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ORIGINAL ARTICLE
A target trial emulation of dexmedetomidine to treat agitation in the intensive care unit
- Ary Serpa Neto
, - Marcus Young ,
- Atthaphong Phongphithakchai ,
- Akinori Maeda ,
- Yukiko Hikasa , [ ... ],
- Rinaldo Bellomo
03-14-2025
Abstract
ORIGINAL ARTICLEA target trial emulation of dexmedetomidine to treat agitation in the intensive care unit
Critical Care Science. 2025;37:e20250010
03-14-2025DOI 10.62675/2965-2774.20250010
- Ary Serpa Neto ,
- Marcus Young ,
- Atthaphong Phongphithakchai ,
- Akinori Maeda ,
- Yukiko Hikasa ,
- Nuttapol Pattamin ,
- Nuanprae Kitisin ,
- Gehan Premaratne ,
- Gabriel Chan ,
- Joseph Furler ,
- Meg Stevens ,
- Dinesh Pandey ,
- Hossein Jahanabadi ,
- Yahya Shehabi ,
- Rinaldo Bellomo
Views118See moreABSTRACT
Objective
Agitation is a major problem in the intensive care unit. However, no treatment has clearly emerged as effective and safe. Using target trial emulation, we aimed to test the hypothesis that early intervention with dexmedetomidine would accelerate agitation resolution.
Methods
We read clinical notes in an electronic medical records system with natural language processing to identify patients with agitation. We obtained their demographics, trajectories, associations, and outcomes. We used g-formulas to study the possible effects of dexmedetomidine on agitation resolution and key outcomes.
Results
We screened 7525 patients. Overall, 2242 patients (29.8%) developed within-intensive care unit agitation, and 2052 (27.3%) were eligible for inclusion in the target trial emulation, with 314 treated with dexmedetomidine. Dexmedetomidine-treated patients had more severe illness and were more likely to have unplanned emergency admissions with medical diagnoses. However, they achieved higher rates of resolution of within-intensive care unit agitation (94% versus 72%; p < 0.001) and lower 30-day mortality (5% versus 9%; p = 0.033). Early initiation of dexmedetomidine accelerated the resolution of agitation (risk ratio [RR] 1.13 [95%CI 1.03 - 1.21]; risk difference [RD] 9.8% [95%CI 2.6% - 15.4%]); extubation by Day 30 (RR 1.03 [95%CI 1.02 - 1.04]; RD 3.1% [95%CI 2.2% - 4.2%]); and reduced the chance of having a tracheostomy by Day 30 (RR 0.67 [95%CI 0.34 - 0.99]; RD -3.5% [95%CI -7.0% - -0.0%])
Conclusion
Through target trial emulation analysis, early dexmedetomidine was associated with an increased rate of resolution of agitation and extubation and decreased tracheostomy risk.
Views118
Abstract
ORIGINAL ARTICLEA target trial emulation of dexmedetomidine to treat agitation in the intensive care unit
Critical Care Science. 2025;37:e20250010
03-14-2025DOI 10.62675/2965-2774.20250010
- Ary Serpa Neto ,
- Marcus Young ,
- Atthaphong Phongphithakchai ,
- Akinori Maeda ,
- Yukiko Hikasa ,
- Nuttapol Pattamin ,
- Nuanprae Kitisin ,
- Gehan Premaratne ,
- Gabriel Chan ,
- Joseph Furler ,
- Meg Stevens ,
- Dinesh Pandey ,
- Hossein Jahanabadi ,
- Yahya Shehabi ,
- Rinaldo Bellomo
Views118See moreABSTRACT
Objective
Agitation is a major problem in the intensive care unit. However, no treatment has clearly emerged as effective and safe. Using target trial emulation, we aimed to test the hypothesis that early intervention with dexmedetomidine would accelerate agitation resolution.
Methods
We read clinical notes in an electronic medical records system with natural language processing to identify patients with agitation. We obtained their demographics, trajectories, associations, and outcomes. We used g-formulas to study the possible effects of dexmedetomidine on agitation resolution and key outcomes.
