Long-term Effect of Optimized Sedation and Pain Management after Sudden Cardiac Arrest

Background and Aims: Appropriate use of sedatives and analgesics is essential to keep critically ill patients comfortable and to prevent prolonged mechanical ventilation time and length of stay in ICU. Aim of this study was to analyse the long-term effect of an algorithm-based individual analgesic-sedative protocol on mechanical ventilation time and ICU length of stay in critically ill patients after sudden cardiac arrest due to ST-elevated myocardial infarction. Subject and Methods: We examined a total of 109 patients before and after implementation of an algorithm-based sedation management. Our sedation protocol included individual defined sedation goals achieved by standardized sedation strategies. Mechanical ventilation time and ICU length of stay were analysed for three groups of patients: before and after the intervention and in the long-term follow-up. Results: We observed shorter median mechanical ventilation time and ICU length of stay in the interventional and longterm follow-up group compared to the standard-care group without statistical significance. Conclusion: Our results demonstrate a long-term reduction of mechanical ventilation time and ICU length of stay achieved by implementation of an individual sedation management. This suggests sedation guidelines as effective tools to reduce the mechanical ventilation time and ICU length of stay in patients after sudden cardiac arrest in ST-elevated myocardial infarction. Investigations with a larger patient number and higher statistical power are required to confirm these findings.

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The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study

Yonsei Medical Journal ◽

10.3349/ymj.2015.56.5.1428 ◽

2015 ◽

Vol 56 (5) ◽

pp. 1428 ◽

Cited By ~ 5

Author(s):

Won Chul Cha ◽

Kyoung Jun Song ◽

Jin Sung Cho ◽

Adam J. Singer ◽

Sang Do Shin

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Term Effect ◽

Long Term Effect ◽

Before And After ◽

Before And After Study

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Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

10.21203/rs.2.230/v2 ◽

2019 ◽

Author(s):

Hesham Abowali ◽

Matteo Paganini ◽

Garrett A Enten ◽

Ayman Elbadawi ◽

Enrico Camporesi

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length ◽

Time Dependent ◽

Hospital Length Of Stay ◽

Ventilation Time ◽

Mechanical Ventilation Time

Abstract Abstract Background : The use of dexmedetomidine for sedation post-cardiac surgery is controversial compared to the use of propofol. Methods : A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed for up to July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the postoperative sedation of cardiac surgery patients were selected. Primary study outcomes were classified as time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results : Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion : Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes for heart valve surgery and CABG patients. Time-dependent outcomes confounded by several factors including variability in staff, site-protocols, and complication rates between individual surgical cases. Keywords: dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

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Shortening the length of stay and mechanical ventilation time by using positive suggestions via MP3 players for ventilated patients

Interventional Medicine and Applied Science ◽

10.1556/imas.6.2014.1.1 ◽

2014 ◽

Vol 6 (1) ◽

pp. 3-15 ◽

Cited By ~ 4

Author(s):

Adrienn K. Szilágyi ◽

Csaba Diószeghy ◽

Gábor Fritúz ◽

János Gál ◽

Katalin Varga

Keyword(s):

Mechanical Ventilation ◽

Length Of Stay ◽

Ventilation Time ◽

Mp3 Players ◽

Mechanical Ventilation Time ◽

Ventilated Patients

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Time influence of mechanical ventilation on functional independence in patients submitted to cardiac surgery: literature review

Fisioterapia em Movimento ◽

10.1590/0103-5150.028.004.ar04 ◽

2015 ◽

Vol 28 (4) ◽

pp. 859-864 ◽

Cited By ~ 2

Author(s):

André Luiz Cordeiro ◽

Thiago Araújo de Melo ◽

Andriele Medeiros Santos ◽

Gisele Freitas Lopes

Keyword(s):

