COVID-19: ICU delirium management during SARS-CoV-2 pandemic

Critical Care, Год журнала: 2020, Номер 24(1)

Опубликована: Апрель 28, 2020

Abstract The novel coronavirus, SARS-CoV-2-causing Coronavirus Disease 19 (COVID-19), emerged as a public health threat in December 2019 and was declared pandemic by the World Health Organization March 2020. Delirium, dangerous untoward prognostic development, serves barometer of systemic injury critical illness. early reports 25% encephalopathy from China are likely gross underestimation, which we know occurs whenever delirium is not monitored with valid tool. Indeed, patients COVID-19 at accelerated risk for due to least seven factors including (1) direct central nervous system (CNS) invasion, (2) induction CNS inflammatory mediators, (3) secondary effect other organ failure, (4) sedative strategies, (5) prolonged mechanical ventilation time, (6) immobilization, (7) needed but unfortunate environmental social isolation quarantine without family. Given insights into pathobiology virus, well emerging interventions utilized treat critically ill patients, prevention management will prove exceedingly challenging, especially intensive care unit (ICU). main focus during lies within organizational issues, i.e., lack ventilators, shortage personal protection equipment, resource allocation, prioritization limited options, end-of-life care. However, standard ICU management, must remain highest quality possible an eye towards long-term survival minimization issues related post-intensive syndrome (PICS). This article discusses how professionals (e.g., physicians, nurses, physiotherapists, pharmacologists) can use our knowledge resources limit burden on reducing modifiable despite imposed heavy workload difficult clinical challenges posed pandemic.

Язык: Английский

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

Critical Care Medicine, Год журнала: 2017, Номер 45(2), С. 321 - 330

Опубликована: Янв. 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.

Язык: Английский

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Analgesia and sedation in patients with ARDS

Intensive Care Medicine, Год журнала: 2020, Номер 46(12), С. 2342 - 2356

Опубликована: Ноя. 10, 2020

Язык: Английский

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Long-term outcomes after critical illness: recent insights

Critical Care, Год журнала: 2021, Номер 25(1)

Опубликована: Март 17, 2021

Abstract Intensive care survivors often experience post-intensive sequelae, which are frequently gathered together under the term “post-intensive syndrome” (PICS). The consequences of PICS on quality life, health-related costs and hospital readmissions real public health problems. In present Viewpoint, we summarize current knowledge gaps in our understanding approaches to management.

Язык: Английский

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Neurocognitive Function after Cardiac Surgery

Anesthesiology, Год журнала: 2018, Номер 129(4), С. 829 - 851

Опубликована: Апрель 6, 2018

Abstract For half a century, it has been known that some patients experience neurocognitive dysfunction after cardiac surgery; however, defining its incidence, course, and causes remains challenging controversial. Various terms have used to describe at different times surgery, ranging from “postoperative delirium” cognitive or decline.” Delirium is clinical diagnosis included in the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Postoperative not DSM-5 heterogeneously defined, though recent international nomenclature effort proposed standardized definitions for it. Here, authors discuss pathophysiologic mechanisms may underlie these complications, review literature on methods prevent them, novel approaches understand their etiology lead treatment strategies. Future studies should measure both delirium postoperative help clarify relationship between important complications.

Язык: Английский

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Effectiveness and Safety of an Extended ICU Visitation Model for Delirium Prevention: A Before and After Study*

Critical Care Medicine, Год журнала: 2017, Номер 45(10), С. 1660 - 1667

Опубликована: Июнь 30, 2017

To evaluate the effect of an extended visitation model compared with a restricted on occurrence delirium among ICU patients.Prospective single-center before and after study.Thirty-one-bed medical-surgical ICU.All patients greater than or equal to 18 years old expected length stay 24 hours consecutively admitted from May 2015 November 2015.Change policy (4.5 hr/d) (12 hr/d).Two hundred eighty-six were enrolled (141 model, 145 model). The primary outcome was cumulative incidence delirium, assessed bid using confusion assessment method for ICU. Predefined secondary outcomes included duration delirium/coma; any ICU-acquired infection; bloodstream infection, pneumonia, urinary tract all-cause mortality; stay. median visits increased 133 minutes (interquartile range, 97.7-162.0) in 245 175.0-272.0) (p < 0.001). Fourteen (9.6%) developed 29 (20.5%) (adjusted relative risk, 0.50; 95% CI, 0.26-0.95). In comparison patients, had shorter delirium/coma (1.5 d [interquartile 1.0-3.0] vs 3.0 2.5-5.0]; p = 0.03) (3.0 2.0-4.0] 4.0 2.0-6.0]; 0.04). rate infections mortality did not differ significantly between two study groups.In this ICU, associated reduced

