scholarly journals Dexmedetomidine Related Polyuria and Hypernatremia in Intensive Care Unit.

2021 ◽  
Vol 5 (02) ◽  
Author(s):  
Mubashar Dilawar ◽  
Muhammad Mohsin Riaz ◽  
Omer Sabir ◽  
Muhammad Bilal Basit
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Diabetes Insipidus ◽  
Surgical Procedures ◽  
Arginine Vasopressin ◽  
Vasopressin Release ◽  
Sedation And Analgesia

Dexmedetomidine is commonly used sedative nowadays. It’s being used as an anesthetic for surgical procedures and frequently being used in ICU Settings for sedation, and analgesia. Dexmedetomidine is a highly selective, alpha-2 agonist that also blocks arginine-vasopressin release. Dexmedetomidine is suspected to cause diabetes insipidus leading to polyuria and hypernatremia. We report a case of Diabetes Insipidus associated with use of dexmedetomidine.

scholarly journals Consenting patients for elective procedures during the pandemic: Are we consenting for risk of nosocomial COVID-19 infection

2021 ◽  
pp. 175045892110452
Author(s):  
CU Menakaya ◽  
M Durand-Hill ◽  
O Okereke ◽  
DM Eastwood
Keyword(s):  
Intensive Care Unit ◽  
United Kingdom ◽  
Intensive Care ◽  
Surgical Procedures ◽  
Surgical Patients ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Risk Of Death ◽  
The United Kingdom

Introduction: Nosocomial COVID-19 increases morbidity and mortality in patients undergoing surgical procedures. This study assesses the consenting process in patients admitted for surgical procedures with regard to risks of contracting nosocomial COVID-19 infection during the three lockdown periods in the United Kingdom. Methods: Retrospective review of consecutive surgical patients admitted to our tertiary referral centre for surgical procedures during the lockdown periods in the United Kingdom. Data from our hospital’s electronic theatre database cross-referenced with the online surgical operative, admission and discharge records were reviewed by three independent reviewers. Discussion: A total of 180 patients (104 males and 76 females) were studied. No patients tested positive perioperatively for COVID-19. The first lockdown had a significantly larger proportion of consultants consenting (P < 0.001). Surgeons consented patients for risk of COVID-19 infection in 34.4% of cases, COVID-19-related illness in 33.9%, inpatient Intensive Care Unit (ITU) admission secondary to COVID-19 infection and risk of death due to COVID-19 in 0.0% and risk of death secondary to inpatient COVID infection in 1.1%. Conclusion: As surgical activity continues and COVID-19 persists, surgeons should be vigilant and ensure proper documentation for consent regarding COVID-19-related complications in line with the Royal College of Surgeons of England guidelines.

Sedation and analgesia in the ICU

2020 ◽  
pp. 3898-3905
Author(s):  
Michael C. Reade
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheal Extubation ◽  
Organ Support ◽  
Pain Anxiety ◽  
Safe Delivery ◽  
Intensive Care Patients ◽  
Sedation And Analgesia ◽  
Assessment Scales ◽  
Minimization Approach

Patients undergoing mechanical ventilation or other forms of invasive organ support in an intensive care unit should ideally be free of pain, anxiety, and delirium, sufficiently cooperative or sedated to enable safe delivery of essential aspects of their care; sufficiently awake such that tracheal extubation is not unnecessarily delayed; and left with few or no unpleasant memories of their illness and treatment. This ideal is often not achieved. Management should be based on an analgesia-first, delirium-control, sedation-minimization approach. Identifying intensive care unit-associated delirium is not straightforward: most delirious intensive care patients are not agitated, and ‘hypoactive’ delirium can mask substantial psychological distress. Various assessment scales can be used to quantitate, monitor, and communicate sedation and sedation goals, and similar tools can be employed to identify delirium.

