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https://www.readbyqxmd.com/read/27898439/limiting-sedation-for-patients-with-acute-respiratory-distress-syndrome-time-to-wake-up
#1
Faraaz Ali Shah, Timothy D Girard, Sachin Yende
PURPOSE OF REVIEW: Critically ill patients with acute respiratory distress syndrome (ARDS) may require sedation in their clinical care. The goals of sedation in ARDS patients are to improve patient comfort and tolerance of supportive and therapeutic measures without contributing to adverse outcomes. This review discusses the current evidence for sedation management in patients with ARDS. RECENT FINDINGS: Deep sedation strategies should be avoided in the care of patients with ARDS because deep sedation has been associated with increased time on mechanical ventilation, longer ICU and hospital length of stay, and higher mortality in critically ill patients...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27890310/same-day-total-hip-arthroplasty-performed-at-an-ambulatory-surgical-center-90-day-complication-rate-on-549-patients
#2
Gregg R Klein, Jason M Posner, Harlan B Levine, Mark A Hartzband
BACKGROUND: There is an increasing interest in outpatient total hip arthroplasty (THA), as there are perceived benefits to the patient, insurer, and overall healthcare system. However, the safety of outpatient total joint arthroplasty has not been studied. METHODS: Five hundred forty-nine patients who underwent mini-posterior THA at a freestanding independent ambulatory surgical center (ASC) were reviewed. All patients were discharged to home on the day of surgery...
October 20, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27858510/patterns-of-naloxone-use-in-hospitalized-patients
#3
Lisa Yung, Kelly C Lee, Chih Hsu, Timothy Furnish, Rabia S Atayee
OBJECTIVES: Naloxone is indicated for reversal of opioid-induced respiratory depression. The objective of this study is to evaluate patterns of naloxone use in hospitalized patients. METHODS: Retrospective chart review at the University of California, San Diego Health. Subjects included adults ≥18 years old who were admitted to and received naloxone in the medical-surgical, telemetry, intermediate care, or obstetrics/gynecology units from May 1(st), 2014 to April 30(th), 2015...
December 1, 2016: Postgraduate Medicine
https://www.readbyqxmd.com/read/27801707/implementation-of-a-nurse-driven-sedation-protocol-in-a-picu-decreases-daily-doses-of-midazolam
#4
Bénédicte Gaillard-Le Roux, Jean-Michel Liet, Pierre Bourgoin, Arnaud Legrand, Jean-Christophe Roze, Nicolas Joram
OBJECTIVES: To evaluate the impact of a nurse-driven sedation protocol on the length of mechanical ventilation, total daily doses of sedatives, and complications of sedation. DESIGN: A single-center prospective before and after study was conducted from October 2010 to December 2013. SETTING: Twelve-bed surgical and medical PICU of the university-affiliated hospital in Nantes, France. PATIENTS: A total of 235 patients, between 28 days and 18 years old, requiring mechanical ventilation for at least 24 hours were included in the study; data from 194 patients were analyzed...
October 28, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27785030/identifying-predictive-clinical-characteristics-of-the-treatment-efficacy-of-mirtazapine-monotherapy-for-major-depressive-disorder
#5
Takahiro Tsutsumi, Hiroko Sugawara, Ryoko Ito, Mizuho Asano, Satoru Shimizu, Jun Ishigooka, Katsuji Nishimura
BACKGROUND: Mirtazapine, which is classified as a noradrenergic and specific serotonergic antidepressant, is widely prescribed for the treatment of major depressive disorder. The potential predictive factors of the efficacy of mirtazapine and the tolerability based on the incidence of oversedation and jitteriness/anxiety syndrome were evaluated. PATIENTS AND METHODS: Patients with major depressive disorder were retrospectively investigated. Study subjects comprised 68 patients with depression who received mirtazapine as an initial antidepressant at the Department of Psychiatry of the Tokyo Women's Medical University Hospital from September 2009 to March 2013...
2016: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/27646881/comparison-of-sedation-strategies-for-critically-ill-patients-a-protocol-for-a-systematic-review-incorporating-network-meta-analyses
#6
Brian Hutton, Lisa D Burry, Salmaan Kanji, Sangeeta Mehta, Melanie Guenette, Claudio M Martin, Dean A Fergusson, Neill K Adhikari, Ingrid Egerod, David Williamson, Sharon Straus, David Moher, E Wesley Ely, Louise Rose
BACKGROUND: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly compared...
