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Breast Surgery

Showing posts with label sedatives. Show all posts
Showing posts with label sedatives. Show all posts

Wednesday, 19 September 2018

Benzodiazepines and Development of Delirium in Critically Ill Children: Estimating the Causal Effect*



by Mody, Kalgi; Kaur, Savneet; Mauer, Elizabeth A.; Gerber, Linda M.; Greenwald, Bruce M.; Silver, Gabrielle; Traube, Chani  
Objectives: Benzodiazepine use may be associated with delirium in critically ill children. However, benzodiazepines remain the first-line sedative choice in PICUs. Objectives were to determine the temporal relationship between administration of benzodiazepines and delirium development, control for time-varying covariates such as mechanical ventilation and opiates, and evaluate the association between dosage of benzodiazepines and subsequent delirium.

Design: Retrospective observational study. Setting: Academic tertiary care PICU. Patients: All consecutive admissions from January 2015 to June 2015. Interventions: Retrospective assessment of benzodiazepine exposure in a population that had been prospectively screened for delirium.

Measurements and Main Results: All subjects were prospectively screened for delirium throughout their stay, using the Cornell Assessment for Pediatric Delirium, with daily cognitive status assigned as follows: delirium, coma, or normal. Multivariable mixed effects modeling determined predictors of delirium overall, followed by subgroup analysis to assess effect of benzodiazepines on subsequent development of delirium. Marginal structural modeling was used to create a pseudorandomized sample and control for time-dependent variables, obtaining an unbiased estimate of the relationship between benzodiazepines and next day delirium. The cumulative daily dosage of benzodiazepines was calculated to test for a dose-response relationship. Benzodiazepines were strongly associated with transition from normal cognitive status to delirium, more than quadrupling delirium rates (odds ratio, 4.4; CI, 1.7–11.1; p < 0.002). Marginal structural modeling demonstrated odds ratio 3.3 (CI, 1.4–7.8), after controlling for time-dependent confounding of cognitive status, mechanical ventilation, and opiates. With every one log increase in benzodiazepine dosage administered, there was a 43% increase in risk for delirium development.

Conclusions: Benzodiazepines are an independent and modifiable risk factor for development of delirium in critically ill children, even after carefully controlling for time-dependent covariates, with a dose-response effect. This temporal relationship suggests causality between benzodiazepine exposure and pediatric delirium and supports limiting the use of benzodiazepines in critically ill children.


Wednesday, 20 May 2009

Dexmedetomidine vs haloperidol in delirious, agitated, intubated patients

Dexmedetomidine vs. haloperidol in delirious, agitated, intubated
patients: a randomised open-label trial. Critical Care 2009 13:R75 [Journal article]

Reade, M.C., O'Sullivan, K., Bates, S., Goldsmith, D., StJ Ainslie, W.R., Bellomo, R.

http://ccforum.com/content/13/3/R75

Agitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives to control agitation can preclude extubation. Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and
dexmedetomidine in facilitating extubation. In this preliminary pilot study, we found dexmedetomidine a promising agent for the treatment of ICU-associated delirious agitation, and we suggest this warrants further testing in a definitive double-blind multi-centre trial.

Tuesday, 15 April 2008

Crital Care Editorials and Letters: Vol 36 Issue 4

Editorials
1357-1358
Validating predictive models of mortality: More than meets the eye
Andrew A. Kramer, PhD

1358-1360
Lung-protective higher frequency oscillatory ventilation
Stephen Derdak, DO

1360-1361
Clinical practice guidelines: Culture eats strategy for breakfast, lunch, and dinner
I Alan Fein, MD, MPH; Robert R. Corrato, MD, MBA

1361-1363
Bull’s eye missed by the magic bullet: Preclinical investigations, publication bias, and promising new interventions
Jyrki J. Tenhunen, MD, PhD

1363-1364
Donation after cardiac death: Should we fear the reaper?
David Crippen, MD, FCCM

1364-1366
End-of-life organ donation for transplantation: Stretching the ethical and legal boundaries of medical practice in society
Joseph L. Verheijde, MBA, PhD; Mohamed Y. Rady, MD, PhD; Joan L. McGregor, PhD

1366-1367
Role of sedation and analgesia in mechanical ventilation
Graziano C. Carlon, MD; Arthur Combs, MD

1368-1369
“The truth, if it exists, is in the details”
David Gilbert, MD

1369-1370
The generic septic response
Donald E. Fry, MD, FACS

1370-1372
Redefine acute renal failure? Not yet, thanks
Lawrence S. Weisberg, MD; Jean-Sebastien Rachoin, MD

