No abstract
to complete MRI, time to complete MRI, time to wake up, and time to discharge. Adverse events measured included bradycardia, incidence of apnea requiring BVM, and hypotension requiring IV bolus. Results: 208 charts (103 PROP, 105 DEX) were reviewed. Median age was 3.9 years. The majority of studies were brain MRI (78%). Forty five (42.9%) DEX patients required rescue boluses of PROP or midazolam to achieve a sedation score of zero. Only 9 (8.7%) PROP patients required rescue boluses of additional PROP (p<0.001). DEX patients had longer recovery times after sedation when compared to PROP patients (55 vs. 33 min, p<0.001). DEX patients took on average 20 minutes longer to be discharged after completion of MRI (p<0.001). 2 DEX patients were not able to complete MRI and required general anesthesia. All PROP patients completed MRI. There were no adverse events in either group. Conclusions: PROP provided superior sedation in regards to completion of MRI, shorter wake up times and time to discharge when compared to DEX. Introduction:To assess the value of adding a 131 bed 24/7 tele-ICU center to a bedside agitation program on ICU outcomes in a 22 bed academic MICU. Methods: System wide comprehensive revisions to pain, agitation and delirium (PAD) guidelines and order sets coupled with specific roles and responsibilities were developed and implemented. The tele-ICU identified ventilated pts receiving continuous infusion sedatives (SCI) with at least 3 consecutive RASS scores of 0 or lower, without a change in dose over the last 6 hours. On a regular basis, the bedside was contacted with the goal of decreasing the SCI by 10% every 6 hrs. The study consisted of 4 phases: Pre Program (1/11-8/11); Phase I -Program development, education and training (9/11-12/11); Phase II -ICU management only (1/12-10/12); Phase III -Tele-ICU and ICU collaboration (10/12-3/13). Data was collected to determine: demographics; ICU and hospital mortality; length of stay (LOS); ICU ventilator days; total PAD drug use (mg/pt). All data was APACHE IV adjusted and statistically analyzed via logistic regression or Cox proportional hazard models. Results: 2,249 pts were evaluated (Pre Phase:685; Phase I:318; Phase II:770; Phase III:476). Overall, 51.5% were male, mean (SD) age=62.0 (16.6) yrs; APACHE IV=82.0 (30.9). There were no statistical differences in: 1) demographics between phases; 2) any outcome from PRE to Phase I; 3) ICU mortality between phases. The only significant difference between PRE/Phase II was in ventilator days (4.9(5.0) vs 4.2(4.0) days, P< 0.01). Statistically significant findings occurred between Phase II/Phase III and PRE/Phase III (except as indicated) as follows (all results are PRE/Phase II/Phase III respectively): Hospital mortality-28.2%/23.6%/17.7% (P<0.001); ventilator days-4.3/3.5/3.2 (P<0.001 between PRE/Phase III only); ICU LOS-5.67/5.17/4.63 (P<0.05); Hospital LOS-15.7/15.9/14.0 (P<0.05 PRE/Phase III Only); Lorazepam use-7.2/0.1/0.0 (P=0.002 PRE/Phase II and PRE/Phase III Only); Propofol use-33.6/32.4/18.1 (P<0.001)....
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