Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency

Xing, Xue-zhong; Gao, Yong; Wang, Haijun; Qu, Shi-ning; Zhang, Hao; Wang, Hao; Xiao, Qing-ling; Sun, Kelin

doi:10.5847/wjem.j.1920-8642.2015.02.011

Cited by 14 publications

(11 citation statements)

References 20 publications

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“…While Kress et al's [11] study found no relationship between DSI and PTSD there was no incidence of PTSD, some studies [12,13] with a focus on shorter and long term outcomes such as delirium and PTSD have similarly found no relationship between these conditions and DSI up to 12 months and other studies [4,9] have found differing results. However, all these studies only provide anecdotal evidence.…”

Section: Introductionmentioning

confidence: 63%

The experience of cognitive impairment in critically ill patients in and beyond intensive care: findings from a larger phenomenological study

Tembo¹

2015

J Nurs

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Background: Although Daily Sedation Interruption (DSI) is associated with better physical outcomes, many intensive care (ICU) survivors continue to suffer from cognitive impairment in and beyond ICU; neither has the meaning patients attach to the experience of cognitive impairment been extensively explored in the context of DSI. Objective: To gain an understanding of and uncover the experience of critical illness in ICU and beyond in the context of DSI. To establish whether or not DSI improves the experience of critical illness in ICU and beyond. Design: A hermeneutic phenomenological study using purposive sampling. Setting: Single centre 16 bed ICU in a 500 bed regional tertiary referral Hospital in Australia. Participants: Fifteen potential participants were approached. Two refused to participate, one died a week before the first interview, and 12 were enrolled into the study. Two participants withdrew from the study after the first interview, one was lost to follow-up and one was hospitalised. Inclusion criteria was patients aged 18 years and above who were mechanically ventilated and underwent DSI for at least 24 hours and were all able to speak English and give informed consent to participate in the study. Patients were excluded from the study if they had a poor prognosis, were less than 18 years old, unable to speak English, not ventilated and sedated for at least 24 hours. Methods: Participants were interviewed using open ended questions at two weeks after discharge from ICU and at six to eleven months following the initial interview. Interviews were tape recorded, transcribed and thematically analysed by highlighting themes using a phenomenological approach. Results: All the participants suffered some form of cognitive impairment resulting in the overarching theme of 'Being in Limbo' with three major themes of 'Being Disrupted', Being Imprisoned' and 'Being trapped'. The major themes 'Being Disrupted and 'Being Trapped' highlighted the prevalence of cognitive impairment. Conclusion: Although DSI is associated with better physical ICU outcomes, it does not improve the experience of critical illness and it does not decrease the incidence of cognitive impairment in and beyond ICU. What is already known about the topic. Daily sedation interruption is associated with improved physical outcomes. Critical illness is associated with cognitive impairment. What this paper adds This research shows that despite DSI the experience of critical illness in ICU and beyond is that of being in limbo during and after critical illness. DSI does not decrease the incidence of cognitive impairment in ICU survivors.

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Section: Introductionmentioning

confidence: 63%

The experience of cognitive impairment in critically ill patients in and beyond intensive care: findings from a larger phenomenological study

Tembo¹

2015

J Nurs

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“…Careful respiratory monitoring and administrating enough sedatives are recommended to prevent early unplanned SE in an inapposite time. all previous studies on this subject have been performed in general ICUs while our patients are OP-poisoned with severe respiratory effects [4].…”

Section: Resultsmentioning

confidence: 99%

“…Although Bambi, et al [7] believed that SE could be prevented with non-benzodiazepines drugs, use of BZDs is strongly recommended for OP poisoning [4,20]. Use of physical restrains without prescription of sedative drugs has not been recommended since it can be a risk factor for SE [7].…”

Section: Sedative Physical Restraint and Agitationmentioning

confidence: 99%

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Outcome of Self- and Planned Extubation in Organophosphate-Poisoned Patients

Aghabiklooei¹,

Mehrpour²,

Hossein³

et al. 2018

Int J Anesthetic Anesthesiol

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Background: Respiratory failure is the most common cause of morbidity and mortality in organophosphate (OP)-intoxicated patients. We aimed to assess and compare the need for re-intubation and outcome between patients with self-extubation (SE) and planned extubation (PE). Methods: All OP-poisoned endotracheally intubated patients admitted to poisoning ICU were included. The frequency and time of SE, need for re-intubation, and its impact on hospital stay and outcome were assessed. Results: In fifteen patients (48.4%) SE was reported. Need for re-intubation in these patients was more than those who underwent PE (60.0% vs. 37.5%; P = 0.2). Early unplanned SE significantly correlated with occurrence of pulmonary complications (P = 0.04). The rate of aspiration pneumonia was high (80%) in SE cases. Hospital stay was also significantly prolonged in these patients (14.6 vs. 5.4 days, P = 0.04). Conclusion: Planning for on-time weaning/extubation in OP-poisoned patients can prevent unplanned SE and decrease the occurrence of lung complications.

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“…Particularly in obese patients, whose pulmonary compliance is already reduced, we recognize a favorable outcome in awake or mildly sedated patients in our clinical practice. Data from large multi-centered cohorts is still needed, but several studies acquired from single centered patient groups (n ¼ 140 patients; n ¼ 91 patients) indicate that a reduction or cessation of sedation in critically ill patients irrespective of body weight is associated with a shorter duration of mechanical ventilation, a shorter stay in the ICU and in hospital generally as well as a decreased in-hospital mortality [26,27]. In order to implement a protocol of no sedation in clinical practice, early tracheotomy may reduce stress and agitation in critically ill patients receiving mechanical ventilation.…”

Section: Sedative Drugs Muscle Relaxants and Early Tracheotomymentioning

confidence: 99%

Management of obese patients with respiratory failure – A practical approach to a health care issue of increasing significance

Fischer

Kaese

Lebiedz

2016

Respiratory Medicine

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In the general population, prevalence of obesity is increasing continuously. Concomitantly, a growing number of obese patients with severe illnesses presents at intensive care units (ICU). Particularly respiratory management of this patient group poses a challenge to intensive care physicians because of differences in respiratory anatomy and physiology in obese compared to non-obese individuals. Aim of this review is to present treatment options for critically ill obese patients requiring mechanical ventilation based on current studies concerning patient positioning, ventilatory regimen as well as extended therapy with veno-venous extracorporeal membrane oxygenation (ECMO). The ideal concept for respiratory management depends on multiple aspects and has to be determined individually. Knowledge of altered respiratory anatomy and physiology in obese patients and possible treatment options may facilitate respiratory management in this patient group.

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Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency

Cited by 14 publications

References 20 publications

The experience of cognitive impairment in critically ill patients in and beyond intensive care: findings from a larger phenomenological study

The experience of cognitive impairment in critically ill patients in and beyond intensive care: findings from a larger phenomenological study

Outcome of Self- and Planned Extubation in Organophosphate-Poisoned Patients

Management of obese patients with respiratory failure – A practical approach to a health care issue of increasing significance

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