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https://www.readbyqxmd.com/read/29153297/pain-management-practice-and-guidelines-in-jordanian-pediatric-intensive-care-units
#1
Ahmad Ismail, Paula Forgeron, Viola Polomeno, Huda Gharaibeh, Denise Harrison
Limited knowledge exists of current pain management practices and supporting guidelines in Jordanian pediatric intensive care units. To determine the current pain management practices and the availability and content of practice guidelines in Jordanian pediatric intensive care units, we conducted a cross-sectional and multisite survey of four pediatric intensive care units in Jordan. A questionnaire was developed and orally administered over the phone or in person to head nurses or their nominees to capture pain management practices and the existence and content of guidelines...
November 15, 2017: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29136716/-the-impact-of-goal-directed-analgesia-on-mechanical-ventilated-patients-s-outcomes-in-intensive-care-unit-a-clinical-observational-study
#2
Q D Li, X Y Wan, Y L Zhang, S W Li, L L Han, W W Li, H Y Shi
To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit.A total of 126 patients who needed mechanical ventilation were recruited.With a method of before and after paired comparison, they were divided into two group: (1) analgesia with empirical administration or control group; (2) goal directed analgesia based on critical-care pain observation tool (CPOT). Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from (368...
November 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29134245/esophageal-pressure-research-or-clinical-tool
#3
REVIEW
E Baedorf Kassis, S H Loring, D Talmor
Esophageal manometry has traditionally been utilized for respiratory physiology research, but clinicians have recently found numerous applications within the intensive care unit. Esophageal pressure (PEs) is a surrogate for pleural pressures (PPl), and the difference between airway pressure (PAO) and PEs provides a good estimate for the pressure across the lung also known as the transpulmonary pressure (PL). Differentiating the effects of mechanical ventilation and spontaneous breathing on the respiratory system, chest wall, and across the lung allows for improved personalization in clinical decision making...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29132458/-efficacy-of-analgesic-and-sedative-treatments-in-children-with-mechanical-ventilation-in-the-pediatric-intensive-care-unit
#4
Xiao-Fang Cai, Fu-Rong Zhang, Long Zhang, Ji-Min Sun, Wen-Bin Li
OBJECTIVE: To compare the efficacy and safety of different analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit (PICU). METHODS: Eighty children with mechanical ventilation in the PICU who needed analgesic and sedative treatments were equally and randomly divided into midazolam group and remifentanil+midazolam group. The sedative and analgesic effects were assessed using the Ramsay Scale and the Face, Legs, Activity, Cry and Consolability (FLACC) Scale...
November 2017: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/29132231/the-use-of-desflurane-for-neurosurgical-procedures-in-rhesus-macaque-macaca-mulatta
#5
Henri Gmj Bertrand, Charlotte Sandersen, Paul A Flecknell
Volatile agents are widely used to anaesthetise laboratory non-human primates as they allow a rapid induction and recovery as well as an easy adjustment of the anaesthesia plan. Desflurane is currently the volatile agent with the lowest solubility in blood, and hence enables the most rapid onset of anaesthesia and most rapid recovery. This study aimed to investigate the suitability of desflurane for maintenance of general anaesthesia in rhesus macaques undergoing elective experimental neurosurgery. Fourteen primates (five males and nine females) were sedated with ketamine (10 mg kg(-1)) and anaesthesia was induced with propofol (usually 8 mg kg(-1) IV)...
