Stress, agitation, and brain failure in critical care medicine

Crippen, David; Ermakov, Sergei

doi:10.1097/00002727-199208000-00005

Cited by 22 publications

(7 citation statements)

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“…The majority of intensive care unit (ICU) patients receiving mechanical ventilation are critically ill. The pain from their disease in combination with invasive treatment and the worry about disease prognosis, often render patients feeling "helpless" and "fearful", hindering the treatment [1]. The pertinent literature reports that sedation can increase comfort and stimulate organ recovery, reduce patient's anxiety, oxygen consumption and the rate of unplanned extubation by the patients [2,3].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of daily interruption of sedation in sedated patients with mechanical ventilation in ICU: A systematic review

Chen

Liu

Chen

et al. 2014

International Journal of Nursing Sciences

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a b s t r a c t Purpose: To evaluate the effectiveness of daily sedation interruption in patients with mechanical ventilation in intensive care unit (ICU). Methods: The randomized controlled trials (RCTs) on the application of daily interruption of sedation in sedated patients with mechanical ventilation in ICU were collected through databases including Cochrane library, MEDLINE, Web of Knowledge, Embase, CNKI, CBM and VIP Data. Two reviewers independently assessed the quality of studies and extracted the data. Meta-analysis was conducted on the included studies. Results: Eight RCTs involving 757 patients were included. The daily sedation interruptions could shorten the duration of mechanical ventilation (Z ¼ 5.36, p < 0.0001), length of stay (Z ¼ 2.93, p ¼ 0.003 < 0.05) and reduce the rate of tracheotomy (Z ¼ 3.97, p < 0.00001) in these patients. Additionally, daily sedation interruption was not associated with increased rate of unplanned extubation by the patients (Z ¼ 0.53, p ¼ 0.6 < 0.05). Conclusion: The application of daily interruption of sedation in patients with mechanical ventilation in ICU is safe and effective.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of daily interruption of sedation in sedated patients with mechanical ventilation in ICU: A systematic review

Chen

Liu

Chen

et al. 2014

International Journal of Nursing Sciences

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“…Agitation is defined as “disquietude”, (Crippen & Ermakov, 1992) “violent motion”, and “tumultuous emotion” (Cohen et al, 2002) and involves increased intensity in behavioral and psychological dimensions (Chevrolet & Jolliet, 2007). Agitation is a visible cue that can occur in isolation, or accompany extreme anxiety (Frazier et al, 2003), delirium (Chevrolet & Jolliet, 2007) or brain dysfunction (Crippen & Ermakov, 1992).…”

Section: Introductionmentioning

confidence: 99%

“…Agitation is a visible cue that can occur in isolation, or accompany extreme anxiety (Frazier et al, 2003), delirium (Chevrolet & Jolliet, 2007) or brain dysfunction (Crippen & Ermakov, 1992). Agitation is common in critical care as a result of waxing and waning levels of consciousness or patients awakening from sedation.…”

Section: Introductionmentioning

confidence: 99%

Anxiety and Agitation in Mechanically Ventilated Patients

et al. 2011

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During an ethnography conducted in an intensive care unit (ICU), we found that anxiety and agitation occurred frequently, and were important considerations in the care of 30 patients weaning from prolonged mechanical ventilation. We conducted a secondary analysis to (a) describe characteristics of anxiety and agitation experienced by mechanically ventilated patients; (b) explore how clinicians recognize and interpret anxiety and agitation and (c) describe strategies and interventions used to manage anxiety and agitation with mechanically ventilated patients. We constructed the Anxiety-Agitation in Mechanical Ventilation Model to illustrate the multidimensional features of symptom recognition and management. Patients’ ability to interact with the environment served as a basis for identification and management of anxiety or agitation. Clinicians’ attributions about anxiety or agitation and “knowing the patient” contributed to their assessment of patient responses. Clinicians chose strategies to overcome either the stimulus or patient’s appraisal of risk of the stimulus. This article contributes to the body of knowledge about symptom recognition and management in the ICU by providing a comprehensive model to guide future research and practice.

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“…Stress usually produces an elevated sense of fear and anxiety which causes increased norepinephrine turnover in the limbic regions (hypocampus, amygdala, locus coeruleus) and cerebral cortex [14]. Stress applied to laboratory animals results in a decreased density of α 2 -adrenergic autoreceptors in the hippocampus and amygdala, reflecting downregulation in response to elevated circulating endogenous circulating catecholamines, among other desensitizing actions [15].…”

Section: Neurotransmitters and Anxietymentioning

confidence: 99%