Patient-Reported Outcomes Associated With Sedation and Agitation Intensity in the Critically Ill

2020 ◽  
Vol 29 (2) ◽  
pp. 140-144
Author(s):  
Ashleigh Malinowski ◽  
Neal J. Benedict ◽  
Meng-Ni Ho ◽  
Levent Kirisci ◽  
Sandra L. Kane-Gill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Patient Reported Outcomes ◽  
Surgical Trauma ◽  
Related Factors ◽  
Patient Reported ◽  
Sedation And Analgesia ◽  
Patients Experience

Background Patient-reported outcomes are essential to understand the relationship between patients’ perception of sedation and clinicians’ assessments of sedation. Objectives To evaluate the association between sedation and agitation indexes and patient-reported outcomes of sedation and analgesia. Methods This prospective, single-center, observational study included adult patients who were continuously sedated for at least 24 hours in a medical or surgical/ trauma intensive care unit. Patients were interviewed after sedation was discontinued regarding their satisfaction with the quality of sedation and potentially related factors. The primary outcome was the correlation between sedation and agitation indexes and patient-reported outcomes. Results A total of 68 patients were interviewed after sedation. Of these, 29 (42.6%) described their overall feelings about their experience while receiving mechanical ventilation in the intensive care unit as "pleasant". When asked about their desires if they were to experience the situation again, 29 patients (42.6%) reported that they would want more sedation. Agitation index was statistically significantly correlated with several patient-reported outcomes. Receiving mechanical ventilation (r = 0.41, P = .002), the amount of noise (r = 0.34, P = .01), suctioning (r = 0.32, P = .02), difficulty resting or sleeping (r = 0.39, P = .003), inability to communicate by talking (r = 0.36, P = .008), anxiety (r = 0.29, P = .03), panic (r = 0.3, P = .02), and frustration (r = 0.47, P &lt; .001) were associated with a higher agitation index. Conclusion Agitation index was significantly associated with several patient-reported outcomes and thus seems to be a promising descriptor of patients’ experience.

scholarly journals Gradient washout and secondary nephrogenic diabetes insipidus after brain injury in an infant: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Nathan Chang ◽  
Karley Mariano ◽  
Lakshmi Ganesan ◽  
Holly Cooper ◽  
Kevin Kuo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Injury ◽  
Diabetes Insipidus ◽  
Nephrogenic Diabetes Insipidus ◽  
Pediatric Intensive Care ◽  
Central Diabetes Insipidus ◽  
Osmotic Gradient ◽  
Cerebral Salt Wasting ◽  
Salt Wasting

Abstract Background Disorders of water and sodium balance can occur after brain injury. Prolonged polyuria resulting from central diabetes insipidus and cerebral salt wasting complicated by gradient washout and a type of secondary nephrogenic diabetes insipidus, however, has not been described previously, to the best of our knowledge. We report an unusual case of an infant with glioblastoma who, after tumor resection, was treated for concurrent central diabetes insipidus and cerebral salt wasting complicated by secondary nephrogenic diabetes insipidus. Case presentation A 5-month-old Hispanic girl was found to have a large, hemorrhagic, suprasellar glioblastoma causing obstructive hydrocephalus. Prior to mass resection, she developed central diabetes insipidus. Postoperatively, she continued to have central diabetes insipidus and concurrent cerebral salt wasting soon after. She was managed with a vasopressin infusion, sodium supplementation, fludrocortisone, and urine output replacements. Despite resolution of her other major medical issues, she remained in the pediatric intensive care unit for continual and aggressive management of water and sodium derangements. Starting on postoperative day 18, her polyuria began increasing dramatically and did not abate with increasing vasopressin. Nephrology was consulted. Her blood urea nitrogen was undetectable during this time, and it was thought that she may have developed a depletion of inner medullary urea and osmotic gradient: a “gradient washout.” Supplemental dietary protein was added to her enteral nutrition, and her fluid intake was decreased. Within 4 days, her blood urea nitrogen increased, and her vasopressin and fluid replacement requirements significantly decreased. She was transitioned soon thereafter to subcutaneous desmopressin and transferred out of the pediatric intensive care unit. Conclusions Gradient washout has not been widely reported in humans, although it has been observed in the mammalian kidneys after prolonged polyuria. Although not a problem with aquaporin protein expression or production, gradient washout causes a different type of secondary nephrogenic diabetes insipidus because the absence of a medullary gradient impairs water reabsorption. We report a case of an infant who developed complex water and sodium imbalances after brain injury. Prolonged polyuria resulting from both water and solute diuresis with low enteral protein intake was thought to cause a urea gradient washout and secondary nephrogenic diabetes insipidus. The restriction of fluid replacements and supplementation of enteral protein appeared adequate to restore the renal osmotic gradient and efficacy of vasopressin.

