Early goal-directed sedation versus standard sedation in mechanically ventilated critically ill patients: a pilot study*.

Abstract:

OBJECTIVE:To assess the feasibility and safety of delivering early goal-directed sedation compared with standard sedation. DESIGN:Pilot prospective, multicenter, randomized, controlled trial. SETTING:Six ICUs. PATIENTS:Critically ill adults mechanically ventilated for greater than 24 hours. INTERVENTIONS:Patients randomized to early goal-directed sedation received a dexmedetomidine-based algorithm targeted to light sedation (Richmond Agitation Sedation Score of -2 to 1). Patients randomized to standard sedation received propofol and/or midazolam-based sedation as clinically appropriate. MEASUREMENTS AND MAIN RESULTS:The main feasibility outcomes were time to randomization and proportion of Richmond Agitation Sedation Score assessments in the first 48 hours in the light and deep sedation range. Safety outcomes were delirium-free days, vasopressor and physical restraints use, and device removal. Randomization occurred within a median (interquartile range) of 1.1 hours (0.46-1.9) after intubation or ICU admission for out of ICU intubation. Patients in the early goal-directed sedation (n = 21) mean (SD) Acute Physiology and Chronic Health Evaluation II score was 20.2 (6.2) versus 18.6 (8.8; p = 0.53) in the standard sedation (n = 16). A significantly higher proportion of patients was lightly sedated on days 1, 2, and 3 (12/19 [63.2%], 19/21 [90.5%], and 18/20 [90%] vs 2/14 [14.3%], 8/15 [53.3%], and 9/15 [60%]; p = 0.005, 0.011, 0.036) and more Richmond Agitation Sedation Scale assessments between (-2 and 1), in the first 48 hours (203/307 [66%] versus (74/197 [38%]; p = 0.01) in the early goal-directed sedation versus standard sedation, respectively. Early goal-directed sedation patients received midazolam on 6 of 173 (3.5%) versus 4 of 114 (3.5%) standard sedation patient-days when dexmedetomidine was given. Propofol was given to 16 of 21 (76%) of early goal-directed sedation versus 16 of 16 (100%) of standard sedation patients (p = 0.04). Early goal-directed sedation patients had 101 of 175 (58%) versus 54 of 114 (47%; p = 0.27) delirium-free days and required significantly less physical restraints 1 (5%) versus 5 (31%; p = 0.03) than standard sedation patients. There were no differences in vasopressor use and self-extubation. CONCLUSIONS:Delivery of early goal-directed sedation was feasible, appeared safe, achieved early light sedation, minimized benzodiazepines and propofol, and decreased the need for physical restraints. The findings of this pilot study justify further investigation of early goal-directed sedation.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Shehabi Y,Bellomo R,Reade MC,Bailey M,Bass F,Howe B,McArthur C,Murray L,Seppelt IM,Webb S,Weisbrodt L,Sedation Practice in Intensive Care Evaluation Study Investigators.,Australian and New Zealand Intensive Care Society Clinical

doi

10.1097/CCM.0b013e31828a437d

subject

Has Abstract

pub_date

2013-08-01 00:00:00

pages

1983-91

issue

8

eissn

0090-3493

issn

1530-0293

pii

00003246-201308000-00019

journal_volume

41

pub_type

杂志文章,多中心研究,随机对照试验
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    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/CCM.0b013e318287f0dd

    authors: Uy J,White DB,Mohan D,Arnold RM,Barnato AE

    更新日期:2013-06-01 00:00:00

  • Validation of a compact system for measuring gas exchange.

    abstract::Measuring gas exchange in critically ill patients can provide valuable information on their nutritional status and energy expenditure. Several semiautomated machines are available for measuring oxygen consumption (VO2) and carbon dioxide production (VCO2). This study evaluated, under controlled laboratory conditions, ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198609000-00010

    authors: Eccles RC,Swinamer DL,Jones RL,King EG

    更新日期:1986-09-01 00:00:00

  • Catecholamines: study of interspecies variation.

