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https://www.readbyqxmd.com/read/28304319/a-case-of-infant-delirium-in-the-neonatal-intensive-care-unit
#1
L E Edwards, L B Hutchison, C D Hornik, P B Smith, C M Cotten, M Bidegain
Infant delirium is an under-recognized clinical entity in neonatal intensive care, and earlier identification and treatment could minimize morbidities associated with this condition. We describe a case of a 6-month-old former 32 weeks gestation infant undergoing a prolonged mechanical ventilation course diagnosed with delirium related to the combination of his underlying illness and the use of multiple sedative and analgesic mediations. Initiation of the atypical antipsychotic risperidone allowed for weaning from continuous infusions of benzodiazepines and opiods, and lower dosages of bolus-dosed sedation and analgesics...
March 16, 2017: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/28297813/-clinical-application-and-evaluation-of-an-early-non-sedation-protocol-for-critically-ill-respiratory-patients
#2
J B Huang, C Q Lan, H Y Li, L Chen, J G Pan, L L Chen, H Weng, Y M Zeng
Objective: To study the value of an early (mechanical ventilation after 24 h) non-sedation protocol for intubated, mechanically ventilated patients in the respiratory intensive care unit (RICU). Methods: Seventy intubated, mechanically ventilated patients were prospectively enrolled and randomly assigned to management with early non-sedation (intervention group; n=35) or with daily interruption of sedation (DIS) (control group; n=35). The duration of mechanical ventilation, length of the RICU and hospital stay, RICU and hospital mortality, drug consumption, RICU and hospitalization expenses, incidence of complications and adverse events and serum levels of vital organ damage and inflammatory markers after mechanical ventilation for 48 h were recorded and compared...
March 12, 2017: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28285322/intensive-care-medicine-research-agenda-on-cardiac-arrest
#3
REVIEW
Jerry P Nolan, Robert A Berg, Stephen Bernard, Bentley J Bobrow, Clifton W Callaway, Tobias Cronberg, Rudolph W Koster, Peter J Kudenchuk, Graham Nichol, Gavin D Perkins, Tom D Rea, Claudio Sandroni, Jasmeet Soar, Kjetil Sunde, Alain Cariou
Over the last 15 years, treatment of comatose post-cardiac arrest patients has evolved to include therapeutic strategies such as urgent coronary angiography with percutaneous coronary intervention (PCI), targeted temperature management (TTM)-requiring mechanical ventilation and sedation-and more sophisticated and cautious prognostication. In 2015, collaboration between the European Resuscitation Council (ERC) and the European Society for Intensive Care Medicine (ESICM) resulted in the first European guidelines on post-resuscitation care...
March 11, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28275225/low-flow-veno-venous-extracorporeal-co2-removal-for-acute-hypercapnic-respiratory-failure
#4
Matthias P Hilty, Thomas Riva, Silvia R Cottini, Eva-Maria Kleinert, Alessandra Maggiorini, Marco Maggiorini
BACKGROUND: Ventilation with low tidal volume and airway pressure results in a survival benefit in ARDS patients. Previous research suggests that avoiding mechanical ventilation altogether may be beneficial in some cases of respiratory failure. Our hypothesis was that low flow veno-venous extracorporeal CO2 removal (ECCO2R) enables maintenance of a lung protective ventilation strategy or awake spontaneous ventilation despite severe hypercapnic respiratory failure (HRF). METHODS: Twenty patients with HRF were investigated while mechanically ventilated (n=14) or breathing spontaneously close to respiratory exhaustion (n=6)...
