scholarly journals Perbedaan Sedasi Midazolam dan Ketamin terhadap Base Excess Pasien dengan Ventilator

2014 ◽  
Vol 6 (1) ◽  
pp. 47-55
Author(s):  
Eka Adhiany ◽  
Heru Dwi Jatmiko ◽  
Uripno Budiono
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Base Excess ◽  
Ramsay Score

Latar belakang: Agitasi dan kecemasan sering terjadi pada pasien-pasien Intensive Care Unit (ICU). Kejadian kecemasan berkisar di atas 70% dari pasien-pasien ICU). Ini membutuhkan pemberian obat sedasi dan analgesia. Obat sedasi yang dapat digunakan antara lain midazolam dan ketamin. Kedua obat ini memiliki perbedaan dalam efek ke pembuluh darah.Tujuan: Untuk menemukan perbedaan nilai base excess (BE) melalui analisa gas darah arteri pasien ICU yang menggunakan midazolam dibandingkan dengan ketamin sebagai sedasi.Metode: Suatu uji klinik eksperimental yang dilakukan secara acak tersamar ganda pada pasien yang menggunakan ventilator di unit rawat intensif. Pasien (n : 28) dibagi menjadi 2 kelompok, K1 yang mendapat sedasi ketamin dan K2 mendapat midazolam. Pasien diberikan sedasi selama 24 jam dengan dosis bervariasi dengan target kedalaman sedasi pasien pada Ramsay Score 4, kemudian diperiksa nilai analisis gas darah pada jam ke-0, 6, dan 24.Hasil: Hasil perbandingan sedasi midazolam dengan ketamin ini menunjukkan perbedaan bermakna pada nilai base excess yang menggunakan sedasi ketamin jam ke-0 dan jam ke-6 saja dengan nilai p=0,04 (p<0.05), sedangkan untuk jam ke-0 dan jam ke-24 didapatkan perbedaan yang tidak bermakna dimana p=0,55, dan untuk jam ke-6 dan jam ke-24 juga didapatkan perbedaan yang tidak bermakna dimana p=0,786.Simpulan: Tidak ada perbedaan yang bermakna pada hasil pemeriksaan base excess darah arteri pada pasien menggunakan ventilator dalam 24 jam yang diberikan midazolam dibandingkan dengan ketamin.

scholarly journals Hypernatremia is common in patients with severe COVID-19 and indicates a poor prognosis

2020 ◽  
Author(s):  
Anna Sjöström ◽  
Susanne Rysz ◽  
Henrik Sjöström ◽  
Charlotte Höybye
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort ◽  
Poor Prognosis ◽  
Base Excess ◽  
Electrolyte Imbalance ◽  
Electrolyte Balance ◽  
Important Indicator ◽  
Treatment Of Hypertension

Abstract Background: Fluid homeostasis, including electrolyte balance, is dependent on an interaction between the renin-angiotensin-aldosterone system (RAAS) and the release of arginine vasopressin from the pituitary. An imbalance can lead to both hypo- and hypernatremia. We investigated the frequency, dynamics and severity of electrolyte imbalance in critically ill patients with COVID-19. Methods: In this retrospective cohort study 223 patients with confirmed COVID-19, treated at the intensive care unit (ICU), were included. Levels of electrolytes, base excess, pH and serum osmolality were collected from the laboratory database. Clinical data was retrieved from patients’ medical records.Results: Hyponatremia was present in 63% of the patients, at admission. Within two weeks of hospitalization, 65% of the patients developed hypernatremia often combined with a rise of base excess. The mortality rate was twice as high in the group with hypernatremia compared to the patients not developing hypernatremia. Treatment of hypertension before the onset of COVID-19 was more common in patients without hypernatremia.Conclusion: Our study shows that hypernatremia is very common in severe COVID-19. Patients that developed hypernatremia needed longer time in ICU and had a higher risk of dying, suggesting that the level of sodium is an important indicator of severity in COVID-19.

Characteristics Associated With Unplanned Extubations in a Surgical Intensive Care Unit

2008 ◽  
Vol 17 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Kim Curry ◽  
Sarah Cobb ◽  
Mary Kutash ◽  
Crystal Diggs
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Care Nurse ◽  
Unplanned Extubations ◽  
Scale Scores ◽  
Sedation And Analgesia ◽  
Low Levels ◽  
Ramsay Score

Background Unplanned extubations can result in serious complications. Objectives To determine characteristics of patients and nurses and risk factors that affect extubations. Methods A retrospective exploratory design was used. Ram-say Sedation Scale scores, need for reintubation, time between intubation and extubation, use of sedation and analgesia in the preceding 48 hours, and use of restraints were collected on 31 patients in a surgical intensive care unit who had unplanned extubations. For nurses, data collected included years’ experience in nursing and as an intensive care nurse, professional credentials, and location at the time of extubation. Results All unplanned extubations were self-extubations; 15 required reintubation. Most patients had low levels of sedation in the hour preceding the extubation (mean Ramsay score, 2.42; SD, 1.06). Patients who needed reintubation had higher mean Ramsay scores (2.85; SD, 1.14) than patients who did not (2.00; SD, 0.86; P = .04). Ramsay scores correlated with need for reintubation (r=0.423; P=.03). Of the 31 patients, 27 (87%) were restrained at the time of extubation (χ2 = 17.06; df=1; P&lt;.001). Among the nurses, 32.3% had less than 5 years’ experience in nursing, and 51.6% had less than 5 years’ experience in intensive care; 89% of extubations occurred when the nurse was away from the bedside. Sedative and analgesic doses in the 24 hours before extubation did not differ significantly from those in the 2 hours before extubation. Conclusions Levels of sedation and use of restraints are associated with unplanned extubations and need for reintubation.

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

2019 ◽  
Vol 4 (6) ◽  
pp. 1507-1515
Author(s):  
Lauren L. Madhoun ◽  
Robert Dempster
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Hospital Discharge ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
Medical Attention ◽  
Primary Role ◽  
Speech Language Pathologists ◽  
The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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