    abstract::In the last three decades, numerous articles on plasma catecholamine concentrations in various settings have been published in the medical literature. Despite this abundance of information, no summary article has analyzed the species variations in circulating catecholamine concentrations. In this paper, the plasma cat...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:

    authors: Hart BB,Stanford GG,Ziegler MG,Lake CR,Chernow B

    更新日期:1989-11-01 00:00:00

  • Early experience with continuous arteriovenous hemofiltration in critically ill pediatric patients.

    abstract::The applicability of continuous arteriovenous hemofiltration (CAVH) for renal replacement therapy was evaluated in three infants and two young children with catastrophic medical and surgical illnesses. In the first four patients, CAVH was used in conjunction with either peritoneal or hemodialysis. In the fifth patient...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198612000-00014

    authors: Leone MR,Jenkins RD,Golper TA,Alexander SR

    更新日期:1986-12-01 00:00:00

  • Aerosolized anticoagulants ameliorate acute lung injury in sheep after exposure to burn and smoke inhalation.

    abstract:OBJECTIVE:Acute lung injury is a detrimental complication for victims of burn accidents. Airway obstruction plays an important role in pulmonary dysfunction in these patients. In this study, we tested the hypothesis that aerosolized anticoagulants will reduce the degree of airway obstruction and improve pulmonary funct...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000291647.18329.83

    authors: Enkhbaatar P,Cox RA,Traber LD,Westphal M,Aimalohi E,Morita N,Prough DS,Herndon DN,Traber DL

    更新日期:2007-12-01 00:00:00

  • Increased resistance of hygroscopic condenser humidifiers when using a closed circuit suction system.

    abstract:OBJECTIVES:To examine a hygroscopic condenser after clinical use and to describe the interaction of a hygroscopic condenser and a closed circuit suction system used simultaneously. DESIGN:Prospective evaluation of hygroscopic condensers used clinically, and laboratory investigation of a hygroscopic condenser used with...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:

    authors: Martinez FJ,Pietchel S,Wise C,Walek J,Beamis JF

    更新日期:1994-10-01 00:00:00

  • Survival of critically ill patients hospitalized in and out of intensive care units under paucity of intensive care unit beds.

    abstract:OBJECTIVE:The demand for intensive care beds far exceeds their availability in many European countries. Consequently, many critically ill patients occupy hospital beds outside intensive care units, throughout the hospital. The outcome of patients who fit intensive care unit admission criteria but are hospitalized in re...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000133021.22188.35

    authors: Simchen E,Sprung CL,Galai N,Zitser-Gurevich Y,Bar-Lavi Y,Gurman G,Klein M,Lev A,Levi L,Zveibil F,Mandel M,Mnatzaganian G

    更新日期:2004-08-01 00:00:00

  • Effects of temperature on bleeding time and clotting time in normal male and female volunteers.

    abstract:OBJECTIVE:This study was done to assess the effects of temperature on bleeding time and clotting time in normal male and female volunteers. DESIGN:Open study utilizing normal volunteers. SETTING:University research laboratory. SUBJECTS:Fifty-four healthy male and female volunteers, ranging in age from 19 to 35 yrs, ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199504000-00019

    authors: Valeri CR,MacGregor H,Cassidy G,Tinney R,Pompei F

    更新日期:1995-04-01 00:00:00

  • Efficacy of silver-coating central venous catheters in reducing bacterial colonization.

    abstract:OBJECTIVE:To compare silver-coated and uncoated central venous catheters regarding bacterial colonization. To assess the relative contribution of catheter hub and skin colonization to catheter tip colonization. DESIGN:Prospective, randomized clinical trial. SETTING:Intensive care unit in a university hospital. PATIE...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00003246-199903000-00028

    authors: Bach A,Eberhardt H,Frick A,Schmidt H,Böttiger BW,Martin E

    更新日期:1999-03-01 00:00:00

  • Nonphysician transport of intubated pediatric patients: a system evaluation.

