilated patients...
February 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28157809/withdrawal-assessment-tool-1-monitoring-in-picu-a-multicenter-study-on-iatrogenic-withdrawal-syndrome
#4
Angela Amigoni, Maria Cristina Mondardini, Ilaria Vittadello, Federico Zaglia, Emanuele Rossetti, Francesca Vitale, Stefania Ferrario, Fabio Savron, Giancarlo Coffaro, Luca Brugnaro, Roberta Amato, Andrea Wolfler, Linda S Franck
OBJECTIVES: Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17% and 57% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients' outcome between patients with and without withdrawal syndrome...
February 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28151790/management-of-opioid-and-sedative-weaning-in-pediatric-congenital-heart-disease-patients-assessing-the-state-of-practice
#5
Caitlin O'Connell, Sonja Ziniel, Lauren Hartwell, Jean Connor
BACKGROUND: Opioid and sedative medications are commonly used to treat pediatric patients with congenital heart disease; however, their use is not without adverse effects. Symptoms of withdrawal can occur if the medications are discontinued abruptly or weaned too quickly. OBJECTIVE: The aim of this study was to understand and describe the current management of opioid and sedative weaning in pediatric congenital heart disease patients in freestanding children's hospitals across the United States...
March 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28119385/anaesthesia-modalities-during-laser-photocoagulation-for-retinopathy-of-prematurity-a-retrospective-longitudinal-study
#6
Jing-Bo Jiang, Randy Strauss, Xian-Qiong Luo, Chuan Nie, Yan-Li Wang, Jia-Wen Zhang, Zhi-Wei Zhang
OBJECTIVES: Laser photocoagulation surgery is a routine treatment for threshold retinopathy of prematurity (ROP). However, little is known about which anaesthesia protocols provide efficient pain control while minimising exposure risk to vulnerable infants. In this study, therefore, we assessed the efficacy and tolerability of multiple anaesthesia techniques used on premature infants during laser therapy. DESIGN AND MAIN OUTCOME MEASURES: Anaesthesia modalities consisted of topical eye drops anaesthesia, general anaesthesia and intravenous fentanyl sedation with mechanical ventilation...
January 24, 2017: BMJ Open
https://www.readbyqxmd.com/read/28109052/the-use-of-methadone-to-facilitate-opioid-weaning-in-pediatric-critical-care-patients-a-systematic-review-of-the-literature-and-meta-analysis
#7
REVIEW
Leslie A Dervan, Beryl Yaghmai, Robert Scott Watson, Fredric M Wolf
BACKGROUND: Continuous opioid infusion therapy is commonly utilized in the pediatric intensive care setting to treat pain and facilitate tolerance of invasive therapies. Transitioning to methadone is one common strategy for weaning from continuous opioid infusions, but in practice this transition can be challenging, and many children still experience iatrogenic withdrawal. AIM: We reviewed the literature to evaluate the best available evidence to guide methadone therapy in this setting, and to summarize associated adverse events...
January 20, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27980751/a-case-of-veno-venous-extracorporeal-membrane-oxygenation-for-severe-respiratory-failure-in-a-superobese-patient
#8
Mirko Belliato, Luca Cremascoli, Anna Aliberti, Michele Pagani, Carlo Pellegrini, Giorgio Antonio Iotti
After risk assessment, veno-venous extracorporeal membrane oxygenation (ECMO) has been achieved in a superobese adult patient as a bridge to recovery of respiratory failure, despite the weight-related difficulties. Early v-v ECMO implantation could be considered to support and to conduct weaning both from sedation and from invasive mechanical ventilation, with the goal to perform physiokinesitherapy during awake ECMO.
December 2016: Clinical Case Reports
https://www.readbyqxmd.com/read/27935778/anesthesia-involvement-in-palliative-care
#9
Amanda C Faircloth
Palliative care teams require multidisciplinary support. While this is an emerging area in anesthesia practice, there are many avenues for certified registered nurse anesthetists (CRNAs) to share their unrivaled clinical knowledge. CRNAs may become involved with or consult on palliative sedation, medical management, interventional pain management, terminal wean/extubation, and organ donation. Additionally, CRNAs need to understand the unique needs of this patient population so that they can appropriately care for palliative care patients presenting to the operating room for palliative surgery...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27907958/critical-care-management-after-cardiac-arrest
#10
Hans Friberg, Tobias Cronberg
Sudden cardiac arrest is a devastating event with high mortality and substantial morbidity among survivors. Early recognition and intervention to restore circulation is the primary goal; once that is achieved, the path toward a meaningful recovery starts. Initial in-hospital care is focused on emergency cardiac care, but soon there is a change to a more brain-oriented critical care including targeted temperature management, brain monitoring, sedation, and repeated neurologic assessments. In patients who show early signs of awakening from coma once sedation has been stopped, the prognosis is generally good...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27889726/prolonged-infusion-of-dexmedetomidine-in-critically-ill-children
#11
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
#12
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
#13
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...
February 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27850632/994-application-of-a-protocolized-sedation-wean-to-children-post-invasive-mechanical-ventilation
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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...
January 2017: Critical Care Medicine
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