Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Critical Care Medicine, Journal Year: 2018, Volume and Issue: 46(9), P. e825 - e873

Published: Aug. 16, 2018

To update and expand the 2013 Clinical Practice Guidelines for Management of Pain, Agitation, Delirium in Adult Patients ICU.Thirty-two international experts, four methodologists, critical illness survivors met virtually at least monthly. All section groups gathered face-to-face annual Society Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict interest policy was developed a priori enforced throughout process. Teleconferences electronic discussions among subgroups whole panel were part guidelines' development. general content review completed by all members January 2017.Content ICU represented each five sections guidelines: Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), Sleep (disruption). Each created Population, Intervention, Comparison, Outcome, nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, patients prioritized importance. For Outcome question, searched best available evidence, determined its quality, formulated recommendations as "strong," "conditional," or "good" practice statements Grading Recommendations Assessment, Development Evaluation principles. In addition, evidence gaps caveats explicitly identified.The Agitation/Sedation, (disruption) issued 37 (three strong 34 conditional), two good statements, 32 ungraded, nonactionable statements. Three from patient-centered question list remained without recommendation.We found substantial agreement large, interdisciplinary cohort experts regarding supporting recommendations, remaining literature assessment, prevention, treatment critically ill adults. Highlighting this research needs will improve management provide foundation improved outcomes science vulnerable population.

Language: Английский

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Enhancing Recovery From Sepsis

JAMA, Journal Year: 2018, Volume and Issue: 319(1), P. 62 - 62

Published: Jan. 2, 2018

Importance

Survival from sepsis has improved in recent years, resulting an increasing number of patients who have survived treatment. Current guidelines do not provide guidance on posthospital care or recovery.

Observations

Each year, more than 19 million individuals develop sepsis, defined as a life-threatening acute organ dysfunction secondary to infection. Approximately 14 survive hospital discharge and their prognosis varies. Half recover, one-third die during the following one-sixth severe persistent impairments. Impairments include development average 1 2 new functional limitations (eg, inability bathe dress independently), 3-fold increase prevalence moderate cognitive impairment (from 6.1% before hospitalization 16.7% after hospitalization), high mental health problems, including anxiety (32% survive), depression (29%), posttraumatic stress disorder (44%). About 40% are rehospitalized within 90 days discharge, often for conditions that potentially treatable outpatient setting, such infection (11.9%) exacerbation heart failure (5.5%). Compared with hospitalized other diagnoses, those at increased risk recurrent matched (8.0%) (P < .001), renal (3.3% vs 1.2%,P cardiovascular events (adjusted hazard ratio [HR] range, 1.1-1.4). Reasons deterioration multifactorial accelerated progression preexisting chronic conditions, residual damage, impaired immune function. Characteristics associated complications treatment fully understood but both poorer presepsis status, characteristics septic episode severity infection, host response infection), quality timeliness initial care, avoidance treatment-related harms). Although there is paucity clinical trial evidence support specific postdischarge rehabilitation treatment, experts recommend referral physical therapy improve exercise capacity, strength, independent completion activities daily living. This recommendation supported by observational study involving 30 000 survivors found was lower 10-year mortality compared propensity-matched controls HR, 0.94; 95% CI, 0.92-0.97,P .001).

Conclusions Relevance

In months management should focus (1) identifying physical, mental, problems referring appropriate (2) reviewing adjusting long-term medications, (3) evaluating commonly result hospitalization, failure, aspiration. For poor declining prior experience further it may be palliation symptoms.

Language: Английский

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Delirium

Nature Reviews Disease Primers, Journal Year: 2020, Volume and Issue: 6(1)

Published: Nov. 12, 2020

Language: Английский

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Posttraumatic Stress Disorder in Critical Illness Survivors

Critical Care Medicine, Journal Year: 2015, Volume and Issue: 43(5), P. 1121 - 1129

Published: Feb. 5, 2015

To conduct a systematic review and metaanalysis of the prevalence, risk factors, prevention/treatment strategies for posttraumatic stress disorder symptoms in critical illness survivors.PubMed, Embase, CINAHL, PsycINFO, Cochrane Library from inception through March 5, 2014.Eligible studies met following criteria: 1) adult general/nonspecialty ICU, 2) validated instrument greater than or equal to 1 month post-ICU, 3) sample size 10 patients.Duplicate independent data abstraction all eligible titles/abstracts/full-text articles.The search identified 2,817 titles/abstracts, with 40 articles on 36 unique cohorts (n = 4,260 patients). The Impact Event Scale was most common instrument. Between 6 months post-ICU (six studies; n 456), pooled mean (95% CI) score 20 (17-24), prevalences clinically important were 25% (18-34%) 44% (36-52%) using thresholds 35 20, respectively. 7 12 (five 698), 17 (9-24), 17% (10-26%) 34% (22-50%), ICU factors included benzodiazepine administration memories frightening experiences. Posttraumatic associated worse quality life. In European-based studies: an diary significant reduction symptoms, self-help rehabilitation manual symptom at 2 months, but not months; nurse-led follow-up clinic did reduce symptoms.Clinically occurred one fifth survivors 1-year follow-up, higher prevalence those who had comorbid psychopathology, received benzodiazepines, early European studies, diaries reduced symptoms.