Management and Outcomes of Laryngeal Injuries in the Pediatric Population

2011 ◽  
Vol 120 (12) ◽  
pp. 787-795 ◽  
Author(s):  
Douglas Sidell ◽  
Abie H. Mendelsohn ◽  
Nina L. Shapiro ◽  
Maie St. John
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Procedures ◽  
Data Bank ◽  
Fracture Repair ◽  
Laryngeal Trauma ◽  
Discharge Disposition ◽  
National Trauma ◽  
Organ Systems ◽  
National Trauma Data Bank

Objectives: Pediatric laryngeal trauma is an uncommon event. The purpose of this study was to identify outcomes following surgical procedures for pediatric laryngeal trauma, and to provide an in-depth review of the literature. Methods: The National Trauma Data Bank was utilized to identify pediatric laryngeal trauma incidents with admission years 2002 through 2006. Patient demographics, injury type, surgical procedures, hospital and intensive care unit durations, ventilator duration, and discharge disposition were abstracted. Results: There were 69 laryngeal trauma incidents identified, with a median patient age of 12.8 years and an overall mortality rate of 8.7%. Laryngeal injury was frequently blunt-force in nature (82.8%) and often occurred in conjunction with trauma to multiple organ systems (76.8%). Tracheotomy (16 procedures), laryngeal suturing (13 procedures), and laryngeal fracture repair (10 procedures) were the most frequent procedures identified. Laryngeal fracture repair was noted to increase the overall hospital duration (p = 0.040). The communication scores were affected only by tracheotomy (p = 0.013). Surgical intervention did not significantly affect the frequency of home discharge. Conclusions: Pediatric laryngeal trauma is an uncommon event that can be evaluated with the National Trauma Data Bank. Although patients who undergo laryngeal fracture repair appear to have an increased duration of hospitalization, patients who undergo tracheotomy or laryngeal suturing do not have increased durations of ventilator dependence, stay in an intensive care unit, or hospitalization.

Sedation and analgesia in the intensive care unit: Evaluating the role of dexmedetomidine

2007 ◽  
Vol 64 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Paul M. Szumita ◽  
Steven A. Baroletti ◽  
Kevin E. Anger ◽  
Michael E. Wechsler
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sedation And Analgesia

Sedation and Analgesia

2015 ◽  
pp. 278-312
Author(s):  
Jordan Brand
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Experimental Evidence ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Effects ◽  
Hemodynamic Characteristics ◽  
Pain And Suffering ◽  
Sedation And Analgesia

Patients in the cardiothoracic intensive care unit (CTICU) are subject to numerous physical and mental stresses. While most of these cannot be completely eliminated, intensivists have many tools in their armamentarium to alleviate patients' pain and suffering. This chapter will consider the importance of analgesia and sedation in the CTICU and the relevant consequences of over- or under-treatment. We will examine the tools available for monitoring and titrating analgesia and sedation in critically ill patients. The major classes of medications available will be reviewed, with particular attention to their clinical effects, metabolism and excretion, and hemodynamic characteristics. Lastly, experimental evidence will be assessed regarding the best strategies for treatment of pain and agitation in the CTICU, including use of non-pharmacologic adjuvants.

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