January 1, 2017: Laboratory Animals
https://www.readbyqxmd.com/read/29121287/analgesia-nociception-index-for-the-assessment-of-pain-in-critically-ill-patients-a-diagnostic-accuracy-study
#6
G Chanques, T Tarri, A Ride, A Prades, A De Jong, J Carr, N Molinari, S Jaber
Background: Behavioural pain tools are used in Intensive Care Unit (ICU) patients unable to self-report their pain-intensity but need sustained efforts to educate and train the ICU team because of the subjective nature of these clinical tools. This study measured the validity and performance of an electrophysiological monitoring tool based on the spectral analysis of heart rate variability, the Analgesia Nociception Index (ANI) which varies from 0 (minimal parasympathetic tone, maximal stress-response and pain) to 100 (maximal parasympathetic tone, minimal stress-response and pain)...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29118839/acute-angle-closure-glaucoma-a-potential-blind-spot-in-critical-care
#7
Anna Petsas, George Chapman, Richard Stewart
We report a case of a 69-year-old gentleman who developed an acutely painful eye with loss of visual acuity whilst on the critical care unit. He was admitted three days previously with an infective exacerbation of chronic obstructive pulmonary disease requiring invasive mechanical ventilation. In addition, he received intravenous antibiotics, steroids, nebulised bronchodilators and intravenous aminophylline, together with noradrenaline for blood pressure support. On development of visual symptoms, an emergency ophthalmology review diagnosed acute angle closure glaucoma...
August 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/29117063/effect-of-dexmedetomidine-on-lactate-clearance-in-patients-with-septic-shock-a-sub-analysis-of-a-multicenter-randomized-controlled-trial
#8
Kyohei Miyamoto, Tsuyoshi Nakashima, Nozomu Shima, Seiya Kato, Kentaro Ueda, Yu Kawazoe, Yoshinori Ohta, Takeshi Morimoto, Hitoshi Yamamura
Lactate clearance is useful to guide initial resuscitation of patients with septic shock. We conducted this study to evaluate whether dexmedetomidine increases lactate clearance in patients with septic shock. This was a randomized controlled trial that involved a post hoc subgroup analysis. Adult patients with septic shock under ventilation were randomized to receive sedation strategy with or without dexmedetomidine (60 in the dexmedetomidine and 51 in the non-dexmedetomidine groups). The primary outcome was the lactate clearance at 6 h, defined as the percent decrease in lactate from randomization to 6 h after...
November 7, 2017: Shock
https://www.readbyqxmd.com/read/29112023/behavior-of-anesthesiology-residents-in-a-situation-of-intravenous-route-occlusion-during-syringe-pump-use-in-a-simulated-intensive-care-unit
#9
Takayuki Kariya, Tetsuya Miyashita, Hitoshi Sato, Hiromasa Kawakami, Takahisa Goto
INTRODUCTION: Unintentional catecholamine flush caused by inappropriate release of an intravenous occlusion during use of a syringe pump in the intensive care unit (ICU) can have dangerous consequences in patients receiving critical care. We investigated whether anesthesiology residents understood how to deal with syringe pump occlusion in a simulated ICU setting. METHODS: We set up a mannequin that virtually simulated a sedated patient under mechanical ventilation after cardiac surgery, with epinephrine and dopamine being infused by syringe pumps to maintain blood pressure at 100/50 mm Hg...
November 4, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/29109631/comparative-evaluation-of-midazolam-dexmedetomidine-and-propofol-as-intensive-care-unit-sedatives-in-postoperative-electively-ventilated-eclamptic-patients
#10
Malik Rameez Rashid, Rukhsana Najeeb, Saima Mushtaq, Rizwana Habib
Background and Aims: Eclampsia is a common hypertensive disorder of pregnancy and treatment often includes termination of pregnancy with elective postoperative mechanical ventilation. The present study was aimed to compare midazolam, propofol, and dexmedetomidine for sedation and antihypertensive requirements of such patients admitted to Intensive Care Unit (ICU) after termination of pregnancy. Material and Methods: A total of ninety eclamptic patients administered general anesthesia for the termination of pregnancy through cesarean section and who also required postoperative ventilation were taken up for the study and were randomly allocated into three groups...
