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sedation mechanical ventilation

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https://www.readbyqxmd.com/read/29338772/incidence-risk-factors-and-impact-of-protocolised-care-on-exposure-keratopathy-in-critically-ill-adults-a-two-phase-prospective-cohort-study
#1
Obaid Kousha, Zubaid Kousha, Jonathan Paddle
BACKGROUND: Exposure keratopathy (EK) has a high incidence in critically ill patients. We aimed to determine the rate of EK in patients admitted to our intensive care unit (ICU), identify risk factors for developing EK and ascertain the effectiveness of a protocol to prevent EK. METHODS: We undertook a two-phase prospective cohort single-centre study in a general adult ICU. The first phase of the study was observational. In the second phase of the study an eye care protocol was introduced...
January 16, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29335074/trends-in-narcotics-and-sedative-use-during-mechanical-ventilation-of-preterm-infants-in-canadian-neonatal-intensive-care-units
#2
(no author information available yet)
OBJECTIVE: Mechanical ventilation (MV) in preterm infants (PTI) causes discomfort. Whether it causes pain is controversial. Meta analysis reviews of published work on PTI during MV have shown no clinically significant impact of opioids on pain scales, and hence not recommended for routine use in neonatal intensive care units (NICUs). Similarly regular use of sedative midazolam is also not recommended. Therefore we hypothesized a downward trend in narcotics and sedatives used in MV of PTI in NICUs...
January 2018: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/29329164/a-systematic-review-of-risk-factors-associated-with-cognitive-impairment-after-pediatric-critical-illness
#3
Alicia G Kachmar, Sharon Y Irving, Cynthia A Connolly, Martha A Q Curley
OBJECTIVES: To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness. DATA SOURCES: For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017. STUDY SELECTION: Included were studies with subjects 3-18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension...
January 11, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29325842/use-of-dexmedetomidine-in-cardiothoracic-and-vascular-anesthesia
#4
REVIEW
Lucía Gallego-Ligorit, Marc Vives, Jorge Vallés-Torres, T Alberto Sanjuán-Villarreal, Azucena Pajares, Mario Iglesias
Dexmedetomidine is a highly selective α2-adrenergic agonist with analgesic and sedative properties. In the United States, the Food and Drug Administration approved the use of the drug for short-lasting sedation (24 h) in intensive care units (ICUs) in patients undergoing mechanical ventilation and endotracheal intubation. In October 2008, the Food and Drug Administration extended use of the drug for the sedation of nonintubated patients before and during surgical and nonsurgical procedures. In the European Union, the European Medicine Agency approved the use of dexmedetomidine in September 2011 with a single recognized indication: ICU adult patients requiring mild sedation and awakening in response to verbal stimulus...
December 2, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29304923/potentially-modifiable-risk-factors-for-long-term-cognitive-impairment-after-critical-illness-a-systematic-review
#5
REVIEW
Amra Sakusic, John C O'Horo, Mikhail Dziadzko, Dziadzko Volha, Rashid Ali, Tarun D Singh, Rahul Kashyap, Ann M Farrell, John D Fryer, Ronald Petersen, Ognjen Gajic, Alejandro A Rabinstein
Long-term cognitive impairment is common in survivors of critical illness. Little is known about the etiology of this serious complication. We sought to summarize current scientific knowledge about potentially modifiable risk factors during intensive care unit (ICU) treatment that may play a substantial role in the development of long-term cognitive impairment. All searches were run on October 1, 2017. The search strategy included Ovid MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effect, Scopus, and Web of Science, and included MeSH headings and keywords related to intensive care, critical care, and cognitive disorders...