Results
We screened 7525 patients. Overall, 2242 patients (29.8%) developed within-intensive care unit agitation, and 2052 (27.3%) were eligible for inclusion in the target trial emulation, with 314 treated with dexmedetomidine. Dexmedetomidine-treated patients had more severe illness and were more likely to have unplanned emergency admissions with medical diagnoses. However, they achieved higher rates of resolution of within-intensive care unit agitation (94% versus 72%; p < 0.001) and lower 30-day mortality (5% versus 9%; p = 0.033). Early initiation of dexmedetomidine accelerated the resolution of agitation (risk ratio [RR] 1.13 [95%CI 1.03 - 1.21]; risk difference [RD] 9.8% [95%CI 2.6% - 15.4%]); extubation by Day 30 (RR 1.03 [95%CI 1.02 - 1.04]; RD 3.1% [95%CI 2.2% - 4.2%]); and reduced the chance of having a tracheostomy by Day 30 (RR 0.67 [95%CI 0.34 - 0.99]; RD -3.5% [95%CI -7.0% - -0.0%])
Conclusion
Through target trial emulation analysis, early dexmedetomidine was associated with an increased rate of resolution of agitation and extubation and decreased tracheostomy risk.
- Ary Serpa Neto
-
ORIGINAL ARTICLE
Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial
- Anjishnujit Bandyopadhyay ,
- Lakshmi Narayana Yaddanapudi ,
- Vikas Saini ,
- Neeru Sahni ,
- Sandeep Grover , [ ... ],
- Vighnesh Ashok
04-09-2024
Abstract
ORIGINAL ARTICLEEfficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial
Critical Care Science. 2024;36:e20240144en
04-09-2024DOI 10.62675/2965-2774.20240144-en
- Anjishnujit Bandyopadhyay ,
- Lakshmi Narayana Yaddanapudi ,
- Vikas Saini ,
- Neeru Sahni ,
- Sandeep Grover ,
- Sunaakshi Puri ,
- Vighnesh Ashok
Views128See moreABSTRACT
Objective:
To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults.
Methods:
In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge).
Results:
We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 - 1.05; p = 0.11). No secondary outcome showed a statistically significant difference.
Conclusion:
Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.
Views128Abstract
ORIGINAL ARTICLEEfficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial
Critical Care Science. 2024;36:e20240144en
04-09-2024DOI 10.62675/2965-2774.20240144-en
- Anjishnujit Bandyopadhyay ,
- Lakshmi Narayana Yaddanapudi ,
- Vikas Saini ,
- Neeru Sahni ,
- Sandeep Grover ,
- Sunaakshi Puri ,
- Vighnesh Ashok
Views128See moreABSTRACT
Objective:
To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults.
Methods:
In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge).
Results:
We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 - 1.05; p = 0.11). No secondary outcome showed a statistically significant difference.
Conclusion:
Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.
- Anjishnujit Bandyopadhyay
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ORIGINAL ARTICLE
Delirium severity and outcomes of critically ill COVID-19 patients
- Luciana Leal do Rego ,
- Jorge Ibrain Figueira Salluh ,
- Vicente Cés de Souza-Dantas ,
- José Roberto Lapa e Silva ,
- Pedro Póvoa , [ ... ],
- Rodrigo Bernardo Serafim
01-17-2023
Abstract
ORIGINAL ARTICLEDelirium severity and outcomes of critically ill COVID-19 patients
Critical Care Science. 2023;35(4):394-401
01-17-2023DOI 10.5935/2965-2774.20230170-en
- Luciana Leal do Rego ,
- Jorge Ibrain Figueira Salluh ,
- Vicente Cés de Souza-Dantas ,
- José Roberto Lapa e Silva ,
- Pedro Póvoa ,
- Rodrigo Bernardo Serafim
Views41ABSTRACT
Objective:
To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes.
Methods:
This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality.
Results:
Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty.
Conclusion:
In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.