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29081581/xylazine-infusion-in-isoflurane-anesthetized-and-ventilated-healthy-horses-effects-on-cardiovascular-parameters-and-intestinal-perfusion
#11
Klaus Hopster, Liza Wittenberg-Voges, Sabine B R Kästner
To investigate the effects of a xylazine infusion during isoflurane anesthesia on global perfusion parameters and gastrointestinal oxygenation and microperfusion, 8 adult warmblood horses were sedated with xylazine and anesthesia induced with midazolam and ketamine. Horses were mechanically ventilated during anesthesia. After 3 h of stable isoflurane anesthesia (FEIso 1.3 Vol %), a xylazine infusion with 1 mg/kg body weight (BW) per hour was started for 1 h and then stopped. Before, during, and after xylazine infusion, heart rate (HR), arterial blood pressure (MAP), cardiac output (CO), central venous pressure (CVP), and pulmonary artery pressure (PAP) were measured and systemic vascular resistance (SVR) was calculated...
October 2017: Canadian Journal of Veterinary Research, Revue Canadienne de Recherche Vétérinaire
https://www.readbyqxmd.com/read/29064259/the-cardiovascular-implications-of-sedatives-in-the-cardiac-intensive-care-unit
#12
Sammy Zakaria, Helaine J Kwong, Jonathan E Sevransky, Marlene S Williams, Nisha Chandra-Strobos
Patients admitted to the cardiac intensive care unit frequently develop multi-organ system dysfunction associated with their cardiac disease. In many cases, invasive mechanical ventilation is required, which often necessitates sedation for patient-ventilator synchrony, reduction of work of breathing, and patient comfort. In this paper, we describe the use of common sedatives available in the endotracheally intubated critically ill patient and emphasize the clinical and cardiovascular effects. We review γ-aminobutyric acid agonists such as etomidate, benzodiazepines, and propofol, the centrally acting α2-agonist dexmedetomidine, and the N-methyl-D-aspartate receptor antagonist ketamine...
February 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29058092/anthrax-immune-globulin-improves-hemodynamics-and-survival-during-b-anthracis-toxin-induced-shock-in-canines-receiving-titrated-fluid-and-vasopressor-support
#13
Dante A Suffredini, Xizhong Cui, Dharmvir Jaswal, Kenneth E Remy, Yan Li, Junfeng Sun, Steven B Solomon, Yvonne Fitz, Mahtab Moayeri, Stephen Leppla, Peter Q Eichacker
BACKGROUND: Although anthrax immune globulin (AIG) improved survival in antibiotic-treated Bacillus anthracis-challenged animal models, whether it adds to the benefit of conventional hemodynamic support for B. anthracis toxin-associated shock is unknown. METHODS: We therefore tested AIG in sedated, mechanically ventilated canines challenged with 24-h B. anthracis lethal and edema toxin infusions and supported for 96 h with a previously demonstrated protective regimen of titrated normal saline and norepinephrine...
October 23, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29044304/delirium-in-a-latin-american-intensive-care-unit-a-prospective-cohort-study-of-mechanically-ventilated-patients
#14
Patricia Mesa, Ignacio José Previgliano, Sonia Altez, Silvina Favretto, María Orellano, Cinthya Lecor, Ana Soca, Ely Wesley
OBJECTIVE: To establish the prevalence of delirium in a general intensive care unit and to identify associated factors, clinical expression and the influence on outcomes. METHODS: This was a prospective cohort study in a medical surgical intensive care unit. The Richmond Agitation-Sedation Scale and Confusion Assessment Method for the Intensive Care Unit were used daily to identify delirium in mechanically ventilated patients. RESULTS: In this series, delirium prevalence was 80% (N = 184 delirious patients out of 230 patients)...
July 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29042870/update-of-minimally-invasive-surfactant-therapy
#15
REVIEW
Gyu-Hong Shim
To date, preterm infants with respiratory distress syndrome (RDS) after birth have been managed with a combination of endotracheal intubation, surfactant instillation, and mechanical ventilation. It is now recognized that noninvasive ventilation (NIV) such as nasal continuous positive airway pressure (CPAP) in preterm infants is a reasonable alternative to elective intubation after birth. Recently, a meta-analysis of large controlled trials comparing conventional methods and nasal CPAP suggested that CPAP decreased the risk of the combined outcome of bronchopulmonary dysplasia or death...
