scholarly journals Outcomes When Using Adjunct Dexmedetomidine with Propofol Sedation in Mechanically Ventilated Surgical Intensive Care Patients

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 93
Author(s):  
Jessica Louie ◽  
Nick Lonardo ◽  
Mary Mone ◽  
Vanessa Stevens ◽  
Rishi Deka ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
A Priori ◽  
Absolute Difference ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Intensive Care Patients ◽  
Continuous Sedation

Objective: Compare the duration of mechanical ventilation between patients receiving sedation with continuous infusions of propofol alone or combination with the use of dexmedetomidine and propofol. Design: Retrospective, propensity matched (1:1) cohort study, employing eight variables chosen a priori for matching. Timing of exposure to dexmedetomidine initiation was incorporated into a matching algorithm. Setting: Level 1, university-based, 32-bed, adult, mixed trauma and surgical intensive care unit (SICU). Continuous sedation was delivered according to a protocol methodology with daily sedation vacation and spontaneous breathing trials. Choice of sedation agent was physician directed. Patients: Between 2010 and 2014, 149 SICU patients receiving mechanical ventilation for >24 h received dexmedetomidine with propofol. Propensity matching resulted in 143 pair cohorts. Interventions: Dexmedetomidine with propofol or propofol alone. Measurements and Main Results: There was no statistical difference in SICU length of stay (LOS), with a median absolute difference of 5.3 h for propofol alone group (p = 0.43). The SICU mortality was not statistically different (RR = 1.002, p = 0.88). Examining a 14-day period post-treatment with dexmedetomidine, on any given day (excluding days 1 and 14), dexmedetomidine with propofol-treated patients had a 0.5% to 22.5% greater likelihood of being delirious (CAM-ICU positive). In addition, dexmedetomidine with propofol-treated patients had a 4.5% to 18.8% higher likelihood of being above the target sedation score (more agitated) compared to propofol-alone patients. Conclusions: In this propensity matched cohort study, adjunct use of dexmedetomidine to propofol did not show a statistically significant reduction with respect to mechanical ventilation (MV) duration, SICU LOS, or SICU mortality, despite a trend toward receiving fewer hours of propofol. There was no evidence that dexmedetomidine with propofol improved sedation scores or reduced delirium.

Five-Year Outcomes After Implementing a Pain, Agitation, and Delirium Protocol in a Mixed Intensive Care Unit

2021 ◽  
pp. 088506662110634
Author(s):  
Jeffrey T. Fish ◽  
Jared T. Baxa ◽  
Ryan R. Draheim ◽  
Matthew J. Willenborg ◽  
Jared C. Mills ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Academic Medical Center ◽  
Admission Diagnosis ◽  
Surgical Intensive Care Unit ◽  
Standardized Mortality Ratio ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Mortality Ratio ◽  
Apache Iv

Objective: Assess for continued improvements in patient outcomes after updating our institutional sedation and analgesia protocol to include recommendations from the 2013 Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium (PAD) guidelines. Methods: Retrospective before-and-after study in a mixed medical/surgical intensive care unit (ICU) at an academic medical center. Mechanically ventilated adults admitted from September 1, 2011 through August 31, 2012 (pre-implementation) and October 1, 2012 through September 30, 2017 (post-implementation) were included. Measurements included number of mechanically ventilated patients, APACHE IV scores, age, type of patient (medical or surgical), admission diagnosis, ICU length of stay (LOS), hospital LOS, ventilator days, number of self-extubations, ICU mortality, ICU standardized mortality ratio, hospital mortality, hospital standardized mortality ratio, medication data including as needed (PRN) analgesic and sedative use, and analgesic and sedative infusions, and institutional savings. Results: Ventilator days (Pre-PAD = 4.0 vs. Year 5 post = 3.2, P < .0001), ICU LOS (Pre-PAD = 4.8 days vs. Year 5 post = 4.1 days, P = .0004) and hospital LOS (Pre-PAD = 14 days vs. Year 5 post = 12 days, P < .0001) decreased after protocol implementation. Hospital standardized mortality ratio (Pre-PAD = 0.69 vs. Year 5 post = 0.66) remained constant; while, APACHE IV scores (Pre-PAD = 77 vs. Year 5 post = 89, P < .0001) and number of intubated patients (Pre-PAD = 1146 vs. Year 5 post = 1468) increased over the study period. Using the decreased ICU and hospital LOS estimates, it is projected the institution saved $4.3 million over the 5 years since implementation. Conclusions: Implementation of an updated PAD protocol in a mixed medical/surgical ICU was associated with a significant decrease in ventilator time, ICU LOS, and hospital LOS without a change in the standardized mortality ratio over a five-year period. These favorable outcomes are associated with a significant cost savings for the institution.