2016: Systematic Reviews
https://www.readbyqxmd.com/read/27537929/the-impact-of-residual-neuromuscular-blockade-oversedation-and-hypothermia-on-adverse-respiratory-events-in-a-postanesthetic-care-unit-a-prospective-study-of-prevalence-predictors-and-outcomes
#7
Paul A Stewart, Sophie S Liang, Qiushuang Susan Li, Min Li Huang, Ayse B Bilgin, Dukyeon Kim, Stephanie Phillips
BACKGROUND: Residual neuromuscular blockade (RNMB) has been linked to adverse respiratory events (AREs) in the postanesthetic care unit (PACU). However, these events are often not attributed to RNMB by anesthesiologists because they may also be precipitated by other factors including obstructive sleep apnea, opioids, or hypnotic agents. Many anesthesiologists believe RNMB occurs infrequently and is rarely associated with adverse outcomes. This study evaluated the prevalence and predictors of RNMB and AREs...
October 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27408521/prevalence-of-delirium-and-coma-in-mechanically-ventilated-patients-sedated-with-dexmedetomidine-or-propofol
#8
Yi Kai Johnny Jiang, Shan Wang, Timothy S Lam, Adel Hanna, Jonas P DeMuro, Rose Calixte, Collin E M Brathwaite
OBJECTIVE: To assess the prevalence of delirium and coma in mechanically ventilated patients sedated with dexmedetomidine or propofol alone; to evaluate the hospital length of stay for both treatment groups; and to evaluate the level of sedation, adverse effects, and hospital outcomes. METHODS: Medical records were reviewed retrospectively for patients who were admitted to the medical or surgical intensive care units (ICUs) in a 591-bed teaching hospital and who received either dexmedetomidine or propofol alone for 24 hours or more for sedation...
July 2016: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/27372773/extended-monitoring-during-endoscopy
#9
REVIEW
Nadim Mahmud, Tyler M Berzin
Gastrointestinal endoscopic sedation has improved procedural and patient outcomes but is associated with attendant risks of oversedation and hemodynamic compromise. Therefore, close monitoring during endoscopic procedures using sedation is critical. This monitoring begins with appropriate staff trained in visual assessment of patients and analysis of basic physiologic parameters. It also mandates an array of devices widely used in practice to evaluate hemodynamics, oxygenation, ventilation, and depth of sedation...
July 2016: Gastrointestinal Endoscopy Clinics of North America
https://www.readbyqxmd.com/read/27310958/analgesic-efficacy-of-intrathecal-fentanyl-during-the-period-of-highest-analgesic-demand-after-cesarean-section-a-randomized-controlled-study
#10
Wojciech Weigl, Andrzej Bierylo, Monika Wielgus, Swietlana Krzemień-Wiczyńska, Iwona Szymusik, Marcin Kolacz, Michal J Dabrowski
Cesarean section (CS) is one of the most common surgical procedures in female patients. We aimed to evaluate the postoperative analgesic efficacy of intrathecal fentanyl during the period of greatest postoperative analgesic demand after CS. This period was defined by detailed analysis of patient-controlled analgesia (PCA) usage.This double-blind, placebo-controlled, parallel-group randomized trial included 60 parturients who were scheduled for elective CS. Participants received spinal anesthesia with bupivacaine supplemented with normal saline (control group) or with fentanyl 25 μg (fentanyl group)...
June 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27303078/comparison-of-intraoperative-periarticular-injections-versus-liposomal-bupivacaine-as-part-of-a-multimodal-approach-to-pain-management-in-total-knee-arthroplasty
#11
Mikayla J Klug, Michael P Rivey, Jean T Carter
BACKGROUND: Total knee arthroplasty (TKA) has been shown to restore mobility, return an individual to activities of daily living, and improve quality of life. Nearly 80% of patients undergoing TKA report moderate to severe pain in the first 2 weeks following surgery. METHODS: A retrospective study was conducted in 103 patients who underwent TKA between October 12, 2014 and May 30, 2015 by a single surgeon at a small community hospital. During this period, data were analyzed for differences in outcomes with a change from intraoperative periarticular (IOPA) injections containing an anesthetic/analgesic mixture of ropivacaine, epinephrine, ketorolac, and clonidine to liposomal bupivacaine...
April 2016: Hospital Pharmacy
https://www.readbyqxmd.com/read/27302000/target-controlled-versus-fractionated-propofol-sedation-in-flexible-bronchoscopy-a-randomized-noninferiority-trial
#12
Daniel Franzen, Daniel J Bratton, Christian F Clarenbach, Lutz Freitag, Malcolm Kohler
BACKGROUND AND OBJECTIVE: Fractionated propofol administration (FPA) in flexible bronchoscopy (FB) may lead to oversedation and an increased risk of adverse events, because a stable plasma concentration of propofol is not maintainable. The purpose of this randomized noninferiority trial was to evaluate whether target-controlled infusion (TCI) of propofol is noninferior to FPA in terms of safety in FB. METHODS: Coprimary outcomes were the mean lowest arterial oxygen saturation (SpO2 ) during FB and the number of propofol dose adjustments in relation to procedure duration...