September 2017: Korean Journal of Pediatrics
https://www.readbyqxmd.com/read/29042486/parameters-for-simulation-of-adult-patients-during-mechanical-ventilation
#16
Jean-Michel Arnal, Aude Garnero, Mathieu Saoli, Robert L Chatburn
BACKGROUND: Simulation studies are often used to examine ventilator performance. However, there are no standards for selecting simulation parameters. This study collected data in passively-ventilated adult human subjects and summarized the results as a set of parameters that can be used for simulation studies of intubated, passive, adult subjects with normal lungs, COPD, or ARDS. METHODS: Consecutive adult patients admitted to the ICU were included if they were deeply sedated and mechanically ventilated for <48 h without any spontaneous breathing activity...
October 17, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29038671/inspiratory-muscle-training-in-the-intensive-care-unit-a-new-perspective
#17
Rodrigo Marques Tonella, Ligia Dos Santos Roceto Ratti, Lilian Elisabete Bernardes Delazari, Carlos Fontes Junior, Paula Lima Da Silva, Aline Ribeiro Da Silva Herran, Daniela Cristina Dos Santos Faez, Ivete Alonso Bredda Saad, Luciana Castilho De Figueiredo, Rui Moreno, Desanka Dragosvac, Antonio Luis Eiras Falcao
BACKGROUND: Prolonged use of mechanical ventilation (MV) leads to weakening of the respiratory muscles, especially in patients subjected to sedation, but this effect seems to be preventable or more quickly reversible using respiratory muscle training. The aims of the study were to assess variations in respiratory and hemodinamic parameters with electronic inspiratory muscle training (EIMT) in tracheostomized patients requiring MV and to compare these variations with those in a group of patients subjected to an intermittent nebulization program (INP)...
November 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29037800/clinical-comparison-of-dexmedetomidine-and-medetomidine-for-isoflurane-balanced-anaesthesia-in-horses
#18
Muriel Sacks, Simone K Ringer, Andrea S Bischofberger, Sabrina M Berchtold, Regula Bettschart-Wolfensberger
OBJECTIVE: To compare the effects of two balanced anaesthetic protocols (isoflurane-dexmedetomidine versus medetomidine) on sedation, cardiopulmonary function and recovery in horses. STUDY DESIGN: Prospective, blinded, randomized clinical study. ANIMALS: Sixty healthy adult warm blood horses undergoing elective surgery. METHODS: Thirty horses each were sedated with dexmedetomidine 3.5 μg kg(-1) (group DEX) or medetomidine 7 μg kg(-1) (group MED) intravenously...
April 26, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29033344/a-prospective-study-of-ketamine-as-primary-therapy-for-prehospital-profound-agitation
#19
Jon B Cole, Lauren R Klein, Paul C Nystrom, Johanna C Moore, Brian E Driver, Brandon J Fryza, Justin Harrington, Jeffrey D Ho
OBJECTIVE: We investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation. METHODS: This was a prospective observational study of patients receiving 5mg/kg of intramuscular ketamine for profound agitation, defined as a score of +4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from -4 (unresponsive) to +4 (most agitated). The primary outcome was time to adequate sedation (AMSS<+1). Secondary outcomes included need for additional sedatives, intubation frequency, complications associated with ketamine, and mortality...
October 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29030928/pharmacokinetics-of-s-ketamine-during-prolonged-sedation-at-the-pediatric-intensive-care-unit
#20
Robert B Flint, Carole N M Brouwer, Anne S C Kränzlin, Loraine Lie-A-Huen, Albert P Bos, Ron A A Mathôt
BACKGROUND: S-ketamine is the S(+)-enantiomer of the racemic mixture ketamine, an anesthetic drug providing both sedation and analgesia. In clinical practice, significant interpatient variability in drug effect of S-ketamine is observed during long-term sedation. AIMS: The aim of this study was to evaluate the pharmacokinetic variability of S-ketamine in children aged 0-18 years during long-term sedation. Twenty-five children (median age: 0.42 years, range: 0...
November 2017: Paediatric Anaesthesia
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