Mechanical Ventilation ◽

Cardiac Surgery ◽

Length Of Stay ◽

Functional Capacity ◽

Negative Impact ◽

Ventilation System ◽

Functional Independence ◽

Ventilation Time ◽

Immobility Time ◽

Mechanical Ventilation Time

Abstract Introduction: Patients submitted to cardiovascular surgery present motor and respiratory complications mainly due to high surgery manipulation and the use of mechanical ventilation. Reducing the weaning start time and disconnecting patient's ventilation system prematurely can decrease the pulmonary complications and hospitalization time. Motor complications are the most relevant as they have a direct effect on functional independence provoked by immobility time. Objectives : Identify if mechanical ventilation time has an impact on functional capacity on patients submitted to cardiac surgery in order to contribute to the establishment of reliable evidence to practice through this patient's profile. Materials and methods : Original articles were analyzed, published between 2000 and 2014, which focused on the influence of mechanical ventilation time concerning the functional independence on patients submitted to cardiac surgery, contained in the following electronic database: Scielo, BIREME (LILACS), PubMed e CAPES. Results : It was observed that the length of stay in the intensive care unit in cardiac surgery was influenced directly by CPB, VM and pulmonary dysfunction. Functional independence was compromised in patients with longer duration of mechanical ventilation, postoperative pain and prolonged bed rest. It was also found that there is no consensus on the protocol for improved functional capacity. Conclusion : There is a functional decline in patients undergoing cardiac surgery, especially those at increased length of stay in mechanical ventilation, reflecting a direct and negative impact on their functional independence and quality of life.

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Weaning of Children With Burn Injury by Noninvasive Ventilation: A Clinical Experience

Journal of Burn Care & Research ◽

10.1093/jbcr/irz068 ◽

2019 ◽

Vol 40 (5) ◽

pp. 689-695

Author(s):

Marco Piastra ◽

Enzo Picconi ◽

Tony C Morena ◽

Luca Brasili ◽

Alessandro Pizza ◽

...

Keyword(s):

Mechanical Ventilation ◽

Length Of Stay ◽

Noninvasive Ventilation ◽

Burn Injury ◽

Invasive Mechanical Ventilation ◽

Pediatric Intensive Care ◽

Invasive Ventilation ◽

Ventilation Time ◽

Respiratory Management ◽

Mechanical Ventilation Time

Abstract The aim of this study was to report the respiratory management of a cohort of infants admitted to a Pediatric Intensive Care Unit (PICU) over a 7-year period due to severe burn injury and the potential benefits of noninvasive ventilation (NIV). A retrospective review of all pediatric patients admitted to PICU between 2009 and 2016 was conducted. From 2009 to 2016, 118 infants and children with burn injury were admitted to our institution (median age 16 months [IQR = 12.2–20]); 51.7% of them had face burns, 37.3% underwent tracheal intubation, and 30.5% had a PICU stay greater than 7 days. Ventilated patients had a longer PICU stay (13 days [IQR = 8–26] vs 4.5 days [IQR = 2–13]). Both ventilation requirement and TBSA% correlated with PICU stay (r = .955, p < .0001 and r = .335, p = .002, respectively), while ventilation was best related in those >1 week (r = .964, p < .0001 for ventilation, and r = −.079, p = .680, for TBSA%). NIV was introduced in 10 patients, with the aim of shorten the invasive ventilation requirement. As evidenced in our work, mechanical ventilation is frequently needed in burned children admitted to PICU and it is one of the main factors influencing PICU length of stay. No difference was found in terms of PICU length of stay and invasive mechanical ventilation time between children who underwent NIV and children who did not, despite children who underwent NIV had a larger burn surface. NIV can possibly shorten the total invasive ventilation time and related complications.

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Sedative use of Dexmedetomidine vs. Propofol after Cardiac Surgery: A critical review and meta-analysis.