scholarly journals A pilot study assessing the spiritual, emotional, physical/environmental, and physiological needs of mechanically ventilated surgical intensive care unit patients via eye tracking devices, head nodding, and communication boards

2018 ◽  
Vol 3 (1) ◽  
pp. e000180 ◽  
Author(s):  
Erin I Duffy ◽  
Jonah Garry ◽  
Lillian Talbot ◽  
David Pasternak ◽  
Ashley Flinn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Eye Tracking ◽  
Tertiary Care ◽  
Basic Needs ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Head Nodding ◽  
Surgical Icu

BackgroundMechanically ventilated patients in the intensive care unit (ICU) are unable to communicate verbally. We sought to evaluate their needs via a communication board (CB) and a novel eye tracking device (ETD) that verbalizes selections made by gazing.MethodsThis was a pilot prospective study conducted in a tertiary care surgical ICU. Continuously mechanically ventilated adult surgical ICU patients with a Richmond Agitation-Sedation Scale score of −1 to +1, without cognitive impairment, were eligible. We asked patients four yes-or-no questions to assess basic needs regarding presence of pain, need for endotracheal suction, satisfactory room temperature, and position comfort. Patients were then asked if there was anything else that they wanted to communicate. All responses were confirmed by head nodding.ResultsThe median accuracy of the CB (100% (IQR 100%–100%)) for basic needs communication (yes/no questions) was comparable with that of the ETD (100% (IQR 68.8%–100%); p=0.14) in the 12 enrolled patients. Notably, 83% of patients desired to communicate additional information, ranging from spiritual (eg, desire for prayer/chaplain), emotional (eg, frustration, desire for comfort), physical/environmental (eg, television), to physiological (eg, thirst/hunger) needs.DiscussionThe majority of patients desired to communicate something other than basic needs. Unless specifically assessed via an assistive communication device (eg, CB or ETD), some of these other needs would have been difficult to discern.Level of evidenceIV therapeutic care/management.

scholarly journals A prospective, observational, longitudinal cohort study of sedation practices in SGH intensive care units

2017 ◽  
Vol 27 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Yi Lin Lee ◽  
Kalyanasundaram Ganesh ◽  
Lian Kah Ti ◽  
Shin Yi Ng
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Early Period ◽  
Patient Comfort ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Medical Patients ◽  
Surgical Intensive Care ◽  
Icu Length Of Stay ◽  
Icu Discharge

Background: Critically ill patients require sedation for patient comfort and ventilator synchrony. Despite the extensive use of sedation, to date there is no consensus on the best sedation practices. We attempt to investigate our local sedation practices. Method: This was a single-centre prospective, observation cohort study in medical and surgical intensive care unit (ICU) patients who were ventilated and sedated for more than 24 hours. Baseline demographics were obtained and patients followed-up for 28 days or to ICU discharge. Details on sedatives, ventilation duration, vasopressors and renal replacement therapy use, hospital/ICU length of stay, mortality, delirium, and sedation depth were collected and analysed. Results: From March to July 2012, 58 patients were recruited with a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 20.2 ±8.5. Hospital mortality rates were 32.8%. Patients were followed-up for 387 ICU patient-days. In the early period (first 48 h), the most popular sedative used was propofol (74.1%), followed by morphine (29.3%). In the subsequent period (>48 h), most patients were not sedated (47.6%); morphine became the most popular sedation drug (32.5%) followed by propofol (31%). Ketamine, haloperidol and diazepam were not given. In total, 1994 Richmond Agitation and Sedation Score (RASS) assessments were performed over 387 ICU patient-days; 11.1% of RASS assessments were prescribed a sedation target, and 86% of them met the prescribed targets. Delirium was observed in 22.4% of patients. Compared with medical patients, surgical patients were more likely to be prescribed a sedation target (14.2% vs. 7.4%, p<0.01), require lower doses of sedation, have a RASS score of between −2 to 1 (84.8% vs. 72.3%, p<0.01) and have fewer incidences of delirium (4.1% vs. 12.1%, p=0.01). Conclusion: Propofol and morphine were the most commonly prescribed sedatives. Different sedation practices between units may contribute to a reduction in delirium incidence.

scholarly journals Progression of Fibrinogen Decrease during High Dose Tigecycline Therapy in Critically Ill Patients: A Retrospective Analysis

