Tag: sedation

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
Upvote Story 6
Dexmedetomidine provides sedation for patients undergoing ventilation; however, its effects on mortality and ventilator-free days have not been well studied among patients with sepsis. This randomized clinical trial compares the effects of sedation with vs without dexmedetomidine on mortality and ventilator-free days in patients with sepsis. Among patients requiring mechanical ventilation, the use of dexmedetomidine compared with no dexmedetomidine did not result in statistically significant... Read More | Comment
Upvote Story 5
This is a retrospective cohort study describing 86 admissions to the ICU for alcohol withdrawal between 2011-2015. 86% were treated with benzodiazepines before ICU admission, usually on the general ward. The average dose of benzodiazepine before ICU admission was equivalent to 23 mg of lorazepam. Following ICU admission, all benzodiazepines were discontinued and patients were treated solely with IV phenobarbital. Doses of 130 mg IV... Read More | Comment
Upvote Story 6
Among ICU patients receiving acute ventilatory support for respiratory failure, patient-directed music (PDM) resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH. The mean age was 59 years with... Read More | Comment
Upvote Story 15
Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect, and in the general ICU 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. Of 428 patients assessed... Read More | Comment
Upvote Story 4
Do you spend time finding out what the “why” is for your patient? Have you considered it’s not what is the matter with the patient but what matters to the patient? What the patient thinks their purpose is? Or at the very least, what they wish for during the next part of life, however short that may be? In this episode American intensivist, Dr Wes... Read More | Comment
Upvote Story 13
Synchrony between the patient and the ventilator is defined as the appropriate interaction between the two, where the ventilator recognizes patient’s effort and provides support for breathing at the right time—that is, inspiratory and expiratory times matches with patients’ times (patient’s neural time equals to ventilator times). In our humble opinion, the mismatch between the patient and the ventilator occurs because we set the ventilator... Read More | Comment
Upvote Story 9
This updated and revised edition of the classic bedside pocket reference remains the gold standard in critical care medicine. The new edition maintains Dr. Marik’s trademark humor and engaging writing style, while adding numerous references to make this book the most current and thorough treatment of evidence-based critical care available. The handbook enables the clinician to find the evidence to support or refute an intervention... Read More | Comment