March 8, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28269712/heart-rate-variability-as-a-biomarker-for-sedation-depth-estimation-in-icu-patients
#5
Sunil B Nagaraj, Sowmya M Ramaswamy, Siddharth Biswal, Emily J Boyle, David W Zhou, Lauren M Mcclain, Eric S Rosenthal, Patrick L Purdon, M Brandon Westover
An automated patient-specific system to classify the level of sedation in ICU patients using heart rate variability signal is presented in this paper. ECG from 70 mechanically ventilated adult patients with administered sedatives in an ICU setting were used to develop a support vector machine based system for sedation depth monitoring using several heart rate variability measures. A leave-one-subject-out cross validation was used for classifier training and performance evaluations. The proposed patient-specific system provided a sensitivity, specificity and an AUC of 64%, 84...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28267272/effect-of-ventilator-mode-on-patient-ventilator-synchrony-and-work-of-breathing-in-neonatal-pigs
#6
Shayna M Wood, Tracy L Thurman, Shirley J Holt, Shasha Bai, Mark J Heulitt, Sherry E Courtney
BACKGROUND: Patient-ventilator asynchrony can result in increased work of breathing (WOB) and need for increased sedation, as well as respiratory muscle fatigue and prolonged mechanical ventilation. Different ventilator modes may result in varying degrees of asynchrony and WOB. OBJECTIVE: The objectives of this study were to assess the incidence of asynchrony and the effect of asynchrony on WOB in three modes of ventilation: pressure regulated volume control (PRVC), synchronized intermittent mandatory ventilation/volume control plus pressure support (SIMV/VC plus PS), and SIMV/PRVC plus PS...
March 7, 2017: Pediatric Pulmonology
https://www.readbyqxmd.com/read/28263192/the-confusion-assessment-method-for-the-icu-7-delirium-severity-scale-a-novel-delirium-severity-instrument-for-use-in-the-icu
#7
Babar A Khan, Anthony J Perkins, Sujuan Gao, Siu L Hui, Noll L Campbell, Mark O Farber, Linda L Chlan, Malaz A Boustani
OBJECTIVES: Delirium severity is independently associated with longer hospital stays, nursing home placement, and death in patients outside the ICU. Delirium severity in the ICU is not routinely measured because the available instruments are difficult to complete in critically ill patients. We designed our study to assess the reliability and validity of a new ICU delirium severity tool, the Confusion Assessment Method for the ICU-7 delirium severity scale. DESIGN: Observational cohort study...
March 3, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28260348/current-views-of-pediatric-intensive-care-unit-picu
#8
Conghai Fan, Boxiang Qi, Chao Chen
International best practice endorses the use of standardized approaches in the management of pediatric patients in the Pediatric Intensive Care Unit (PICU). There is increasing awareness of the risk of prolonged duration of mechanical ventilation as a consequence of morphine use leading to ventilator associated pneumonia (VAP), extended PICU and hospital length of stay and increased morbidity and mortality. Accordingly a fundamental outcome measure of this study was to determine whether raising awareness of these issues and the introduction of analgesia and sedation guidelines led to a reduction in the amount of analgesics and sedatives administered to PICU patients, while not exposing them to pain and distress...
March 3, 2017: Minerva Pediatrica
https://www.readbyqxmd.com/read/28259355/-effects-of-the-positive-end-expiratory-pressure-increase-on-sublingual-microcirculation-in-patients-with-acute-respiratory-distress-syndrome
#9
Nathaly Fonseca Nunes, Antônio Tonete Bafi, Eduardo Souza Pacheco, Luciano Cesar Pontes de Azevedo, Flavia Ribeiro Machado, Flávio Geraldo Rezende Freitas
OBJECTIVE: The aim of this study was to evaluate the impact of increased positive end-expiratory pressure on the sublingual microcirculation. METHODS: Adult patients who were sedated, under mechanical ventilation, and had a diagnosis of circulatory shock and acute respiratory distress syndrome were included. The positive end-expiratory pressure level was settled to obtain a plateau pressure of 30cmH2O and then maintained at this level for 20minutes. Microcirculatory (obtained by videomicroscopy) and hemodynamic variables were collected at baseline and compared with those at the end of 20min...
March 2, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28258734/-validation-of-the-brazilian-version-of-behavioral-pain-scale-in-adult-sedated-and-mechanically-ventilated-patients
#10
Isabela Freire Azevedo-Santos, Iura Gonzalez Nogueira Alves, Manoel Luiz de Cerqueira Neto, Daniel Badauê-Passos, Valter Joviniano Santana-Filho, Josimari Melo de Santana
BACKGROUND AND OBJECTIVES: The Behavioral Pain Scale is a pain assessment tool for uncommunicative and sedated Intensive Care Unit patients. The lack of a Brazilian scale for pain assessment in adults mechanically ventilated justifies the relevance of this study that aimed to validate the Brazilian version of Behavioral Pain Scale as well as to correlate its scores with the records of physiological parameters, sedation level and severity of disease. METHODS: Twenty-five Intensive Care Unit adult patients were included in this study...