2021 ◽  
Vol 10 (20) ◽  
pp. 4702
Author(s):  
Benedikt Treml ◽  
Sasa Rajsic ◽  
Tobias Hell ◽  
Dietmar Fries ◽  
Mirjam Bachler
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Time Course ◽  
Surgical Intensive Care Unit ◽  
High Dose ◽  
Coagulation Disorder ◽  
Surgical Intensive Care ◽  
Intensive Care Patients

Tigecycline is a novel glycylcycline broad-spectrum antibiotic offering good coverage for critically ill patients experiencing complicated infections. A known side effect is a coagulation disorder with distinct hypofibrinogenemia. To date, the information on possible risk factors and outcomes is sparse. Therefore, the aim of this study is to examine the time course of fibrinogen level changes during tigecycline therapy in critically ill patients. Moreover, we sought to identify risk factors for coagulopathy and to report on clinically important outcomes. We retrospectively reviewed all intensive care patients admitted to our General and Surgical Intensive Care Unit receiving tigecycline between 2010 and 2018. A total of 130 patients were stratified into two groups based on the extent of fibrinogen decrease. Patients with a greater fibrinogen decrease received a higher dose, a longer treatment and more dose changes of tigecycline, respectively. In regard to the underlying pathology, these patients showed higher inflammation markers as well as a slightly reduced liver synthesis capacity. We, therefore, conclude that such a fibrinogen decrease may be based upon further impairment of liver synthesis during severe inflammatory states. To decrease the risk of bleeding, cautious monitoring of coagulation in critically ill patients treated with high-dose tigecycline is warranted.

Early Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy in Intensive Care Patients: Sign of Possible Bowel Injury

2007 ◽  
Vol 16 (2) ◽  
pp. 132-136 ◽  
Author(s):  
Siamak Milanchi ◽  
Alexander Allins
Keyword(s):  
Intensive Care ◽  
Chest Radiograph ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Bowel Injury ◽  
Surgical Intensive Care Unit ◽  
Clinical Consequence ◽  
Surgical Intensive Care ◽  
Intensive Care Patients ◽  
Endoscopic Gastrostomy ◽  
Clinically Significant

• Background Although percutaneous endoscopic gastrostomy may be complicated by iatrogenic bowel injury, most clinicians consider a small pneumoperitoneum on radiographs obtained after the procedure a benign finding of little clinical consequence. The possibility of a relationship between findings of early pneumoperitoneum after percutaneous endoscopic gastrostomy and subsequent iatrogenic bowel injury was examined. • Methods Charts of 85 patients in a surgical intensive care unit who had undergone percutaneous endoscopic gastrostomy between 2000 and 2005 were retrospectively reviewed. All patients had a follow-up upright chest radiograph obtained after percutaneous endoscopic gastrostomy. The charts of 4 patients with radiographs that showed early pneumoperitoneum were reviewed. • Results Findings were clinically significant in 1 of the 4 patients. That patient had a perforated transverse colon that required surgical repair. The other 3 patients had no complications. • Conclusion Pneumoperitoneum after percutaneous endoscopic gastrostomy may be a sign of possible bowel injury and requires further evaluation. It should not be dismissed as benign. Obtaining a chest radiograph after a patient has undergone percutaneous endoscopic gastrostomy is essential.

Incidence of pressure injuries and risk factors in a paediatric surgical intensive care unit: a prospective cohort study

2021 ◽  
Vol 30 (Sup20) ◽  
pp. S28-S32
Author(s):  
Jeiel Carlos Lamônica Crespo ◽  
Silvia Regina Secoli ◽  
Ticiane Carolina Gonçalves Faustino Campanili ◽  
Ana Carolina Coelho Duarte ◽  
Renata Eloah de Lucena Ferretti-Rebustini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Length Of Stay ◽  
Stage 1

Objectives: The aim of the study was to evaluate the incidence of, and risk factors for, the occurrence of pressure injuries (PIs) in a paediatric surgical intensive care unit (ICU). Method: This is a prospective cohort study of 153 children in the postoperative period. Patients were assessed daily by physical examination and data were collected. All independent variables were included in a logistic regression. Results: The mean age of the cohort was 2 years, and the incidence of PI was 15.7%. According to the Braden Q Scale, 58.2% of patients were at high risk of developing PI; 79.3% of PIs were related to immobility and 69.0% were at stage 1. Risk factors were ICU length of stay and the number of medical devices used. Conclusion: The incidence of PI was high because patients were mostly at a considerable risk of developing a PI. PI was associated with several factors, especially length of ICU stay and number of devices, both of which are indirect indicators of the severity of patient condition and healthcare costs.

Sign in / Sign up

Export Citation Format

Share Document