1372-1373
The search for a good death—Are there quality insights accessible from medical records?
Richard A. Mularski, MD, MSHS, MCR

1374-1375
Monkey see, monkey do: Adhering to scientific principles
M Susan Mandell, MD, PhD

1375-1376
The latest in resting energy expenditure prediction: New! Improved! Better?
Marc J. Popovich, MD, FCCM

1378-1379
Since when did sedatives start to save lives?
Huang-Ping Yu, MD, PhD; Ying-Tung Lau, PhD

1380-1381
Electrical impedance tomography—A new toy for boys or the future for mechanically ventilated patients?
Marcus J. Schultz, MD, PhD, FCCP

1381-1382
Critical illness myopathy: A direct role for endotoxin
G Bryan Young, MD, FRCPC

1382-1383
Investigating the role of bacterial zinc-containing metalloproteases in the pathogenesis of complicated pneumococcal pneumonia
Michael Eisenhut

1383-1384
Right data, wrong conclusions
Giora Netzer, MD, MSCE; Richard P. Dutton, MD, MBA; John R. Hess, MD, MPH

1385-1386
Critical care workforce crisis: Time to look in the mirror
Mark A. Kelley, MD

Letters to the Editors
1387
From “inconvenient truth” to “assault on reason”
Marcus J. Schultz, MD, PhD; Mart J. de Graaff; Michael A. Kuiper; Peter E. Spronk

1387
From “inconvenient truth” to “assault on reason”
James S. Krinsley, MD, FCCM; Aarti Grover, MD

1387-1388
Not euthanasia, simply compassionate clinical care
Robert D. Truog, MD

1388
Euthanasia in the critical care setting
Alberto Giannini, MD

1389
Euthanasia in the critical care setting
Erwin J. O. Kompanje, PhD; Inez D. de Beaufort, PhD; Jan Bakker, MD, PhD

1390
Severe hypoglycemia in critically ill: Risk and outcomes
T M. Vriesendorp, MD, PhD; J H. DeVries, MD, PhD; F Rosendaal, MD, PhD; J B. L. Hoekstra, MD, PhD

1390-1391
Severe hypoglycemia in critically ill: Risk and outcomes
James S. Krinsley, MD, FCCM; Aarti Grover, MD

1391
Tight glucose control and hypoglycemia
Jean-Charles Preiser, MD, PhD; Frank Brunkhorst

1391-1392
Tight glucose control and hypoglycemia
James S. Krinsley, MD, FCCM; Aarti Grover, MD

1392
Acid base balances
George John, MBBS, MD, FRACP, FJFICM

1392
Acid base balances
John A. Kellum, MD, FCCM

Book Review
1393
Manual of Overdoses and Poisons
James H. Diaz, MD, MPH, DrPH, FCCP, FAAP, FCCM

Critical Care Medicine: April 2008, Volume 36, Issue 4

Feature Articles
1031-1042
Veterans Affairs intensive care unit risk adjustment model: Validation, updating, recalibration
Marta L. Render, MD; James Deddens, PhD; Ron Freyberg, MS; Peter Almenoff, MD; Alfred F. Connors, Jr, MD; Douglas Wagner, PhD; Timothy P. Hofer, MD, MSc

1043-1048
Feasibility of very high-frequency ventilation in adults with acute respiratory distress syndrome
Henry E. Fessler, MD; David N. Hager, MD; Roy G. Brower, MD

1049-1058
Quality of professional society guidelines and consensus conference statements in critical care
Tasnim Sinuff, MD, PhD; Rakesh V. Patel, MD, PharmD, MSc; Neill K. J. Adhikari, MD, CM, MSc; Maureen O. Meade, MD, MSc; Holger J. Schünemann, MD, PhD; Deborah J. Cook, MD, MSc

Clinical Investigations
1083-1088
Use of sedatives, opioids, and neuromuscular blocking agents in patients with acute lung injury and acute respiratory distress syndrome
for the Acute Respiratory Distress Syndrome Network

1089-1096
Efficacy and safety of intravenous infusion of doripenem versus imipenem in ventilator-associated pneumonia: A multicenter, randomized study
Jean Chastre, MD; Richard Wunderink, MD; Philippe Prokocimer, MD; Michael Lee, PhD; Koné Kaniga, PhD; Ian Friedland, MD