Keywords:Coronavirus infectionsCOVID-19Critical care outcomescritical illnessdeliriumintensive care unitsprognosisPsychiatric status rating scalesrisk factorsSurveys and questionnairesSee moreViews41Abstract
ORIGINAL ARTICLEDelirium severity and outcomes of critically ill COVID-19 patients
Critical Care Science. 2023;35(4):394-401
01-17-2023DOI 10.5935/2965-2774.20230170-en
- Luciana Leal do Rego ,
- Jorge Ibrain Figueira Salluh ,
- Vicente Cés de Souza-Dantas ,
- José Roberto Lapa e Silva ,
- Pedro Póvoa ,
- Rodrigo Bernardo Serafim
Views41ABSTRACT
Objective:
To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes.
Methods:
This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality.
Results:
Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty.
Conclusion:
In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.
Keywords:Coronavirus infectionsCOVID-19Critical care outcomescritical illnessdeliriumintensive care unitsprognosisPsychiatric status rating scalesrisk factorsSurveys and questionnairesSee more
- Luciana Leal do Rego
-
ORIGINAL ARTICLE
Translation and cross-cultural adaptation of the anchor points of the Cornell Assessment of Pediatric Delirium scale into Portuguese
- Marina dos Santos Ramos Barbosa ,
- Lívia Barboza Andrade ,
- Maria do Carmo Menezes Bezerra Duarte ,
- Roberta Esteves Vieira de Castro
12-22-2023
Abstract
ORIGINAL ARTICLETranslation and cross-cultural adaptation of the anchor points of the Cornell Assessment of Pediatric Delirium scale into Portuguese
Critical Care Science. 2023;35(3):320-327
12-22-2023DOI 10.5935/2965-2774.20230165-en
- Marina dos Santos Ramos Barbosa ,
- Lívia Barboza Andrade ,
- Maria do Carmo Menezes Bezerra Duarte ,
- Roberta Esteves Vieira de Castro
Views39See moreABSTRACT
Objective:
To translate and cross-culturally adapt the Cornell Assessment of Pediatric Delirium anchor points from English to Brazilian Portuguese.
Methods:
For the translation and cross-cultural adaptation of the anchor points, all steps recommended internationally were followed after authorization for use by the lead author. The stages were as follows: translation of the original version into Portuguese by two bilingual translators who were native speakers of the target language, synthesis of the versions, reverse translation by two translators who were native speakers of the source language, review and synthesis of the back-translation, review by a committee of experts and preparation of the final version.
Results:
The translation and cross-cultural adaptation of the anchor points was conducted in accordance with recommendations. The linguistic and semantic issues that arose were discussed by a committee of judges, with 91.8% agreement, as determined using a Likert scale, after changes by consensus. After reanalysis by the authors, there were no changes, resulting in the final version, which was easy to understand and administer.
Conclusion:
The translation and cross-cultural adaptation of the anchor points of the Cornell Assessment of Pediatric Delirium scale into Portuguese spoken in Brazil were successful, maintaining the linguistic and semantic properties of the original instrument. The table of anchor points is easy to understand and will be helpful during the assessment of children younger than 24 months using the Cornell Assessment of Pediatric Delirium scale.
Views39Abstract
ORIGINAL ARTICLETranslation and cross-cultural adaptation of the anchor points of the Cornell Assessment of Pediatric Delirium scale into Portuguese
Critical Care Science. 2023;35(3):320-327
12-22-2023DOI 10.5935/2965-2774.20230165-en
- Marina dos Santos Ramos Barbosa ,
- Lívia Barboza Andrade ,
- Maria do Carmo Menezes Bezerra Duarte ,
- Roberta Esteves Vieira de Castro
Views39See moreABSTRACT
Objective:
To translate and cross-culturally adapt the Cornell Assessment of Pediatric Delirium anchor points from English to Brazilian Portuguese.
Methods:
For the translation and cross-cultural adaptation of the anchor points, all steps recommended internationally were followed after authorization for use by the lead author. The stages were as follows: translation of the original version into Portuguese by two bilingual translators who were native speakers of the target language, synthesis of the versions, reverse translation by two translators who were native speakers of the source language, review and synthesis of the back-translation, review by a committee of experts and preparation of the final version.
Results:
The translation and cross-cultural adaptation of the anchor points was conducted in accordance with recommendations. The linguistic and semantic issues that arose were discussed by a committee of judges, with 91.8% agreement, as determined using a Likert scale, after changes by consensus. After reanalysis by the authors, there were no changes, resulting in the final version, which was easy to understand and administer.