June 15, 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/27215360/complications-of-sedation-in-critical-illness-an-update
#13
REVIEW
Jan Foster
Sedation is a necessary component of care for the critically ill. Oversedation, however, is associated with immediate complications and long-term problems, termed post-intensive care unit syndrome. It also contributes to unnecessary costs of care. This article describes the physical, functional, psychiatric, and cognitive complications of oversedation, and multiple research-based strategies that minimize complications.
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215358/toward-solving-the-sedation-assessment-conundrum-neurofunction-monitoring
#14
REVIEW
DaiWai M Olson, Kyloni Phillips, Carmelo Graffagnino
The sedation-assessment conundrum is the struggle to balance the need for sedation against the need to awaken the patient and perform a neurologic examination. This article discusses the nuances of the sedation-assessment conundrum as well as approaches to resolve this and reduce the negative impact of abruptly stopping sedative infusions. Both oversedation and undersedation affect critically ill patients. This article discusses methods of assessing sedation and interpreting individualized patient responses to sedation...
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27194197/methadone-conversion-in-infants-and-children-retrospective-cohort-study-of-199-pediatric-inpatients
#15
Alexandra Fife, Andrea Postier, Andrew Flood, Stefan J Friedrichsdorf
OBJECTIVE: Methadone administration has increased in pediatric clinical settings. This review is an attempt to ascertain an equianalgesic dose ratio for methadone in the pediatric population using standard adult dose conversion guidelines. SETTING: US tertiary children's hospital. PATIENTS: Hospitalized pediatric patients, 0-18 years of age. MAIN OUTCOME MEASURES: A retrospective chart review was conducted for patients who were converted from their initial opioid therapy regimen (morphine, hydromorphone, and/or fentanyl) to methadone...
May 2016: Journal of Opioid Management
https://www.readbyqxmd.com/read/27188977/pain-management-in-critically-ill-patients-a-review-of-multimodal-treatment-options
#16
Matthew Kohler, Felicia Chiu, Katherine M Gelber, Christopher Aj Webb, Paul D Weyker
Pain management for critically ill patients provides physicians with the challenge of maximizing patient comfort while avoiding the risks that arise with oversedation. Preventing oversedation has become increasingly important as we better understand the negative impact it has on patients' experiences and outcomes. Current research suggests that oversedation can result in complications such as thromboembolism, pulmonary compromise, immunosuppression and delirium. Fortunately, the analgesic options available for physicians to limit these complications are growing as more treatment modalities are being researched and implemented in the intensive care unit...
May 18, 2016: Pain Management
https://www.readbyqxmd.com/read/27163223/interprofessional-implementation-of-a-pain-sedation-guideline-on-a-trauma-intensive-care-unit
#17
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/27101321/multimodal-analgesia-in-the-hip-fracture-patient
#18
David W Fabi
Hip fracture is one of the most common injuries among the elderly and, because the population is aging, it is expected to remain a major clinical challenge and public health problem for the foreseeable future. The clinical importance of early mobilization and prompt participation in physical therapy after hip fracture surgery is now widely recognized. Because postoperative pain can impair mobility and delay physical therapy, much attention is now being paid to finding more effective ways of controlling pain after hip fracture...
May 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27071831/increased-sleep-duration-precedes-the-improvement-of-other-symptom-domains-during-the-treatment-of-acute-mania-a-retrospective-chart-review
#19
Igor I Galynker, Zimri S Yaseen, Siva S Koppolu, Barney Vaughan, Magdalena Szklarska-Imiolek, Lisa J Cohen, Thomas M Salvanti, Hae-Joon Kim
BACKGROUND: Understanding trajectories of symptom changes may help gauge treatment response and better identify therapeutic targets in treatment of acute mania. We examined how symptoms of sleep disturbance, mania, and psychosis resolved in a naturalistic treatment setting, hypothesizing that improvement in sleep would precede improvement in manic and psychotic symptoms. METHODS: Charts of 100 patients with admitting diagnoses of bipolar mixed or manic episode were retrospectively reviewed...
2016: BMC Psychiatry
https://www.readbyqxmd.com/read/26929661/options-for-perioperative-pain-management-in-neurosurgery
#20
REVIEW
Nalini Vadivelu, Alice M Kai, Daniel Tran, Gopal Kodumudi, Aron Legler, Eugenia Ayrian
Moderate-to-severe pain following neurosurgery is common but often does not get attention and is therefore underdiagnosed and undertreated. Compounding this problem is the traditional belief that neurosurgical pain is inconsequential and even dangerous to treat. Concerns about problematic effects associated with opioid analgesics such as nausea, vomiting, oversedation, and increased intracranial pressure secondary to elevated carbon dioxide tension from respiratory depression have often led to suboptimal postoperative analgesic strategies in caring for neurosurgical patients...
2016: Journal of Pain Research
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