scholarly journals 1039 Sleep And Daytime Activity Among Mechanically Ventilated Adults During Early Critical Illness

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A395-A395
Author(s):  
Z Liang ◽  
M N Elias ◽  
M Ji ◽  
C L Munro
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Controlled Trial ◽  
Activity Patterns ◽  
Activity Count ◽  
Federal Grant ◽  
Mechanically Ventilated ◽  
Daytime Activity ◽  
The Mean ◽  
Rest Activity

Abstract Introduction The purpose of this study is to report 5 consecutive days’ descriptive data for sleep efficiency (SE), total sleep time (TST), and daytime activity ratio (DAR) among critically ill mechanically ventilated adults from 9 intensive care units (ICU) across two hospitals. To our knowledge, this is the first study to describe sleep and activity patterns among mechanically ventilated adults during the early critical illness period. Methods We enrolled 31 critically ill mechanically ventilated subjects within 48 hours of ICU admission. Daytime periods were defined as 06:00-21:59; nighttime periods were defined as 22:00-05:59. Actigraphy estimated nighttime SE, TST, and the DAR. We calculated mean DARs [DAR = (daytime activity count per minute / 24-hour activity count per minute) x 100], which may be an indicator of altered rest/activity cycles. In our study, a DAR of >80% was used to define normal rest/activity patterns. Descriptive analyses were used for this sub-analysis of our parent randomized controlled trial. Results Among the 31 subjects included, the mean age was 59.6 ± 17.3 years, 41.9% were male, 80.6% were White, and 67.7% were Hispanic/Latino. The mean nighttime SE and TST over the 5-day ICU period were 83.1% ± 16.1 and 6.6 ± 1.3 hours, respectively. The mean DAR over the 5-day ICU period was 66.5% ± 19.2. Only 17.5% of subject days (14 days out of a total of 80 recorded days) met the definition of normal rest/activity patterns (DAR >80%). Conclusion Throughout the early ICU period, among mechanically ventilated patients, both the sleep/wake as well as the rest/activity cycle were disturbed. Intervention studies targeting the optimization of nighttime sleep consolidation and daytime activity should be investigated. Support This project was supported by a federal grant from the National Institutes of Health/National Institute of Nursing Research (R01NR016702). This clinical trial is registered with ClinicalTrials.gov (NCT03128671).

scholarly journals Association between early fluid overload and mortality in critically-ill mechanically ventilated children: a single-center retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiangmei Kong ◽  
Yueniu Zhu ◽  
Xiaodong Zhu
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Fluid Overload ◽  
Pediatric Intensive Care ◽  
Multiple Organ ◽  
Mechanically Ventilated ◽  
The Mean ◽  
Severity Of The Disease ◽  
Early Fluid ◽  
The Relationship

Abstract Background Positive fluid overload (FO) may cause adverse effect. This study retrospectively analyzed the relationship between early FO and in-hospital mortality in children with mechanical ventilation (MV) in pediatric intensive care unit (PICU). Methods This study retrospectively enrolled 309 children (ages 28 days to 16 years) receiving invasive MV admitted to the PICU of Xinhua Hospital from March 2014 to March 2019. Children receiving MV for less than 48 h were excluded. The FO in the first 3 days of MV was considered to the early FO. Patients were divided into groups according to early FO and survival to evaluate the associations of early FO, percentage FO(%FO) > 10%, and %FO > 20% with in-hospital mortality. Results A total of 309 patients were included. The mean early FO was 8.83 ± 8.81%, and the mortality in hospital was 26.2% (81/309). There were no significant differences in mortality among different FO groups (P = 0.053) or in early FO between survivors and non-survivors (P = 0.992). Regression analysis demonstrated that use of more vasoactive drugs, the presence of multiple organ dysfunction syndrome, longer duration of MV, and a non-operative reason for PICU admission were related to increased mortality (P < 0.05). Although early FO and %FO > 10% were not associated with in-hospital mortality (β = 0.030, P = 0.090, 95% CI = 0.995–1.067; β = 0.479, P = 0.153, 95% CI = 0.837–3.117), %FO > 20% was positively correlated with mortality (β = 1.057, OR = 2.878, P = 0.029, 95% CI = 1.116–7.418). Conclusions The correlation between early FO and mortality was affected by interventions and the severity of the disease, but %FO > 20% was an independent risk factor for in-hospital mortality in critically ill MV-treated children.

scholarly journals High sedation needs of critically ill COVID-19 ARDS patients—A monocentric observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253778
Author(s):  
Armin Niklas Flinspach ◽  
Hendrik Booke ◽  
Kai Zacharowski ◽  
Ümniye Balaban ◽  
Eva Herrmann ◽  
...  
Keyword(s):  
Critically Ill ◽  
Distress Syndrome ◽  
Demographic Data ◽  
Prone Positioning ◽  
Mixed Effect ◽  
Mechanically Ventilated ◽  
Global Pandemic ◽  
Potential Association ◽  
The Mean ◽  
Sedation Regimen

Background Therapy of severely affected coronavirus patient, requiring intubation and sedation is still challenging. Recently, difficulties in sedating these patients have been discussed. This study aims to describe sedation practices in patients with 2019 coronavirus disease (COVID-19)-induced acute respiratory distress syndrome (ARDS). Methods We performed a retrospective monocentric analysis of sedation regimens in critically ill intubated patients with respiratory failure who required sedation in our mixed 32-bed university intensive care unit. All mechanically ventilated adults with COVID-19-induced ARDS requiring continuously infused sedative therapy admitted between April 4, 2020, and June 30, 2020 were included. We recorded demographic data, sedative dosages, prone positioning, sedation levels and duration. Descriptive data analysis was performed; for additional analysis, a logistic regression with mixed effect was used. Results In total, 56 patients (mean age 67 (±14) years) were included. The mean observed sedation period was 224 (±139) hours. To achieve the prescribed sedation level, we observed the need for two or three sedatives in 48.7% and 12.8% of the cases, respectively. In cases with a triple sedation regimen, the combination of clonidine, esketamine and midazolam was observed in most cases (75.7%). Analgesia was achieved using sufentanil in 98.6% of the cases. The analysis showed that the majority of COVID-19 patients required an unusually high sedation dose compared to those available in the literature. Conclusion The global pandemic continues to affect patients severely requiring ventilation and sedation, but optimal sedation strategies are still lacking. The findings of our observation suggest unusual high dosages of sedatives in mechanically ventilated patients with COVID-19. Prescribed sedation levels appear to be achievable only with several combinations of sedatives in most critically ill patients suffering from COVID-19-induced ARDS and a potential association to the often required sophisticated critical care including prone positioning and ECMO treatment seems conceivable.

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