Язык: Английский

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Sedation Intensity in the First 48 Hours of Mechanical Ventilation and 180-Day Mortality: A Multinational Prospective Longitudinal Cohort Study*

Critical Care Medicine, Год журнала: 2018, Номер 46(6), С. 850 - 859

Опубликована: Март 2, 2018

In the absence of a universal definition light or deep sedation, level sedation that conveys favorable outcomes is unknown. We quantified relationship between escalating intensity in first 48 hours mechanical ventilation and 180-day survival, time to extubation, delirium.Harmonized data from prospective multicenter international longitudinal cohort studies SETTING:: Diverse mix ICUs.Critically ill patients expected be ventilated for longer than 24 hours.Richmond Agitation Sedation Scale pain were assessed every 4 hours. Delirium mobilization daily using Confusion Assessment Method ICU standardized mobility assessment, respectively.Sedation was Index, calculated as sum negative Richmond measurements divided by total number assessments. used multivariable Cox proportional hazard models adjust relevant covariates. performed subgroup sensitivity analysis accounting immortal bias same variables within 120 168 The main outcome survival. 703 42 ICUs with mean (SD) Acute Physiology Chronic Health Evaluation II score 22.2 (8.5) mortality 32.3% (227). median (interquartile range) 4.54 days (2.47-8.43 d). occurred 273 (38.8%) patients. intensity, an dose-dependent relationship, independently predicted increased risk death (hazard ratio [95% CI], 1.29 [1.15-1.46]; p < 0.001, delirium 1.25 [1.10-1.43]), value equals 0.001 reduced chance early extubation (95% CI) 0.80 (0.73-0.87), less 0.001. subsequent (1.04-1.49), 0.02. episodes hours, adjusted not associated survival.Sedation independently, ascending death, delirium, delayed extubation. These observations suggest keeping equivalent 0 clinically desirable goal.

Язык: Английский

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The intensive care delirium research agenda: a multinational, interprofessional perspective

Intensive Care Medicine, Год журнала: 2017, Номер 43(9), С. 1329 - 1339

Опубликована: Июнь 13, 2017

Язык: Английский

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ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Anaesthesiology Intensive Therapy, Год журнала: 2018, Номер 50(2), С. 160 - 167

Опубликована: Июнь 8, 2018

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kotfis K, Marra A, Ely E. ICU delirium — a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiology Intensive Therapy. 2018;50(2). APA Kotfis, K., Marra, A., & Ely, (2018). Therapy, 50(2). Chicago Katarzyna, Annachiara Wesley Ely. 2018. "ICU unit". Therapy 50 (2). Harvard MLA Katarzyna et al. unit." vol. 50, no. 2, Vancouver

Язык: Английский

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INNOVATIONS IN HOSPITAL MANAGEMENT: A REVIEW

International Medical Science Research Journal, Год журнала: 2024, Номер 4(2), С. 224 - 234

Опубликована: Фев. 23, 2024

This review paper explores the transformative landscape of innovations in hospital management, emphasizing their pivotal role shaping healthcare's current and future state. The significance innovations, spanning technology integration, human resource strategies, patient care advancements, is examined. Challenges such as resistance to change financial constraints are addressed, with proposed solutions highlighting importance management strategic planning. identifies research innovation areas, including artificial intelligence integration blockchain technology. Emerging trends, Internet Things telehealth expansion, underscore dynamic trajectory management. concludes by advocating for a collaborative innovative approach, positioning hospitals navigate challenges usher characterized enhanced care, operational efficiency, technological advancement. Keywords: Hospital Management, Innovations, Healthcare, Technology Integration, Patient-Centric Care

Язык: Английский

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