    abstract:OBJECTIVE:To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow. DESIGN:Retrospective chart review. SETTING:A 600-bed...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199207000-00011

    authors: Beyer AJ 3rd,Land G,Zaritsky A

    更新日期:1992-07-01 00:00:00

  • Abnormal pulmonary vascular tone in canine oleic acid lung injury.

    abstract:OBJECTIVE:To characterize the endothelium-dependent and endothelium-independent components of abnormal pulmonary vascular tone in canine oleic acid lung injury. DESIGN:Prospective, interventional study. SETTING:University laboratory. SUBJECTS:Twenty anesthetized mongrel dogs. INTERVENTIONS:Right heart catheterizati...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200207000-00028

    authors: Kafi SA,Scillia P,Mélot C,Gevenois PA,Pagnamenta A,Naeije R

    更新日期:2002-07-01 00:00:00

  • A Dysregulated Balance of Proinflammatory and Anti-Inflammatory Host Cytokine Response Early During Therapy Predicts Persistence and Mortality in Staphylococcus aureus Bacteremia.

    abstract:OBJECTIVES:The contribution of individual immune response to Staphylococcus aureus bacteremia on outcome has not been well studied. The objective was to relate the host cytokine response to outcome of Staphylococcus aureus bacteremia. DESIGN:Prospective observational study. SETTING:Three U.S. university-affiliated me...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001465

    authors: Minejima E,Bensman J,She RC,Mack WJ,Tuan Tran M,Ny P,Lou M,Yamaki J,Nieberg P,Ho J,Wong-Beringer A

    更新日期:2016-04-01 00:00:00

  • Metallothionein alleviates glutathione depletion-induced oxidative cardiomyopathy in murine hearts.

    abstract:OBJECTIVE:Antioxidant therapy has shown some promise in critical care medicine in which glutathione depletion and heart failure are often seen in critically ill patients. This study was designed to examine the impact of glutathione depletion and the free radical scavenger, metallothionein (MT), on cardiac function. DE...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31817bf925

    authors: Ren J,Privratsky JR,Yang X,Dong F,Carlson EC

    更新日期:2008-07-01 00:00:00

  • Effects of hyperventilation on conjunctival oxygen tension in humans.

    abstract::A polarographic conjunctival oxygen sensor was used to measure oxygen tension in a tissue bed supplied by the internal carotid artery. The shared vascular source of the conjunctiva and brain suggests that conjunctival PO2 monitoring may provide an index of cerebral perfusion. We studied the effects of hyperventilation...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198601000-00003

    authors: Nisam M,Albertson TE,Panacek E,Rutherford W,Fisher CJ Jr

    更新日期:1986-01-01 00:00:00

  • Hyperchloremia Is Associated With Acute Kidney Injury in Patients With Subarachnoid Hemorrhage.

    abstract:OBJECTIVE:To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients. DESIGN:Retrospective analysis of all subarachnoid hemorrhage admissions. SETTINGS:Neurocritical care unit. PATIENTS:All patients with a diagnosis of subarachnoid hemorrhage between 2009 and 2014. INTERVENTIO...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000002497

    authors: Sadan O,Singbartl K,Kandiah PA,Martin KS,Samuels OB

    更新日期:2017-08-01 00:00:00

  • Hypoxia-reoxygenation is as damaging as ischemia-reperfusion in the rat liver.

    abstract:OBJECTIVE:We hypothesized that the extent of injury and release of xanthine oxidase, an oxidant generator, into the circulation would be less in normal-flow hypoxia-reoxygenation than in equal duration no-flow ischemia-reperfusion. DESIGN:Randomized study. SETTING:University-based animal research facility. SUBJECTS:...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199806000-00034

    authors: Tan S,Yokoyama Y,Wang Z,Zhou F,Nielsen V,Murdoch AD,Adams C,Parks DA

    更新日期:1998-06-01 00:00:00

  • Simple and accurate monitoring of end-tidal carbon dioxide tensions during high-frequency jet ventilation.