Conclusion:
The translation and cross-cultural adaptation of the anchor points of the Cornell Assessment of Pediatric Delirium scale into Portuguese spoken in Brazil were successful, maintaining the linguistic and semantic properties of the original instrument. The table of anchor points is easy to understand and will be helpful during the assessment of children younger than 24 months using the Cornell Assessment of Pediatric Delirium scale.
- Marina dos Santos Ramos Barbosa
-
ORIGINAL ARTICLE
Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study
- Franciani Rodrigues da Rocha ,
- Renata Casagrande Gonçalves ,
- Gabriele da Silveira Prestes ,
- Danusa Damásio ,
- Amanda Indalécio Goulart, [ ... ],
- Felipe Dal-Pizzol
08-07-2023
Abstract
ORIGINAL ARTICLEBiomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study
Critical Care Science. 2023;35(2):147-155
08-07-2023DOI 10.5935/2965-2774.20230422-en
- Franciani Rodrigues da Rocha ,
- Renata Casagrande Gonçalves ,
- Gabriele da Silveira Prestes ,
- Danusa Damásio ,
- Amanda Indalécio Goulart,
- Andriele Aparecida da Silva Vieira ,
- Monique Michels ,
- Maria Inês da Rosa ,
- Cristiane Ritter ,
- Felipe Dal-Pizzol
Views53ABSTRACT
Objective:
To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit.
Methods:
A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aβ (1-42)], Aβ (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge.
Results:
Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder.
Conclusion:
Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.
Keywords:AnxietyBiomarkersCognitive dysfunctionCritical care outcomescritical illnessdeliriumDepressionintensive care unitsPatient dischargeSee moreViews53Abstract
ORIGINAL ARTICLEBiomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study
Critical Care Science. 2023;35(2):147-155
08-07-2023DOI 10.5935/2965-2774.20230422-en
- Franciani Rodrigues da Rocha ,
- Renata Casagrande Gonçalves ,
- Gabriele da Silveira Prestes ,
- Danusa Damásio ,
- Amanda Indalécio Goulart,
- Andriele Aparecida da Silva Vieira ,
- Monique Michels ,
- Maria Inês da Rosa ,
- Cristiane Ritter ,
- Felipe Dal-Pizzol
Views53ABSTRACT
Objective:
To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit.
Methods:
A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aβ (1-42)], Aβ (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge.
Results:
Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder.
Conclusion:
Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.
Keywords:AnxietyBiomarkersCognitive dysfunctionCritical care outcomescritical illnessdeliriumDepressionintensive care unitsPatient dischargeSee more
- Franciani Rodrigues da Rocha
-
ORIGINAL ARTICLE
Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study
- Maria Carolina Paulino ,
- Isabel Jesus Pereira ,
- Vasco Costa ,
- Aida Neves ,
- Anabela Santos, [ ... ],
- Cristina Granja
08-08-2022
Abstract
ORIGINAL ARTICLESedation, analgesia, and delirium management in Portugal: a survey and point prevalence study
Revista Brasileira de Terapia Intensiva. 2022;34(2):227-236
08-08-2022DOI 10.5935/0103-507X.20220020-en
- Maria Carolina Paulino ,
- Isabel Jesus Pereira ,
- Vasco Costa ,
- Aida Neves ,
- Anabela Santos,
- Carla Margarida Teixeira ,
- Isabel Coimbra ,
- Paula Fernandes ,
- Ricardo Bernardo,
- Pedro Póvoa,
- Cristina Granja
Views45See moreABSTRACT
Objective:
To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice.
Methods:
A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices.
Results:
A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%.
Conclusion:
The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.
Views45Abstract
ORIGINAL ARTICLESedation, analgesia, and delirium management in Portugal: a survey and point prevalence study
Revista Brasileira de Terapia Intensiva. 2022;34(2):227-236
08-08-2022DOI 10.5935/0103-507X.20220020-en
- Maria Carolina Paulino ,
- Isabel Jesus Pereira ,
- Vasco Costa ,
- Aida Neves ,
- Anabela Santos,
- Carla Margarida Teixeira ,
- Isabel Coimbra ,
- Paula Fernandes ,
- Ricardo Bernardo,
- Pedro Póvoa,
- Cristina Granja
Views45See moreABSTRACT
Objective:
To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice.
