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 Medjournal_title
Critical care medicineauthors
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 Clinicaldoi
10.1097/CCM.0b013e31828a437dsubject
Has Abstractpub_date
2013-08-01 00:00:00pages
1983-91issue
8eissn
0090-3493issn
1530-0293pii
00003246-201308000-00019journal_volume
41pub_type
杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:The association between cigarette smoke exposure and the acute respiratory distress syndrome in patients with the most common acute respiratory distress syndrome risk factors of sepsis, pneumonia, and aspiration has not been well studied. The goal of this study was to test the association between biomarker-co...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001089
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:To investigate glycemic dynamics and its relation with mortality in critically ill patients. We searched for differences in complexity of the glycemic profile between survivors and nonsurvivors in patients admitted to a multidisciplinary intensive care unit. DESIGN:Prospective, observational study, convenien...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181ce49cf
更新日期:2010-03-01 00:00:00
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
更新日期:1991-11-01 00:00:00
abstract::The effect of positive-pressure ventilation (PPV) with PEEP on the release of alpha-atrial natriuretic peptide (ANP) was investigated in both humans and an experimental model. In the human study, systemic artery blood samples from 22 critically ill patients were analyzed for ANP. Seventeen of these patients received P...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199008000-00007
更新日期:1990-08-01 00:00:00
abstract:BACKGROUND AND METHODS:A study was performed to examine the effects of the calcium-channel blocker levemopamil on neurologic outcome and neuropathology in a clinically relevant model of complete global cerebral ischemia (ventricular fibrillation in cats). Levemopamil was administered to cats starting 5 mins after resus...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199201000-00025
更新日期:1992-01-01 00:00:00
abstract:OBJECTIVE:Circulating serum levels of procalcitonin rise significantly during bacterial infection. Because calcitonin is known to be a monocyte chemoattractant, we investigated whether procalcitonin, a prohormone of calcitonin, also affects leukocyte migration. DESIGN:Prospective, controlled in vitro study. SETTING:U...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200205000-00025
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVE:To define the relative needs of the staffs of rural, community hospitals for training in advanced cardiac life support (ACLS), identify weaknesses, and modify a standard ACLS course to meet these needs. DESIGN:Prospective assessment of knowledge and skills relating to the practice of ACLS. SETTING:Rural, co...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199405000-00006
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVES:Pneumothorax is a frequent complication during mechanical ventilation. Electrical impedance tomography (EIT) is a noninvasive tool that allows real-time imaging of regional ventilation. The purpose of this study was to 1) identify characteristic changes in the EIT signals associated with pneumothoraces; 2) d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31816a0380
更新日期:2008-04-01 00:00:00
abstract::Doppler ultrasound has been used extensively in assessing adequacy of circulation. We have found it to be convenient in the identification of blood flow, particularly in hypotensive states where percutaneous radial artery cannulation of the vessel is tedious and difficult to perform. The technique is simple, atraumati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197611000-00011
更新日期:1976-11-01 00:00:00
abstract:OBJECTIVES:Low tidal volume (= tidal volume ≤ 6 mL/kg, predicted body weight) ventilation using volume control benefits patients with acute respiratory distress syndrome. Airway pressure release ventilation is an alternative to low tidal volume-volume control ventilation, but the release breaths generated are variable ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0000000000003437
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:To examine the relationship between aminoglycoside disposition kinetics and hemodynamic response to sepsis, as well as vital support therapy, in critically ill patients with sepsis. DESIGN:Cross-sectional study of critically ill patients with sepsis undergoing physiologic and aminoglycoside pharmacokinetic m...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199705000-00016
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVES:The main objective of the study was to determine the prevalence of venous thromboembolism events in patients infected with severe acute respiratory syndrome coronavirus 2 requiring venovenous extracorporeal membrane oxygenation. The secondary objective was to compare venous thromboembolism events and coagula...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004504
更新日期:2020-10-01 00:00:00
abstract::High-frequency jet ventilation using a jet injector located at the right mainstem bronchus was superimposed on standard mechanical ventilation to ventilate the injured lung of a patient with unilateral massive atelectasis secondary to pulmonary hemorrhage. This technique of differential ventilation markedly improved a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198409000-00039
更新日期:1984-09-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to examine whether anandamide, an endogenous cannabinoid receptor ligand, is involved in the pathogenesis of septic encephalopathy. DESIGN:Prospective, controlled study. SUBJECTS:Male Wistar rats (7 wks old) were randomly divided into four groups as follows: group 1, control (...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000187010.14426.cc
更新日期:2005-11-01 00:00:00
abstract::Assessment of creatinine clearance (CC) in ICU patients was compared using three methods. The reference method (CC 24 h) used measurements of serum creatinine and urinary creatinine after collection of urine over a 24-h period. The other two methods were predictive methods: the Kampmann nomogram and the formula develo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199011000-00007