    abstract::To determine whether end-tidal carbon dioxide tension (PETCO2) accurately reflects PaCO2 during high-frequency jet ventilation (HFJV), 43 studies were performed on eight mongrel dogs with normal lungs. During HFJV, minute volume was modified to obtain a range of PaCO2 values from 15.5 to 74.5 torr. When PETCO2 was mea...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198610000-00014

    authors: Algora-Weber A,Rubio JJ,Dominguez de Villota E,Cortes JL,Gomez D,Mosquera JM

    更新日期:1986-10-01 00:00:00

  • Hemoglobin solutions as oxygen-delivering resuscitation fluids.

    abstract::Human hemoglobin (Hb) solution is being developed for use as an oxygen-delivering resuscitation fluid. Substantial improvements in the general purity and quality of experimental Hb solutions have been achieved by recent research efforts. Hb solutions now appear to be free of the undesirable biological effects that wer...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/00003246-198204000-00002

    authors: DeVenuto F

    更新日期:1982-04-01 00:00:00

  • Vascular Endothelial Growth Factor Up-regulation in Human Amniotic Fluid Stem Cell Enhances Nephroprotection After Ischemia-Reperfusion Injury in the Rat.

    abstract:OBJECTIVE:To evaluate if the up-regulation of vascular endothelial growth factor strengthens the protective effect of amniotic fluid stem cells in a renal ischemia-reperfusion injury model. DESIGN:Randomized animal study. SETTINGS:University research laboratory. SUBJECTS:A total of 40 males 12-week-old Wistar rats w...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000002020

    authors: Mori da Cunha MG,Zia S,Beckmann DV,Carlon MS,Arcolino FO,Albersen M,Pippi NL,Graça DL,Gysemans C,Carmeliet P,Levtchenko E,Deprest J,Toelen J

    更新日期:2017-01-01 00:00:00

  • The effect of red blood cell transfusion on cerebral oxygenation and metabolism after severe traumatic brain injury.

    abstract:OBJECTIVE:There is evidence to suggest that anemia after severe traumatic brain injury (sTBI) is detrimental. However, there is a paucity of evidence supporting the use of transfusion of packed red blood cells in patients with sTBI. To understand the acute effect of packed red blood cell transfusion on cerebral oxygena...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/CCM.0b013e318194ad22

    authors: Zygun DA,Nortje J,Hutchinson PJ,Timofeev I,Menon DK,Gupta AK

    更新日期:2009-03-01 00:00:00

  • Effect of ibuprofen in patients with severe sepsis: a randomized, double-blind, multicenter study. The Ibuprofen Study Group.

    abstract:OBJECTIVE:To evaluate the safety and physiologic actions of ibuprofen in patients with severe sepsis. DESIGN:Randomized, double-blind, placebo-controlled trial. SETTING:Three university hospital medical ICUs. PATIENTS:Twenty-nine patients with clinical evidence of sepsis and the need for hemodynamic monitoring with ...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00003246-199111000-00006

    authors: Haupt MT,Jastremski MS,Clemmer TP,Metz CA,Goris GB

    更新日期:1991-11-01 00:00:00

  • Mortality among patients admitted to intensive care units during weekday day shifts compared with "off" hours.

    abstract:OBJECTIVE:To determine whether mortality rates among intensive care unit (ICU) patients differ according to the time of ICU admission, we compared the death rates for patients admitted during weekday day shifts and off hours (from 6:30 pm to 8:29 am the next day for night shifts, from Saturday 1:00 pm to Monday 8:29 am...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000249832.36518.11

    authors: Luyt CE,Combes A,Aegerter P,Guidet B,Trouillet JL,Gibert C,Chastre J

    更新日期:2007-01-01 00:00:00

  • Effect of full-time, specialized physician supervision on the success of a large, urban emergency medical services system.