Methods:
A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices.
Results:
A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%.
Conclusion:
The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.
- Maria Carolina Paulino
-
ORIGINAL ARTICLE
Delirium and quality of life in critically ill patients: a prospective cohort study
- Lúcia Fabiane da Silva Luz,
- Moreno Calcagnotto dos Santos,
- Tiago Almeida Ramos,
- Clarissa Balbão de Almeida,
- Márcia Cristina Rover, [ ... ],
- Márcio Manozzo Boniatti
10-12-2020
Abstract
ORIGINAL ARTICLEDelirium and quality of life in critically ill patients: a prospective cohort study
Revista Brasileira de Terapia Intensiva. 2020;32(3):426-432
10-12-2020DOI 10.5935/0103-507X.20200072
- Lúcia Fabiane da Silva Luz,
- Moreno Calcagnotto dos Santos,
- Tiago Almeida Ramos,
- Clarissa Balbão de Almeida,
- Márcia Cristina Rover,
- Claudia Pellizzer Dal’Pizzol,
- Cristiane Letícia da Silva Pohren,
- Aline Vanessa da Silva Martins,
- Márcio Manozzo Boniatti
Views46Abstract
Objective:
To evaluate the association between the incidence of delirium in the intensive care unit and quality of life 1 month after hospital discharge.
Methods:
This was a prospective cohort study conducted in the intensive care units of two medium-complexity hospitals from December 2015 to December 2016. Delirium was identified using the Confusion Assessment Method for the Intensive Care Unit scale. At the time of hospital discharge, functional capacity and cognition were assessed with the Barthel index and the Mini Mental State Examination, respectively. Thirty days after patient discharge, the World Health Organization Quality of Life-BREF questionnaire was administered by telephone.
Results:
A total of 216 patients were included. Delirium was identified in 127 (58.8%) of them. Patients with delirium exhibited greater functional dependence (median Barthel index 50.0 [21.2 - 70.0] versus 80.0 [60.0 - 95.0]; p < 0.001) and lower cognition (Mini Mental State Examination score 12.9 ± 7.5 versus 20.7 ± 9.8; p < 0.001) at hospital discharge. There was no difference in any of the quality-of-life domains evaluated 1 month after hospital discharge between patients with and without delirium.
Conclusion:
Our findings suggest that patients with delirium in the intensive care unit do not have worse quality of life 1 month after hospital discharge, despite presenting greater cognitive impairment and functional disability at the time of hospital discharge.
Keywords:Cognitiondeliriumintensive care unitsPatient dischargePhysical functional performanceQuality of lifeSee moreViews46Abstract
ORIGINAL ARTICLEDelirium and quality of life in critically ill patients: a prospective cohort study
Revista Brasileira de Terapia Intensiva. 2020;32(3):426-432
10-12-2020DOI 10.5935/0103-507X.20200072
- Lúcia Fabiane da Silva Luz,
- Moreno Calcagnotto dos Santos,
- Tiago Almeida Ramos,
- Clarissa Balbão de Almeida,
- Márcia Cristina Rover,
- Claudia Pellizzer Dal’Pizzol,
- Cristiane Letícia da Silva Pohren,
- Aline Vanessa da Silva Martins,
- Márcio Manozzo Boniatti
Views46Abstract
Objective:
To evaluate the association between the incidence of delirium in the intensive care unit and quality of life 1 month after hospital discharge.
Methods:
This was a prospective cohort study conducted in the intensive care units of two medium-complexity hospitals from December 2015 to December 2016. Delirium was identified using the Confusion Assessment Method for the Intensive Care Unit scale. At the time of hospital discharge, functional capacity and cognition were assessed with the Barthel index and the Mini Mental State Examination, respectively. Thirty days after patient discharge, the World Health Organization Quality of Life-BREF questionnaire was administered by telephone.
