Tag: sedation

Upvote Story 8
Music intervention has been shown to reduce anxiety and sedative exposure among mechanically ventilated patients. The aim of this study was to examine ICU costs for patients receiving a patient-directed music intervention compared with patients who received usual ICU care. The base case cost-effectiveness analysis estimated patient-directed music intervention reduced anxiety by 19 points on the Visual Analogue Scale-Anxiety with a reduction in cost of... Read More | Comment
Upvote Story 6
This trial provides evidence that a strategy of avoiding continuous sedation as early as possible, in the absence of residual neuromuscular blockade and hypothermia, compared with usual sedation care, resulted in improvements in several important clinical outcomes in critically ill postoperative patients. Given the clinical and economic burden of critical illness, postoperative morbidity, and the substantial number of patients who could benefit from this strategy,... Read More | Comment
Upvote Story 4
As little as 30 minutes of exposure to anesthetic and sedative agents may adversely affect the developing brain. Safe, humane management of critically ill infants requires the use of sedative agents, often for prolonged periods. Infants with respiratory diagnoses having non-invasive ventilation without sedation (Group C) or intubation and ventilation with sedation (Group S) were identified by chart review. It is not possible to randomise... Read More | Comment
Upvote Story 6
Propofol, dexmedetomidine, and opioids are commonly used for patients requiring continuous sedation or analgesia, such as for those receiving mechanical ventilation. Although these medications are generally safe, some may be unable to tolerate them due to hemodynamic status. Ketamine is a rapid acting, dissociative anesthetic used frequently in the emergency department for sedation and, more recently, pain relief. Ketamine use during procedural sedation in the... Read More | Comment
Upvote Story 7
This book brings together an international group of clinicians and researchers from a broad swath of inter-related disciplines to offer the most up-to-date information about clinical and preclinical research into ketamine and second-generation “ketamine-like” fast-acting antidepressants. Currently available antidepressant medications act through monoaminergic systems, are ineffective for many individuals suffering from depression, and are associated with a delayed onset of peak efficacy of several months.... Read More | Comment
Upvote Story 7
The results highlight the heterogeneity in sedation practices among intensivists who care for critically ill children as well as a paucity of sleep promotion and delirium screening in PICUs worldwide. The survey was completed by 341 respondents, the majority of whom were from North America (70%). Twenty-seven percent of respondents reported having written sedation protocols. Most respondents worked in PICUs with sedation scoring systems (70%),... Read More | Comment
Upvote Story 8
We developed a computerized algorithm that accurately detects three types of ventilator dyssynchrony. Double-triggered and flow-limited breaths are associated with the frequent delivery of tidal volumes of greater than 10 mL/kg. Although ventilator dyssynchrony is reduced by deep sedation, potentially deleterious tidal volumes may still be delivered. However, neuromuscular blockade effectively eliminates ventilator dyssynchrony. A total of 4.26 million breaths were recorded from 62 ventilated patients.... Read More | Comment
Upvote Story 6
Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness. Before jumping into the results of this study, it will help to establish a couple of foundational principles. Overall, antipsychotics don’t reverse the underlying pathophysiologic causes of delirium. However, antipsychotics can be useful to alleviate symptoms of agitation and insomnia, allowing the patient to be managed safely while delirium... Read More | Comment
Upvote Story 3
Consider sitting deep within the hull of this cruise ship, ignorant to the outside. A leak is sprung and ocean begins to rush in. Thinking quickly you activate the bilge pump which, appropriately, ejects the ocean outside again. You note that the bilge pump has a number of settings from "low" to "high" corresponding to the rate at which it evacuates ocean from inside the... Read More | Comment
Upvote Story 9
The majority of respondents reported targeting moderate to deep sedation following cannulation, with the use of sedative and opioid infusions. There is considerable variability surrounding early physical therapy and mobilization goals for patients with acute respiratory failure (ARF) supported by venovenous extracorporeal membrane oxygenation. We analyzed responses from 209 respondents (53%), mostly from academic centers (63%); 41% respondents provide venovenous extracorporeal membrane oxygenation to adults... Read More | Comment
Upvote Story 6
Dexmedetomidine is associated with less delirium than benzodiazepines, and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring sedation remains unclear. Nocturnal administration of low-dose dexmedetomidine in critically ill adults reduces the incidence of delirium during the ICU stay; patient-reported sleep quality appears unchanged. Nocturnal dexmedetomidine was associated with a greater proportion of... Read More | Comment
Upvote Story 4
Mobilization of critically ill children, many with central lines, endotracheal tubes, and other life-saving devices, is associated with potential risks and complications. Hence, concerns about safety often guide staff perceptions about PICU mobility. These complications may include, but are not limited to, hemodynamic instability, accidental tube or line dislodgement, falls, pain, and anxiety. However, multiple studies have reported that early mobilization of critically ill children... Read More | Comment
Upvote Story 5
The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium. Written informed consent was obtained from 1183 patients or their authorized representatives. Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the... Read More | Comment
Upvote Story 11
This book covers all clinical aspects of acute respiratory distress syndrome (ARDS), from definition to treatment, focusing on the more recent recommendations and evidence-based medicine. The addressed topics are the various ventilation strategies, the impact of prone positioning, the use of partial and total extracorporeal support, the value of vasodilators, the weaning from mechanical ventilation, the pharmacological interventions, noninvasive ventilation, and the strategies using anti-inflammatory... Read More | Comment