March 1, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28257153/assessment-of-continuous-pain-in-newborns-admitted-to-nicus-in-18-european-countries
#11
Kanwaljeet J S Anand, Mats Eriksson, Elaine M Boyle, Alejandro Avila-Alvarez, Randi Dovland Andersen, Kosmas Sarafidis, Tarja Polkki, Cristina Matos, Paola Lago, Thalia Papadouri, Simon Attard-Montalto, Mari-Liis Ilmoja, Sinno Simons, Rasa Tameliene, Bart van Overmeire, Angelika Berger, Anna Dobrzanska, Michael Schroth, Lena Bergqvist, Emilie Courtois, Jessica Rousseau, Ricardo Carbajal
AIM: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown. METHODS: A prospective cohort study in 243 Neonatal Intensive Care Units (NICUs) from 18 European countries recorded frequency of pain assessments, use of mechanical ventilation, sedation, analgesia, or neuromuscular blockade for each neonate upto 28 days after NICU admission. RESULTS: Only 2113/6648 (31·8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46·0%), noninvasive ventilation (NiV, 35·0%), and no ventilation (NoV, 20·1%) groups (p<0·001)...
March 3, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28251431/48%C3%A2-h-cessation-of-mechanical-ventilation-during-venovenous-extracorporeal-membrane-oxygenation-in-severe-trauma-a-case-report
#12
Justyna Swol, Yann Fülling, Christopher Ull, Matthias Bechtel, Thomas A Schildhauer
A 32-year-old motorcyclist who was hit by a tram subsequently presented with blunt force thoracic trauma, a pelvic fracture and a penetrating injury to the left lower extremity. Coagulopathy persisted following surgery of the leg and pelvic vascular intervention. Bedside thoracotomy was performed to treat pneumothorax and pneumopericardium. Severe hypoxemia secondary to lung failure ensued, which required venovenous extracorporeal membrane oxygenation (VV ECMO) support. On the third day after the trauma, ultra-protective mechanical ventilation was not possible due to non-existent lung compliance; thus, the ventilator was disconnected, and the T-piece was connected to the blocked tracheal tube left in the airway...
March 1, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28246074/delirium-after-mechanical-ventilation-in-intensive-care-units-the-cognitive-and-psychosocial-assessment-capa-study-protocol
#13
Daniella Bulic, Michael Bennett, Helen Rodgers, Mary Nourse, Patrick Rubie, Jeffrey Cl Looi, Frank Van Haren
BACKGROUND: In the intensive care unit (ICU), critical illness delirium occurs in the context of multiple comorbidities, multi-organ failure, and invasive management techniques, such as mechanical ventilation, sedation, and lack of sleep. Delirium is characterized by an acute confusional state defined by fluctuating mental status, inattention, and either disorganized thinking or an altered level of consciousness. The long-term cognitive and psychosocial function of patients that experience delirium in the ICU is of crucial interest because preliminary data suggest a strong association between ICU-related delirium and long-term cognitive impairment...
February 28, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28236391/best-practices-for-managing-pain-sedation-and-delirium-in-the-mechanically-ventilated-patient
#14
REVIEW
Kitty M Garrett
Nursing management of pain, agitation, and delirium in mechanically ventilated patients is a challenge in critical care. Oversedation can lead to delayed extubation, prolonged ventilator days, unnecessary neurologic testing, and complications such as weakness and delirium. Undersedation can lead to self-extubation, invasive line removal, unnecessary patient distress, and injury to self or others. Acquiring an optimal level of sedation requires the bedside nurse to be more vigilant than ever with patient assessment and medication titration...
December 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28236389/early-mobilization-of-mechanically-ventilated-patients
#15
REVIEW
Pam Hruska
Critically ill patients requiring mechanical ventilation are least likely to be mobilized and, as a result, are at-risk for prolonged complications from weakness. The use of bed rest and sedation when caring for mechanically ventilated patients is likely shaped by historical practice; however, this review demonstrates early mobilization, with little to no sedation, is possible and safe. Assessing readiness for mobilization in context of progressing patients from passive to active activities can lead to long-term benefits and has been achievable with resource-efficient implementations and team work...