10.21203/rs.2.230/v1 ◽

2019 ◽

Author(s):

Hesham Abowali ◽

Matteo Paganini ◽

Ayman Elbadawi ◽

Enrico Camporesi

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Time Dependent ◽

Confounding Factors ◽

Ventilation Time ◽

Significant Difference ◽

Mechanical Ventilation Time

Abstract BACKGROUND: The efficacy and safety of dexmedetomidine in sedation for postoperative cardiac surgeries is controversial when compared to propofol. METHODS: A computerized search of Medline, Cochrane and Google Scholar databases was performed through August 2018. Studies evaluating the efficacy of dexmedetomidine versus propofol in the sedation of postoperative cardiac surgery patients were searched. The main study outcomes were divided into time dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and in the hospital) and non-time dependent (delirium, bradycardia, and hypotension). RESULTS: The final analysis included 15 trials with a total of 2488 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.54, 95% Confidence Interval (CI): -0.89 to -0.18, p=0.003), as well as mechanical ventilation time (SMD= -0.71, 95% CI: -1.19 to -0.23, p=0.004). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.38, 95% CI: -0.60 to -0.16, p=0.001) and hospital length of stay (SMD= -0.39, 95% CI: -0.60 to -0.19, p<0.001). However, these time dependent outcomes could have been affected by several confounding factors, thus limiting the value of these results. Incidence of delirium was reduced in the dexmedetomidine group (OR: 0.47, 95% CI: 0.29 to 0.76, p=0.002), while this group of patients had higher rates of bradycardia (OR: 2.52, 95% CI: 1.15 to 5.55, p=0.021). There was no significant difference in rates of hypotension between the two groups. CONCLUSION: Despite the apparent time advantages afforded by dexmedetomidine over propofol, the former does not show particular overall improvements in postoperative care of cardiac surgery patients. Since time dependent outcomes seems to be affected by several confounding factors, more efforts are needed to analyze factors that could affect sedation in post-cardiac surgery patients and choose unbiased outcomes. KEYWORDS: Dexmedetomidine; propofol; cardiac surgery; postoperative sedation.

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Sedative Use of Dexmedetomidine vs. Propofol after Cardiac Surgery A Critical Review and Meta-Analysis.

10.21203/rs.2.21359/v1 ◽

2020 ◽

Author(s):

Hesham A. Abowali ◽

Matteo Paganini ◽

Garrett Enten ◽

Ayman Elbadawi ◽

Enrico Camporesi

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length ◽

Time Dependent ◽

Hospital Length Of Stay ◽

Ventilation Time ◽

Mechanical Ventilation Time

Abstract Background The efficacy and safety of dexmedetomidine in sedation for postoperative cardiac surgeries are controversial when compared to propofol. Methods A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was performed through July 2019. Trials evaluating the efficacy of dexmedetomidine versus propofol in the sedation of postoperative cardiac surgery patients were selected. The primary study outcomes were divided into time-dependent (mechanical ventilation time; time to extubation; length of stay in the intensive care unit and the hospital) and non-time dependent (delirium, bradycardia, and hypotension). Results Our final analysis included 11 RCTs published between 2003 and 2019 and involved a total of 1184 patients. Time to extubation was significantly reduced in the dexmedetomidine group (Standardized Mean Difference (SMD) = -0.61, 95% Confidence Interval (CI): -1.06 to -0.16, p=0.008), however no difference in mechanical ventilation time was observed (SMD= -0.72, 95% CI: -1.60 to 0.15, N.S.). Moreover, the dexmedetomidine group showed a significant reduction in Intensive Care Unit length of stay (SMD= -0.70, 95% CI: -0.98 to -0.42, p=0.0005) this did not translate into a reduced hospital length of stay (SMD= -1.13, 95% CI: -2.43 to 0.16, N.S). For non-time dependent factors: incidence of delirium was unaffected between groups (OR: 0.68, 95% CI: 0.43 to 1.06, N.S.), while the propofol group of patients had higher rates of bradycardia (OR: 3.39, 95% CI: 1.20 to 9.55, p=0.020) and hypotension (OR: 1.68, 95% CI: 1.09 to 2.58, p=0.017). Conclusion Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former does not contribute to an overall reduction in hospital length of stay or an overall improvement in postoperative outcomes of heart valve surgery and CABG patients. Additionally, time-dependent outcomes are affected by several confounding factors, and more efforts are needed to analyze factors that could affect sedation in post-cardiac surgery patients and choose unbiased outcomes.

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