Results:
A total of 216 patients were included. Delirium was identified in 127 (58.8%) of them. Patients with delirium exhibited greater functional dependence (median Barthel index 50.0 [21.2 - 70.0] versus 80.0 [60.0 - 95.0]; p < 0.001) and lower cognition (Mini Mental State Examination score 12.9 ± 7.5 versus 20.7 ± 9.8; p < 0.001) at hospital discharge. There was no difference in any of the quality-of-life domains evaluated 1 month after hospital discharge between patients with and without delirium.
Conclusion:
Our findings suggest that patients with delirium in the intensive care unit do not have worse quality of life 1 month after hospital discharge, despite presenting greater cognitive impairment and functional disability at the time of hospital discharge.
Keywords:Cognitiondeliriumintensive care unitsPatient dischargePhysical functional performanceQuality of lifeSee more
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ORIGINAL ARTICLE
Practices for promoting sleep in intensive care units in Brazil: a national survey
Revista Brasileira de Terapia Intensiva. 2020;32(2):268-276
07-13-2020
Abstract
ORIGINAL ARTICLEPractices for promoting sleep in intensive care units in Brazil: a national survey
Revista Brasileira de Terapia Intensiva. 2020;32(2):268-276
07-13-2020DOI 10.5935/0103-507X.20200043
Views50See moreABSTRACT
Objective:
To conduct a national survey of intensive care professionals to identify the practices for promoting sleep in adult intensive care units in Brazil and describe the professionals’ perceptions of the importance of sleep for patients.
Methods:
An electronic questionnaire was distributed by the clinical research cooperation network of the Associação de Medicina Intensiva Brasileira and by the Brazilian Research in Intensive Care Network to physicians and nurses registered with the association. The questionnaire evaluated the profile of the respondents, the profile of their intensive care units, whether protocols for promoting sleep were present, the pharmacological and nonpharmacological measures typically employed in the unit, and the professionals’ perceptions regarding sleep in critically ill patients.
Results:
A total of 118 questionnaires were evaluated. The Southeast region of the country was the most represented (50 questionnaires, 42.4%). The majority of units had a clinical-surgical profile (93 questionnaires; 78.8%), and 26 had a continuous visitation policy (22.0%). Only 18 intensive care units (15.3%) reported having protocols for promoting sleep. The most cited measure for sleep promotion was reducing light during the night (95 questionnaires; 80.5%), which was more often performed in private intensive care units. Almost all of the responders (99%) believed that poor-quality sleep has a negative impact on patient recovery.
Conclusion:
The responses to this Brazilian survey revealed that few intensive care units had a program for promoting sleep, although almost all participants recognized the importance of sleep in patient recovery.
Views50Abstract
ORIGINAL ARTICLEPractices for promoting sleep in intensive care units in Brazil: a national survey
Revista Brasileira de Terapia Intensiva. 2020;32(2):268-276
07-13-2020DOI 10.5935/0103-507X.20200043
Views50See moreABSTRACT
Objective:
To conduct a national survey of intensive care professionals to identify the practices for promoting sleep in adult intensive care units in Brazil and describe the professionals’ perceptions of the importance of sleep for patients.
Methods:
An electronic questionnaire was distributed by the clinical research cooperation network of the Associação de Medicina Intensiva Brasileira and by the Brazilian Research in Intensive Care Network to physicians and nurses registered with the association. The questionnaire evaluated the profile of the respondents, the profile of their intensive care units, whether protocols for promoting sleep were present, the pharmacological and nonpharmacological measures typically employed in the unit, and the professionals’ perceptions regarding sleep in critically ill patients.
Results:
A total of 118 questionnaires were evaluated. The Southeast region of the country was the most represented (50 questionnaires, 42.4%). The majority of units had a clinical-surgical profile (93 questionnaires; 78.8%), and 26 had a continuous visitation policy (22.0%). Only 18 intensive care units (15.3%) reported having protocols for promoting sleep. The most cited measure for sleep promotion was reducing light during the night (95 questionnaires; 80.5%), which was more often performed in private intensive care units. Almost all of the responders (99%) believed that poor-quality sleep has a negative impact on patient recovery.
Conclusion:
The responses to this Brazilian survey revealed that few intensive care units had a program for promoting sleep, although almost all participants recognized the importance of sleep in patient recovery.
delirium Archives - Critical Care Science (CCS)