1097-1104
Effect of infections on 30-day mortality among critically ill patients hospitalized in and out of the intensive care unit
George Mnatzaganian, RN, MPH; Charles L. Sprung, MD; Yana Zitser-Gurevich, MD, MPH; Noya Galai, PhD; Nethanel Goldschmidt, MA; Leon Levi, MD, MPH; Yaron Bar-Lavi, MD; Fabio Zveibil, MD; Inbal Weiss Salz, MD, MPH; Anat Ekka-Zohar, RN, MPH; Elisheva Simchen, MD, MPH

1105-1113
Building a continuous multicenter infection surveillance system in the intensive care unit: Findings from the initial data set of 9,493 patients from 71 Italian intensive care units
for the Italian Group for the Evaluation of Interventions in Intensive Care Medicine

1114-1118
Transfusion of fresh frozen plasma in critically ill surgical patients is associated with an increased risk of infection
Babak Sarani, MD, FACS; W Jonathan Dunkman, BA; Laura Dean;; Seema Sonnad, PhD; Jeffrey I. Rohrbach, RN, MSN; Vicente H. Gracias, MD, FACS

1119-1124
Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority
George E. Thomsen, MD; Gregory L. Snow, PhD; Larissa Rodriguez, AS; Ramona O. Hopkins, PhD

1125-1128
Gene-expression profiling of Gram-positive and Gram-negative sepsis in critically ill patients
Benjamin M.P. Tang, MD; Anthony S. McLean, MD; Ian W. Dawes, PhD; Stephen J. Huang, PhD; Mark J. Cowley, PhD; Ruby C.Y. Lin, PhD

1129-1137
Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: Do we have to revise current definitions of acute renal failure?
Andrea Lassnigg, MD; Edith R. Schmid, MD; Michael Hiesmayr, MD; Christian Falk, MD; Wilfred Druml, MD; Peter Bauer, PhD; Daniel Schmidlin, MD

1138-1146
Using the medical record to evaluate the quality of end-of-life care in the intensive care unit
Bradford J. Glavan, MD; Ruth A. Engelberg, PhD; Lois Downey, MA; J Randall Curtis, MD, MPH

1147-1154
Influence of renal dysfunction on the accuracy of procalcitonin for the diagnosis of postoperative infection after vascular surgery
Julien Amour, MD, PhD; Aurélie Birenbaum, MD; Olivier Langeron, MD, PhD; Yannick Le Manach, MD; Michèle Bertrand, MD; Pierre Coriat, MD; Bruno Riou, MD, PhD; Maguy Bernard, MD, PhD; Pierre Hausfater, MD, PhD

1155-1157
A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients
Zev Williams, MD, PhD; Rodney Chan, MD; Edward Kelly, MD

1158-1167
Discordance between perception and treatment practices associated with intensive care unit-acquired bacteriuria and funguria: A Canadian physician survey
Clarence Chant, PharmD, BCPS; Claudia C. Dos Santos, MD; Paola Saccucci, PharmD; Orla M. Smith, RN, MN, CNCC(C); John C. Marshall, MD, FRCS(C); Jan O. Friedrich, MD, DPhil, FRCP(C)

1168-1174
The costs and cost-effectiveness of an integrated sepsis treatment protocol
Daniel Talmor, MD, MPH; Dan Greenberg, PhD; Michael D. Howell, MD; Alan Lisbon, MD; Victor Novack, MD, PhD; Nathan Shapiro, MD, MPH

1175-1183
Validation of a predictive method for an accurate assessment of resting energy expenditure in medical mechanically ventilated patients
Jean-François Savard, MD, FRCPC; Christophe Faisy, MD, PhD; Nicolas Lerolle, MD; Emmanuel Guerot, MD; Jean-Luc Diehl, MD; Jean-Yves Fagon, MD, PhD

1184-1188
Clinical outcome and prognostic factors of patients with pyogenic liver abscess requiring intensive care
Wei Chen, MD; Chia-Hung Chen, MD; Kuo-Liang Chiu, MD; Hsueh-Chou Lai, MD; Kuan-Fu Liao, MD; Yung-Jen Ho, MD; Wu-Huei Hsu, MD

Neurologic Critical Care
1290-1296
Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury
Santiago Ramón Leal-Noval, MD, PhD; Manuel Muñoz-Gómez, Prof MD, PhD; Victoria Arellano-Orden, MD; Antonio Marín-Caballos, MD, PhD; Rosario Amaya-Villar, MD, PhD; Ana Marín, MD; Antonio Puppo-Moreno, MD, PhD; Carmen Ferrándiz-Millón, MD; Juan Manuel Flores-Cordero, MD, PhD; Francisco Murillo-Cabezas, MD, PhD