更新日期:1990-11-01 00:00:00
abstract:OBJECTIVE:To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. DESIGN:Prospective, randomized, clinical study. SETTING:Three medical inte...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e3181bc8218
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:To assess the influence of private attending physician status on the withdrawal of life-sustaining interventions among patients dying within a medical intensive care unit (ICU). DESIGN:Retrospective cohort analysis. SETTING:An academic tertiary care center. PATIENTS:One hundred fifty-nine consecutive patie...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199606000-00016
更新日期:1996-06-01 00:00:00
abstract::A simple, safe, and effective system for umbilical artery monitoring controls continuous fluid infusion to prevent fluid overinfusion and keep the catheter from clotting. Accurate and continuous pressure measurements can be recorded simultaneously with fluid infusion. A convenient method for checking dynamic response ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198207000-00009
更新日期:1982-07-01 00:00:00
abstract:OBJECTIVE:To determine whether polymorphisms of the surfactant protein B gene may be associated with increased mortality in patients with the acute respiratory distress syndrome. DESIGN:A prospective cohort study. SETTING:Four adult intensive care units at a tertiary academic medical center. PATIENTS:Two hundred fou...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318183f608
更新日期:2008-09-01 00:00:00
abstract:OBJECTIVE:High-frequency oscillation has been proposed for use in adult acute respiratory distress syndrome. However, limited data are available on the effect of pressure amplitude and rate (Hz) on tidal volumes delivered during high-frequency oscillation in adults. DESIGN:Prospective, animal model, lung injury study....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200301000-00035
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVE:To compare four different methods of endotracheal lidocaine administration with respect to the site of administration. DESIGN:Randomized controlled trial. SETTING:University hospital. PATIENTS:Thirty-two female patients (43.6 +/- 11.5 years old) undergoing elective gynecologic operations with an anesthesio...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199107000-00015
更新日期:1991-07-01 00:00:00
abstract::The ICU has been considered a psychologically stressful environment. Although numerous studies have investigated this stress in ICU nurses, virtually none have examined how stressful the ICU is for physicians. This prospective study compares housestaff physicians' ratings of stress in the ICU to other medical-surgical...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198602000-00004
更新日期:1986-02-01 00:00:00
abstract:OBJECTIVE:Toxic free radicals cause dysfunction of respiratory muscles, probably leading to respiratory distress. Exposure to high concentrations of oxygen generates plenty of free radicals. Lidocaine scavenges the reactive molecules. The purposes of the current study were first to examine whether hyperoxia impairs dia...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00048
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:The mitogen-activated protein kinase/extracellular signal-regulated kinase signaling pathway is an essential component of innate immunity necessary for mediating proinflammatory responses in the setting of sepsis. We previously demonstrated that the mitogen-activated protein kinase 1/2 inhibitor trametinib pr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001672
更新日期:2016-08-01 00:00:00
abstract::Doppler ultrasound was used to study cerebral hemodynamics in the pericallosal artery of 21 newborn infants undergoing extracorporeal membrane oxygenation (ECMO) for intractable respiratory failure. Cerebral blood flow velocity waveforms were obtained pre-ECMO, after every major change in cardiopulmonary bypass flow d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199001000-00003
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:To examine the pulmonary and cardiac function of children who survived an episode of acute hypoxemic respiratory failure. DESIGN:Descriptive cohort analysis. SETTING:Pediatric clinical research center of a university hospital. PATIENTS:Utilizing the criteria of PaO2 < 75 torr (< 10 kPa) with an FIO2 of > 0...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199601000-00024
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVES:Palliative care is now recognized as an essential component of comprehensive care in serious illness that interferes with quality of life. We explored utilization of palliative care in spontaneous intracerebral hemorrhage at a population level using a large national database. DESIGN:Population based cross-s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001391
更新日期:2016-03-01 00:00:00
abstract::Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by intravascular fibrin formation occurring in the course of a variety of severe diseases. In gram-negative sepsis, endotoxin is the bacterial component eliciting a cascade of tissue factor dependent hypercoagulable reactions mediated b...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200009001-00003
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVES:To determine the point prevalence of medication errors at the time of transition of care from an ICU to non-ICU location and assess error types and risk factors for medication errors during transition of care. DESIGN:This was a multicenter, retrospective, 7-day point prevalence study. SETTING:Fifty-eight I...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000003633
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVES:Studies have shown that endothelium-dependent relaxation (mediated by endothelium-derived nitric oxide) is depressed during the early, hyperdynamic stage of sepsis. Although it is known that ATP-MgCl2 produces beneficial effects following various adverse circulatory conditions, it remains unknown whether thi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199905000-00035
更新日期:1999-05-01 00:00:00