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By Arthur Zacharjasz DePaul University SON 2015 MSN candidate
Germano De Cosmo, Elisabetta Congedo, Antonio Clemente, Paola Aceto
In critically ill patients, adequate sedation increases comfort, minimizes stress response and facilitates diagnostic and therapeutic procedures. Propofol (2-, 6-diisopropylphenol) is an intravenous sedative-hypnotic agent popular for sedation in the Intensive Care Unit. The favorable propofol pharmacokinetic, characterized by a three compartment linear model, allows rapid onset and short duration of action. The emergence time from sedation with propofol varies with the depth and the duration of sedation and the patient's bodyweight...
November 2005: Current Drug Targets
Lisa J Rosenthal, Victor Kim, Deborah R Kim
OBJECTIVE: To report the use of a second-generation antipsychotic agent to assist weaning from prolonged mechanical ventilation in an anxious patient. DESIGN: Case report. SETTING: Medical intensive care unit at the Hospital of the University of Pennsylvania. PATIENT: A 39-yr-old white female whose severe anxiety prohibited weaning from prolonged mechanical ventilation. INTERVENTIONS: Initiation of quetiapine as treatment for severe anxiety that was unresponsive to sedative hypnotics...
October 2007: Critical Care Medicine
Timothy D Girard, John P Kress, Barry D Fuchs, Jason W W Thomason, William D Schweickert, Brenda T Pun, Darren B Taichman, Jan G Dunn, Anne S Pohlman, Paul A Kinniry, James C Jackson, Angelo E Canonico, Richard W Light, Ayumi K Shintani, Jennifer L Thompson, Sharon M Gordon, Jesse B Hall, Robert S Dittus, Gordon R Bernard, E Wesley Ely
BACKGROUND: Approaches to removal of sedation and mechanical ventilation for critically ill patients vary widely. Our aim was to assess a protocol that paired spontaneous awakening trials (SATs)-ie, daily interruption of sedatives-with spontaneous breathing trials (SBTs). METHODS: In four tertiary-care hospitals, we randomly assigned 336 mechanically ventilated patients in intensive care to management with a daily SAT followed by an SBT (intervention group; n=168) or with sedation per usual care plus a daily SBT (control group; n=168)...
January 12, 2008: Lancet
Maged Tanios, Scott Epstein, Mark Grzeskowiak, Huan Mark Nguyen, Hyunsoon Park, James Leo
BACKGROUND: Identifying risk factors for unplanned extubation in patients receiving mechanical ventilation can help guide prevention strategies. OBJECTIVE: To assess the risk of unplanned extubation with different sedation strategies. METHODS: A 36-month quality improvement study in a 33-bed intensive care unit at a tertiary-care center. RESULTS: A total of 92 unplanned extubations occurred (7.5 events/1000 days of mechanical ventilation): patients who were receiving continuous sedation protocol with daily interruption of sedatives had 1...
July 2014: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Alejandro C Arroliga, B Taylor Thompson, Marek Ancukiewicz, Jeffrey P Gonzales, Kalpalatha K Guntupalli, Pauline K Park, Herbert P Wiedemann, Antonio Anzueto
OBJECTIVE: The use of sedatives, opioids, and neuromuscular blocking agents (NMBAs) may delay weaning and prolong intensive care unit length of stay. We hypothesized that in patients on higher positive end-expiratory pressure (PEEP), sedatives, opioids, and NMBAs are used in a higher proportion of patients and in higher doses and that the use of these medications is associated with prolongation of weaning and mortality. DESIGN: Retrospective analysis. SETTING: The ALVEOLI trial...
April 2008: Critical Care Medicine
Stephan M Jakob, Esko Ruokonen, R Michael Grounds, Toni Sarapohja, Chris Garratt, Stuart J Pocock, J Raymond Bratty, Jukka Takala
CONTEXT: Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an α(2)-agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort. OBJECTIVE: To determine the efficacy of dexmedetomidine vs midazolam or propofol (preferred usual care) in maintaining sedation; reducing duration of mechanical ventilation; and improving patients' interaction with nursing care...
March 21, 2012: JAMA: the Journal of the American Medical Association
Thomas Strøm, Torben Martinussen, Palle Toft
BACKGROUND: Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect, and in the general intesive care unit of Odense University Hospital, Denmark, standard practice is a protocol of no sedation. We aimed to establish whether duration of mechanical ventilation could be reduced with a protocol of no sedation versus daily interruption of sedation. METHODS: Of 428 patients assessed for eligibility, we enrolled 140 critically ill adult patients who were undergoing mechanical ventilation and were expected to need ventilation for more than 24 h...
February 6, 2010: Lancet
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