January 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29284834/comparison-of-dexmedetomidine-and-midazolam-for-sedation-in-mechanically-ventilated-patients-guided-by-bispectral-index-and-sedation-agitation-scale
#6
Manoj Tripathi, Virendra Kumar, Mahendra B Kalashetty, Deepak Malviya, Prateek Singh Bais, Om Prakash Sanjeev
Background: Mechanical ventilation and sedation are inextricably linked components of critical care that represent, what we do for the patients during their vulnerable course in Intensive Care Unit (ICU). Aims: The aim of this study is to compare the efficacy and safety of midazolam and dexmedetomidine in patients on mechanical ventilator with the help of Bispectral Index (BIS) monitoring and correlation of BIS with Sedation-Agitation Scale (SAS). Settings and Design: Prospective, observational, and comparative study...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29275138/does-a-history-of-psychoactive-substances-abuse-play-a-role-in-the-level-of-pain-of-the-patient-with-severe-trauma
#7
C López-López, A Arranz-Esteban, M V Martinez-Ureta, M C Sánchez-Rascón, C Morales-Sánchez, M Chico-Fernández
OBJECTIVE: To analyse the influence of psychotropic substance use on the level of pain in patients with severe trauma. DESIGN: Longitudinal analytical study. SCOPE: Intensive Care Unit (ICU) of Trauma and Emergencies. PATIENTS: severe trauma, non-communicative and mechanical ventilation >48hours. Two groups of patients were created: users and non-users of psychotropic substances according to medical records. INTERVENTIONS: Measurement of pain level at baseline and during mobilization, using the Pain Indicator Behaviour Scale...
December 20, 2017: Enfermería Intensiva
https://www.readbyqxmd.com/read/29259935/dexmedetomidine-based-sedation-for-post-surgery-critically-ill-adults-a-meta-analysis-of-randomized-controlled-trials
#8
REVIEW
Heng Fan, Yu Zhao, Min Sun, Ji-Hui Ye, Guo-Dong Chen, Jian-Hua Zhu
Background: Using dexmedetomidine (Dex) as a sedative agent may benefit the clinical outcomes of post-surgery patients. We reviewed randomized controlled trials (RCTs) to assess whether use of a Dex could improve the outcomes in post-surgery critically ill adults. Methods: We searched Medline, Embase, PubMed, and the Cochrane databases for RCTs comparing Dex with propofol or a placebo in post-operative patients, all included RCTs should be published in English before Jul 2016...
December 2017: Iranian Journal of Public Health
https://www.readbyqxmd.com/read/29258778/effects-of-deep-sedation-under-mechanical-ventilation-on-cognitive-outcome-in-patients-undergoing-surgery-for-oral-and-maxillofacial-cancer-and-microvascular-reconstruction
#9
Y Terada, S Inoue, M Konda, J Egawa, J Ueda, T Kirita, M Kawaguchi
OBJECTIVE: Cognitive impairment after intensive care unit (ICU) admission is becoming increasingly recognized. High-dose deep sedation has been suggested to play an important role in the development of cognitive impairment. However, the impact of heavy sedation as a single cause in the development of cognitive impairment in ICU patients remains unclear. In this study we investigated whether a three-day deep sedation protocol could reduce cognitive function in mechanically ventilated non-critical patients...
December 16, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/29234838/clinical-characteristics-and-prognosis-of-traumatic-head-injury-following-road-traffic-accidents-admitted-in-icu-analysis-of-694-cases
#10
Hedi Chelly, Mabrouk Bahloul, Rania Ammar, Ahmed Dhouib, Khaireddine Ben Mahfoudh, Mohamed Zaher Boudawara, Olfa Chakroun, Imen Chabchoub, Anis Chaari, Mounir Bouaziz
BACKGROUND: The aim of the present study is to analyze the clinical and epidemiological characteristics of Traumatic Brain Injury (TBI) following Road Traffic Accidents (RTAs). Moreover, we aim to evaluate the outcome of the TBI victims referred to our medico-surgical Intensive Care Unit (ICU), and to define predictive factors associated with poor prognosis. METHODS: A retrospective study over a 4-year period (2009 to 2012) of 694 patients with head injuries, incurred during road traffic accidents, admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia)...
December 12, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29227367/practice-patterns-and-outcomes-associated-with-early-sedation-depth-in-mechanically-ventilated-patients-a-systematic-review-and-meta-analysis
#11
Robert J Stephens, Matthew R Dettmer, Brian W Roberts, Enyo Ablordeppey, Susan A Fowler, Marin H Kollef, Brian M Fuller
OBJECTIVES: Emerging data suggest that early deep sedation may negatively impact clinical outcomes. This systematic review and meta-analysis defines and quantifies the impact of deep sedation within 48 hours of initiation of mechanical ventilation, as described in the world's literature. The primary outcome was mortality. Secondary outcomes included hospital and ICU lengths of stay, mechanical ventilation duration, and delirium and tracheostomy frequency. DATA SOURCES: The following data sources were searched: MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews and Effects, Cochrane Database of Systematic Reviews databases, ClinicalTrials...