December 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28236042/respiratory-induced-heart-rate-variability-during-slow-mechanical-ventilation-marker-to-exclude-brain-death-patients
#16
Pavel Jurak, Josef Halamek, Vlastimil Vondra, Peter Kruzliak, Vladimir Sramek, Ivan Cundrle, Pavel Leinveber, Mariusz Adamek, Vaclav Zvonicek
BACKGROUND: Respiratory induced heart rate variability (rHRV) was analysed in mechanically ventilated patients during two levels of sedation and brain death. Our aim was to determine whether rHRV can distinguish between different levels of sedation and especially between brain death and sedated patients. METHODS: In this study 30 critically ill and 23 brain death patients were included and four respiratory rates of 15, 12, 8 and 6 breaths per minute, each lasting 5 min were used...
February 24, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28230150/an-experimental-study-on-the-impacts-of-inspiratory-and-expiratory-muscles-activities-during-mechanical-ventilation-in-ards-animal-model
#17
Xianming Zhang, Juan Du, Weiliang Wu, Yongcheng Zhu, Ying Jiang, Rongchang Chen
In spite of intensive investigations, the role of spontaneous breathing (SB) activity in ARDS has not been well defined yet and little has been known about the different contribution of inspiratory or expiratory muscles activities during mechanical ventilation in patients with ARDS. In present study, oleic acid-induced beagle dogs' ARDS models were employed and ventilated with the same level of mean airway pressure. Respiratory mechanics, lung volume, gas exchange and inflammatory cytokines were measured during mechanical ventilation, and lung injury was determined histologically...
February 23, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28227974/heart-rate-variability-as-a-biomarker-for-sedation-depth-estimation-in-icu-patients
#18
Sunil B Nagaraj, Sowmya M Ramaswamy, Siddharth Biswal, Emily J Boyle, David W Zhou, Lauren M Mcclain, Eric S Rosenthal, Patrick L Purdon, M Brandon Westover, Sunil B Nagaraj, Sowmya M Ramaswamy, Siddharth Biswal, Emily J Boyle, David W Zhou, Lauren M Mcclain, Eric S Rosenthal, Patrick L Purdon, M Brandon Westover, M Brandon Westover, Sunil B Nagaraj, Siddharth Biswal, Sowmya M Ramaswamy, Lauren M Mcclain, David W Zhou, Emily J Boyle, Patrick L Purdon, Eric S Rosenthal
An automated patient-specific system to classify the level of sedation in ICU patients using heart rate variability signal is presented in this paper. ECG from 70 mechanically ventilated adult patients with administered sedatives in an ICU setting were used to develop a support vector machine based system for sedation depth monitoring using several heart rate variability measures. A leave-one-subject-out cross validation was used for classifier training and performance evaluations. The proposed patient-specific system provided a sensitivity, specificity and an AUC of 64%, 84...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28222644/use-of-the-injection-test-to-indicate-the-oesophageal-balloon-position-in-patients-without-spontaneous-breathing-a-clinical-feasibility-study
#19
Han Chen, Yan-Lin Yang, Ming Xu, Zhong-Hua Shi, Xuan He, Xiu-Mei Sun, Xu-Ying Luo, Guang-Qiang Chen, Jian-Xin Zhou
Objective To investigate the clinical feasibility of the injection test for balloon placement during oesophageal pressure measurement in patients without spontaneous breathing. Methods The injection test was performed in 12 mechanically ventilated patients under deep sedation and paralysis. During withdrawal of the balloon from the stomach and air injection into the gastric lumen of the catheter, the presence of the injection test wave in the balloon pressure tracing indicated that the whole balloon was positioned above the lower oesophageal sphincter (LES)...
February 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28212163/multiple-organ-dysfunction-in-children-mechanically-ventilated-for-acute-respiratory-failure
#20
Scott L Weiss, Lisa A Asaro, Heidi R Flori, Geoffrey L Allen, David Wypij, Martha A Q Curley
OBJECTIVES: The impact of extrapulmonary organ dysfunction, independent from sepsis and lung injury severity, on outcomes in pediatric acute respiratory failure is unclear. We sought to determine the frequency, timing, and risk factors for extrapulmonary organ dysfunction and the independent association of multiple organ dysfunction syndrome with outcomes in pediatric acute respiratory failure. DESIGN: Secondary observational analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure cluster-randomized prospective clinical trial conducted between 2009 and 2013...
February 16, 2017: Pediatric Critical Care Medicine
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