Language: Английский

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The ABCDEF Bundle in Critical Care

Critical Care Clinics, Journal Year: 2017, Volume and Issue: 33(2), P. 225 - 243

Published: March 8, 2017

Language: Английский

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Four-Month Clinical Status of a Cohort of Patients After Hospitalization for COVID-19

JAMA, Journal Year: 2021, Volume and Issue: 325(15), P. 1525 - 1525

Published: March 17, 2021

Little is known about long-term sequelae of COVID-19.

Language: Английский

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Post-intensive care syndrome: An overview

Journal of Translational Internal Medicine, Journal Year: 2017, Volume and Issue: 5(2), P. 90 - 92

Published: June 1, 2017

Abstract Survival of critically unwell patients has improved in the last decade due to advances critical care medicine. Some these survivors develop cognitive, psychiatric and /or physical disability after treatment intensive unit (ICU), which is now recognized as post syndrome (PICS). Given limited awareness about PICS medical faculty this aspect often overlooked may lead reduced quality life cause a lot suffering their families. Efforts should be directed towards preventing by minimizing sedation early mobilization during ICU.All evaluated for those having signs symptoms it managed multidisciplinary team includes physician, neuro-psychiatrist, physiotherapist respiratory therapist, with use pharmacological non-apharmacological interventions. This can achieved through an organizational change improvement, knowing high rate incidence its adverse effects on survivor’s daily activities effect family.

Language: Английский

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Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study

The Lancet Respiratory Medicine, Journal Year: 2021, Volume and Issue: 9(3), P. 239 - 250

Published: Jan. 12, 2021

Language: Английский

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The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families

Critical Care Medicine, Journal Year: 2017, Volume and Issue: 45(2), P. 321 - 330

Published: Jan. 18, 2017

Over the past 20 years, critical care has matured in a myriad of ways resulting dramatically higher survival rates for our sickest patients. For millions new survivors comes de novo suffering and disability called "the postintensive syndrome." Patients with syndrome are robbed their normal cognitive, emotional, physical capacity cannot resume previous life. The ICU Liberation Collaborative is real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically ABCDEF bundle through team- evidence-based care. This article explains science philosophy liberating patients families from harm that both inherent illness iatrogenic. liberation an extensive program facilitate implementation pain, agitation, delirium guidelines using bundle. Participating teams adapt data hundreds peer-reviewed studies operationalize systematic reliable methodology shifts culture harmful inertia sedation restraints animated filled who awake, cognitively engaged, mobile family members engaged as partners team at bedside. In doing so, "liberated" iatrogenic aspects threaten his or her sense self-worth human dignity. goal this 2017 plenary lecture 47th Society Critical Care Medicine Congress provide clinical synthesis literature led creation explain how patient- family-centered, novel, generalizable, practice changing.

Language: Английский

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Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness*

Critical Care Medicine, Journal Year: 2018, Volume and Issue: 46(9), P. 1393 - 1401

Published: May 22, 2018

To describe the frequency of co-occurring newly acquired cognitive impairment, disability in activities daily livings, and depression among survivors a critical illness to evaluate predictors being free post-intensive care syndrome problems.Prospective cohort study.Medical surgical ICUs from five U.S. centers.Patients with respiratory failure or shock, excluding those preexisting impairment livings.None.At 3 12 months after hospital discharge, we assessed patients for disability, depression. We categorized into eight groups reflecting combinations cognitive, mental health problems. Using multivariable logistic regression, modeled association between age, education, frailty, durations mechanical ventilation, delirium, severe sepsis odds free. analyzed 406 median age 61 years an Acute Physiology Chronic Health Evaluation II 23. At months, one more problems were present 64% 56%, respectively. Nevertheless, (i.e., two domains) 25% at 21% months. Post-intensive all three domains only 6% 4% More education was associated greater (p < 0.001 mo). frailty lower = 0.005 mo p 0.048 mo).In this multicenter study, majority survivors, but out four. Education protective predictive development Future studies are needed understand better heterogeneous subtypes identify modifiable risk factors.

Language: Английский

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