December 8, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29223743/early-vs-late-tracheostomy-in-intensive-care-settings-impact-on-icu-and-hospital-costs
#12
Brent Herritt, Dipayan Chaudhuri, Kednapa Thavorn, Dalibor Kubelik, Kwadwo Kyeremanteng
INTRODUCTION: Up to 12% of the 800,000 patients who undergo mechanical ventilation in the United States every year require tracheostomies. A recent systematic review showed that early tracheostomy was associated with better outcomes: more ventilator-free days, shorter ICU stays, less sedation and reduced long-term mortality. However, the financial impact of early tracheostomies remain unknown. OBJECTIVES: To conduct a cost-analysis on the timing of tracheostomy in mechanically ventilated patients...
December 7, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29208343/single-center-experience-with-intrathecal-administration-of-nusinersen-in-children-with-spinal-muscular-atrophy-type-1
#13
Astrid Pechmann, Thorsten Langer, Sabine Wider, Janbernd Kirschner
BACKGROUND: Spinal muscular atrophy (SMA) is a neuromuscular disorder mainly characterized by proximal muscle weakness. There have been enormous advances in therapeutic development with the possibility to influence the clinical course of the disease. Nusinersen is the first approved drug to treat SMA. It is administered intrathecally and acts as splicing modifier of the SMN2 gene. METHODS: Lumbar punctures were performed using a standardized protocol. To evaluate safety and feasibility of the intrathecal treatment, vital signs and the need for sedation, analgesia or mechanical ventilation during the procedure were monitored...
November 21, 2017: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/29202258/the-spice-iii-study-protocol-and-analysis-plan-a-randomised-trial-of-early-goaldirected-sedation-compared-with-standard-care-in-mechanically-ventilated-patients
#14
RANDOMIZED CONTROLLED TRIAL
Yahya Shehabi, Andrew B Forbes, Yaseen Arabi, Frances Bass, Rinaldo Bellomo, Suhaini Kadiman, Belinda D Howe, Colin McArthur, Michael C Reade, Ian Seppelt, Jukka Takala, Steve Webb, Matthew P Wise
BACKGROUND: Sedation strategy in critically ill patients who are mechanically ventilated is influenced by patient-related factors, choice of sedative agent and the intensity or depth of sedation prescribed. The impact of sedation strategy on outcome, in particular when delivered early after initiation of mechanical ventilation, is uncertain. OBJECTIVES: To present the protocol and analysis plan of a large randomised clinical trial investigating the effect of a sedation strategy, in critically ill patients who are mechanically ventilated, based on a protocol targeting light sedation using dexmedetomidine as the primary sedative, termed "early goal-directed sedation", compared with usual practice...
December 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29200045/the-addition-of-dexmedetomidine-as-an-adjunctive-therapy-to-benzodiazepine-use-in-alcohol-withdrawal-syndrome-a-literature-review
#15
Tarenne A Ferenchak
Alcohol withdrawal syndrome (AWS) is commonly encountered in the intensive care unit population. Currently, the mainstay treatment for AWS is the use of benzodiazepines. However, some patients are refractory to benzodiazepine treatment due to heavy alcohol abuse. In addition, escalating doses of benzodiazepines can lead to respiratory depression, requiring intubation and mechanical ventilation. Intubation and mechanical ventilation increase both intensive care unit and hospital length of stay. The addition of pharmacological agents to reduce the amount of benzodiazepine use in AWS has recently been studied...
