Sedation and Analgesia in the Mechanically Ventilated Patient

Patel, Shruti; Kress, John P.

doi:10.1164/rccm.201102-0273ci

Cited by 162 publications

(127 citation statements)

References 156 publications

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“…Positive endexpiratory pressure (PEEP) was adjusted by FiO 2 to meet the PaO 2 ≥55 mmHg or oxygen saturation of pulse oximetry (SpO 2 ) ≥88% (3,20). On the basis of analgesia by fentanyl, we sedated the patients with midazolam and/or propofol to meet the goal of Richmond Agitation-Sedation Scale between −2 and −4 (21). Additional treatment strategies such as organ function support, circulation stabilization, nutrition and internal environment maintenance were implemented in accordance with corresponding guidelines.…”

Section: Treatment Strategiesmentioning

confidence: 99%

Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

Luo

et al. 2017

J. Thorac. Dis.

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Background: Severe pneumonia is the predominant cause for acute respiratory distress syndrome (ARDS).Identification of ARDS from patients with severe pneumonia remains a significant clinical problem due to the overlap of clinical presentations and symptoms. Early recognition of risks for ARDS from severe pneumonia is of great clinical value.Methods: From April 2014 to December 2015, patients with severe pneumonia at admission were retrieved from the hospital database, of which ARDS developed within 7 days were further identified. We compared the demographic and clinical characteristics at admission between severe pneumonia patients with and without ARDS development, followed by analysis of potential predictors for ARDS development and mortality. Multivariate logistic regression and receiver operating characteristic (ROC) curves were performed to screen independent risk factors and identify their sensitivity in predicting ARDS development and prognosis.Results: Compared with severe pneumonia without ARDS development, patients with ARDS development had shorter disease duration before admission, higher lung injury score (LIS), serum fibrinogen (FiB), and positive end-expiratory pressure (PEEP), lower Marshall score, sequential organ failure assessment score and proportion of cardiovascular and gastrointestinal diseases, but similar mortality. Serum FiB >5.15 g/L [adjusted odds ratio (OR) 1.893, 95% confidence interval (CI): 1.141-3.142, P=0.014] and PEEP >6.5 cmH 2 O (adjusted OR 1.651, 95% CI: 1.218-2.237, P=0.001) were independent predictors for ARDS development with a sensitivity of 58.3% and 87.5%, respectively, and pH <7.35 (adjusted OR 0.832, 95% CI: 0.702-0.985, P=0.033) was an independent risk factor for ARDS mortality with a sensitivity of 95.2%.Conclusions: ARDS development risk could be early recognized by PEEP >6.5 cmH 2 O and serum FiB >5.15 g/L in severe pneumonia patients, and pH <7.35 is a reliable prognostic factor in predicting ARDS mortality risk.

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Section: Treatment Strategiesmentioning

confidence: 99%

Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

Luo

et al. 2017

J. Thorac. Dis.

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“…[20][21][22] because of these considerations, evaluating communication between ICU nurses and on-call ICU physicians at night about patients' pain, agitation, and delirium provides a good focus for estimating the overall quality of ICU nurse-physician communication at night.…”

Section: Pharmacology In Critical Carementioning

confidence: 99%

Perceptions of Nurses and Physicians of Their Communication at Night About Intensive Care Patients' Pain, Agitation, and Delirium

Al-Qadheeb¹,

Hoffmeister²,

Roberts³

et al. 2013

American Journal of Critical Care

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Background Ineffective daytime nurse-physician communication in intensive care adversely affects patients' outcomes. Nurses' and physicians' communications and perceptions of this communication at night are unknown. Objectives To determine perceptions of nurses and physicians of their communication with each other at night in the intensive care unit about patients' pain, agitation, and delirium and to develop a qualitative survey instrument to investigate this topic. Methods A validated survey was distributed to nighttime nurses and physicians in 2 medical intensive care units. Results Most nurses (30/45; 67%) and physicians (56/75; 75%) responded. Nurses (35%) and physicians (31%) thought that a similar proportion of communications was related to pain, agitation, and delirium. Most nurses (70%) and physicians (80%) agreed that nurses used good judgment when paging physicians at night because of patients' pain, agitation, and delirium, but physicians (72%) were more likely than nurses (48%) to think that these pages did not portray the situation accurately (P = .004). For many text pages, physicians attributed a heightened level of urgency more often than did the nurses who sent the texts. Nurses often thought that physicians did not appreciate the urgency (33%) or complexity (33%) of the situations the nurses communicated via pages. More physicians (41%) than nurses (14%) agreed that nurses exceeded medication orders for pain, agitation, and delirium before contacting a physician (P = .008). Conclusions Perceptual differences between physicians and nurses about nurse-physician communications at night regarding pain, agitation, and delirium were numerous and should be studied further. (American Journal of Critical Care. 2013;22:e49-e61) Pharmacology in Critical Careby AACN on May 9, 2018 http://ajcc.aacnjournals.org/ Downloaded from because of the fluctuation in pain, agitation, and delirium in critically ill patients, the increased focus on maintaining patients in a light (rather than deep) level of sedation and current recommendations that pain, level of sedation, and delirium be evaluated on a 24/7 basis, the number of issues related to pain, agitation, and delirium that ICU nurses working at night may have to address with the on-call physician most likely has never been greater. [20][21][22] because of these considerations, evaluating communication between ICU nurses and on-call ICU physicians at night about patients' pain, agitation, and delirium provides a good focus for estimating the overall quality of ICU nurse-physician communication at night.Although qualitative research methods are ideal for characterizing the rich, contextual, and likely complex themes that affect communication between nurses and physicians at night, because of the current lack of data on nurse-physician communications at night, we thought that the first step should be a quantitative survey that could serve as the foundation for future qualitative and interventional investigations. [23][24][25] We therefore sought to determine ...

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“…Numerous studies have demonstrated that propofol, an intravenous anaesthetic widely used for general anaesthesia in ECT probably reduces adverse effects of ECT on memory and cognitive function 67and 68 .Propofol is an intravenous anaesthetic that is metabolized quickly hence leading to early awakening. It's a short-acting lipophilic drug that quickly crosses the blood-brain barrier with an onset of action ranging from seconds to minutes 69 . Butterfield et al also reported greater reduction in post ECT cognitive impairment with propofol compared with thiopental when assessing cognitive states 5 minutes after each ECT by applying various neuropsychological tests, including immediate and delay verbal memory 67 , confirming that propofolanaesthesia is less damaging to cognitive function when compared to older anesthetic agents such as thiopental.…”

Section: Prevention Of Neurocognitive Side-effect Of Electroconvumentioning

confidence: 99%

Neurocognitive Effects of Electroconvulsive Therapy in Psychiatric Disorders, Mechanism of Action And its Prevention: Review Article

Kara¹,

Bakari²,

Mayala³

et al. 2017

IOSR JDMS

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Sedation and Analgesia in the Mechanically Ventilated Patient

Cited by 162 publications

References 156 publications

Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

Perceptions of Nurses and Physicians of Their Communication at Night About Intensive Care Patients' Pain, Agitation, and Delirium

Neurocognitive Effects of Electroconvulsive Therapy in Psychiatric Disorders, Mechanism of Action And its Prevention: Review Article

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