    abstract:OBJECTIVES:Despite the universal proliferation of emergency medical services programs throughout the United States since 1970, only a few have ever documented a valid lifesaving effect, particularly in large, urban centers. The purpose of this study was to demonstrate the effect of specialized physician supervision on ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199309000-00009

    authors: Pepe PE,Mattox KL,Duke JH,Fisher PB,Prentice FD

    更新日期:1993-09-01 00:00:00

  • Head computed tomography in medical intensive care unit patients: clinical indications.

    abstract:OBJECTIVE:To assess whether clinical variables might be useful in selecting patients who will have an acute intracranial abnormality seen in head computed tomographic scans (HCT). DESIGN:Retrospective study. SETTING:Medical intensive care unit (MICU) in a tertiary teaching hospital. MEASUREMENTS:Medical records of p...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200005000-00008

    authors: Rafanan AL,Kakulavar P,Perl J 2nd,Andrefsky JC,Nelson DR,Arroliga AC

    更新日期:2000-05-01 00:00:00

  • Protective effects of a selective neutrophil elastase inhibitor (sivelestat) on lipopolysaccharide-induced acute dysfunction of the pulmonary microcirculation.

    abstract:OBJECTIVE:The purpose of this study was to evaluate the effect of a neutrophil elastase inhibitor, sivelestat, on lipopolysaccharide-induced acute lung injury through analysis of hemodynamic changes in the pulmonary microcirculation. DESIGN:Randomized animal study. SETTING:Medical school laboratory. SUBJECTS:Twenty-...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000172547.54086.ad

    authors: Inoue Y,Seiyama A,Tanaka H,Ukai I,Akimau P,Nishino M,Shimazu T,Sugimoto H

    更新日期:2005-08-01 00:00:00

  • Bedside digital subtraction angiography in critical care medicine.

    abstract::A portable video image-processor unit used to evaluate bedside digital subtraction angiography yields sufficient information on the major arterial vessels and the heart, using standard x-ray equipment at fluoroscopic energy levels. This unit should contribute to the evaluation of the critically ill patient in the ICU....

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198412000-00014

    authors: Janssen JH,Ackermans J,Tijdens F,Verstraelen B,de Zwaan C,Bär F,Brugada P

    更新日期:1984-12-01 00:00:00

  • Predictors of patients who present to the emergency department with sepsis and progress to septic shock between 4 and 48 hours of emergency department arrival.

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    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000000861

    authors: Capp R,Horton CL,Takhar SS,Ginde AA,Peak DA,Zane R,Marill KA

    更新日期:2015-05-01 00:00:00

  • Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: use of restraining therapies--American College of Critical Care Medicine Task Force 2001-2002.

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    pub_type: 杂志文章,评审

    doi:10.1097/01.CCM.0000095463.72353.AD

    authors: Maccioli GA,Dorman T,Brown BR,Mazuski JE,McLean BA,Kuszaj JM,Rosenbaum SH,Frankel LR,Devlin JW,Govert JA,Smith B,Peruzzi WT,American College of Critical Care Medicine, Society of Critical Care Medicine.

    更新日期:2003-11-01 00:00:00

  • Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing.

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    journal_title:Critical care medicine

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    doi:10.1097/CCM.0000000000003773

    authors: Bakhru RN,Basner M,Kerlin MP,Halpern SD,Hansen-Flaschen J,Rosen IM,Dinges DF,Schweickert WD

    更新日期:2019-07-01 00:00:00

  • Streptococcus pneumoniae and Pseudomonas aeruginosa pneumonia induce distinct host responses.

    abstract:OBJECTIVE:Pathogens that cause pneumonia may be treated in a targeted fashion by antibiotics, but if this therapy fails, then treatment involves only nonspecific supportive measures, independent of the inciting infection. The purpose of this study was to determine whether host response is similar after disparate infect...

    journal_title:Critical care medicine

    pub_type: 杂志文章

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    更新日期:2010-01-01 00:00:00