October 2017: Journal of Addictions Nursing
https://www.readbyqxmd.com/read/29193185/ketamine-infusion-for-adjunct-sedation-in-mechanically-ventilated-adults
#16
Lara M Groetzinger, Ryan M Rivosecchi, William Bain, Marshall Bahr, Katherine Chin, Ian Barbash, Bryan J McVerry
BACKGROUND: Many critically ill patients receive ketamine for adjunct sedation despite a paucity of evidence on its usage, dosing, and monitoring in this setting. OBJECTIVE: To describe the dosing and safety considerations of ketamine for adjunct sedation in a population of mechanically ventilated critically ill patients targeting light sedation. METHODS: We conducted a retrospective review of mechanically ventilated patients receiving continuous ketamine infusion between January 2012 and April 2016...
November 29, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29191721/changes-in-the-use-of-intensive-and-supportive-procedures-for-patients-with-stroke-in-taiwan-in-the-last-month-of-life-between-2000-and-2010
#17
Pei-Yi Wang, Yen-Ni Hung, Robert Smith, Chia-Chin Lin
CONTEXT: Stroke is the second leading cause of death and the primary cause of disability worldwide. It is uncertain what care patients with stroke receive in their end of life care and what trends in care are in recent years. OBJECTIVES: To investigate the changes in the use of intensive and supportive procedures received by Taiwanese stroke patients in their last month of life during 2000-2010. METHODS: Analysis of claims data of 55,930 patients with stroke obtained from the National Health Insurance Research Database were performed to investigate the changes in the use of intensive and supportive procedures for Taiwanese stroke patients in their last month of life during 2000-2010...
November 27, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29189706/unplanned-extubations-in-intensive-care-unit-evidences-for-risk-factors-a-literature-review
#18
Chiara Cosentino, Mattia Fama, Chiara Foà, Giorgia Bromuri, Serena Giannini, Marco Saraceno, Angela Spagnoletta, Mbemo Tenkue, Elena Trevisi, Leopoldo Sarli
BACKGROUND AND AIM: Unplanned extubations (UE) are getting more and more relevant in Critical Care, becoming a quality and care safeness outcome. This happens because after an UE the patient can face some complications concerning the airway management, respiratory and hemodynamic problems, lengthen in the hospital stay and in the mechanical ventilation time.  The aim of this review is identify and classify the factors that could increase UE risk. METHODOLOGY: A systematic review of scientific articles was performed consulting the databases PubMed, Cinahl, Medline, EBSCOhost and Google Scholar...
November 30, 2017: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29189639/effects-of-closed-endotracheal-suctioning-on-systemic-and-cerebral-oxygenation-and-hemodynamics-in-children
#19
Madhuradhar Chegondi, Teshaun Francis, Wei-Chiang Lin, Sayed Naqvi, Andre Raszynski, Balagangadhar R Totapally
OBJECTIVES: To evaluate the effects of closed endotracheal tube suctioning on systemic oxygen saturation, cerebral regional oxygen saturation, and somatic regional (renal) oxygen saturation and hemodynamic variables in children. DESIGN: Prospective observational. SETTING: A tertiary care PICU. SUBJECTS: Children aged 0-18 years, requiring invasive mechanical ventilation and with an arterial line. INTERVENTIONS: Closed endotracheal suction...
January 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29189346/impact-of-quality-bundle-enforcement-by-a-critical-care-pharmacist-on-patient-outcome-and-costs
#20
Géraldine Leguelinel-Blache, Tri-Long Nguyen, Benjamin Louart, Hélène Poujol, Jean-Philippe Lavigne, Jason A Roberts, Laurent Muller, Jean-Marie Kinowski, Claire Roger, Jean-Yves Lefrant
OBJECTIVES: Surgical and medical ICU patients are at high risk of mortality and provide a significant cost to the healthcare system. The aim of this study is to describe the effect of pharmacist-led interventions on drug therapy and clinical strategies on ICU patient outcome and hospital costs. DESIGN: Before and after study in two French ICUs (16 and 10 beds). PATIENTS: ICU patients. INTERVENTION: From January 1, 2013, to June 30, 2015, a pharmacist observation period was compared with an intervention period in which a critical care pharmacist provided recommendations to clinicians regarding sedative drugs and doses, choice of mechanical ventilation mode and related settings, antimicrobial de-escalation, and central venous and urinary catheters removal...
November 20, 2017: Critical Care Medicine
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