Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit

Background: Patients under mechanical ventilation in the Intensive Care Unit (ICU) have a higher risk of delirium. To date, the ideal sedative combination for delirium treatment in terms of cost and side effects has not been determined. Objectives: This study was designed to compare the effects of haloperidol and dexmedetomidine on delirium in trauma patients under mechanical ventilation in the ICU. Methods: Sixty patients with a moderate traumatic brain injury were randomly divided into two groups. Patients in the haloperidol group received 2.5 mg of haloperidol intravenously every eight hours for ten minutes daily, and the dexmedetomidine group received 0.5 µg/kg of dexmedetomidine via intravenous infusion every other day. Delirium, agitation, length of hospitalization, duration of mechanical ventilation, and need for sedation up to seven days were measured and recorded in both groups. The Richmond Agitation-Sedation scale (RASS) and Acute Physiology and Chronic Health evaluation (APACHE II) scales were used to determine the level of agitation in patients. The Confusion Assessment method (CAM)-ICU criteria were used to determine the incidence of delirium. Results: Based on the results of this study, age and sex of the two groups were not significantly different. The mean age of the patients was 36.83 years in the haloperidol group and 40.1 years in the dexmedetomidine group. After the intervention, there was no significant difference in terms of the level of consciousness, number of days required for ventilation (P = 0.17), and number of days in the ICU (P = 0.49); however, there was a significant difference between the two groups three to seven days after the intervention. Besides, there was a significant difference between the two groups regarding the incidence of delirium five to seven days after the intervention (P < 0.05). Conclusions: There was a significant difference between the two groups in terms of the incidence of delirium and the level of agitation; the patients in the dexmedetomidine group were calmer and experienced less delirium.

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Behavioral Pain Indicators in Patients with Traumatic Brain Injury Admitted to an Intensive Care Unit

Journal of Caring Sciences ◽

10.15171/jcs.2018.030 ◽

2018 ◽

Vol 7 (4) ◽

pp. 197-203 ◽

Cited By ~ 1

Author(s):

Roghieh Nazari ◽

Saeed Pahlevan Sharif ◽

Kelly A Allen ◽

Hamid Sharif Nia ◽

Bit-Lian Yee ◽

...

Keyword(s):

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Injury Severity ◽

Repeated Measure ◽

Neck Stiffness ◽

Significant Difference ◽

Eye Opening ◽

Different Levels

Introduction: A consistent approach to pain assessment for patients admitted to intensive care unit (ICU) is a major difficulty for health practitioners due to some patients’ inability, to express their pain verbally. This study aimed to assess pain behaviors (PBs) in traumatic brain injury (TBI) patients at different levels of consciousness. Methods: This study used a repeated-measure, within-subject design with 35 patients admitted to an ICU. The data were collected through observations of nociceptive and non-nociceptive procedures, which were recorded through a 47-item behavior-rating checklist. The analyses were performed by SPSS ver.13 software. Results: The most frequently observed PBs during nociceptive procedures were facial expression levator contractions (65.7%), sudden eye openings (34.3%), frowning (31.4%), lip changes (31.4%), clear movement of extremities (57.1%), neck stiffness (42.9%), sighing (31.4%), and moaning (31.4%). The number of PBs exhibited by participants during nociceptive procedures was significantly higher than those observed before and 15 minutes after the procedures. Also, the number of exhibited PBs in patients during nociceptive procedures was significantly greater than that of exhibited PBs during the non-nociceptive procedure. The results showed a significant difference between different levels of consciousness and also between the numbers of exhibited PBs in participants with different levels of traumatic brain injury severity. Conclusion: The present study showed that most of the behaviors that have been observed during painful stimulation in patients with traumatic brain injury included facial expressions, sudden eye opening, frowning, lip changes, clear movements of extremities, neck stiffness, and sighing or moaning.

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Delirium in Trauma Patients: Prevalence and Predictors

Critical Care Nurse ◽

10.4037/ccn2017373 ◽

2017 ◽

Vol 37 (1) ◽

pp. 40-48 ◽

Cited By ~ 9

Author(s):

Kathryn T. Von Rueden ◽

Breighanna Wallizer ◽

Paul Thurman ◽

Karen McQuillan ◽

Tiffany Andrews ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Vision Loss ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Costs ◽

Assessment Method ◽

Trauma Patients ◽

Intermediate Care

BACKGROUNDDelirium is associated with increased mortality, morbidity, hospital costs, and postdischarge cognitive dysfunction. Most research focuses on nontrauma patients receiving mechanical ventilation in the intensive care unit.OBJECTIVESTo determine the prevalence and predictors of delirium in trauma patients residing in intensive and intermediate care units of an academic medical center.METHODSTrauma patients were screened for delirium by using the Confusion Assessment Method for the Intensive Care Unit. Exclusion criteria included documented brain injury, history of psychosis or cognitive impairment, not speaking English, and hearing or vision loss.RESULTSOf the 215 study patients, 24% were positive for delirium; 36% of patients in the intensive care unit and 11% of patients in the intermediate care unit. Delirium-positive patients were older (mean age, 53.4 years) than patients who were not (mean age, 44 years; P = .004). Although mechanical ventilation (odds ratio, 4.73, P = .004) was the strongest independent risk factor for delirium, 12% of delirium-positive patients were not receiving mechanical ventilation. Other predictors of delirium were use of antipsychotic medications, higher scores on the Acute Physiology and Chronic Health Evaluation III, and lower scores on the Richmond Agitation-Sedation Scale.CONCLUSIONSPatients in both the intermediate and intensive care units, whether mechanical ventilation was used or not, were positive for delirium. Delirium prevention protocols may benefit trauma patients regardless of their inpatient location.

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Hemotransfusion and mechanical ventilation time are associated with intra-hospital mortality in patients with traumatic brain injury admitted to intensive care unit

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160093 ◽

2016 ◽

Vol 74 (8) ◽

pp. 644-649 ◽

Cited By ~ 3

Author(s):

Kelson James Almeida ◽

Ânderson Batista Rodrigues ◽

Luiz Euripedes Almondes Santana Lemos ◽

Marconi Cosme Soares de Oliveira Filho ◽

Brisa Fideles Gandara ◽

...

Keyword(s):

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Intensive Care ◽

Brain Injury ◽

Hospital Mortality ◽

Hospital Death ◽

Factors Associated ◽

Ventilation Time ◽

Mechanical Ventilation Time

ABSTRACT Objective To identify the factors associated with the intra-hospital mortality in patients with traumatic brain injury (TBI) admitted to intensive care unit (ICU). Methods The sample included patients with TBI admitted to the ICU consecutively in a period of one year. It was defined as variables the epidemiological characteristics, factors associated with trauma and variables arising from clinical management in the ICU. Results The sample included 87 TBI patients with a mean age of 28.93 ± 12.72 years, predominantly male (88.5%). The intra-hospital mortality rate was of 33.33%. The initial univariate analysis showed a significant correlation of intra-hospital death and the following variables: the reported use of alcohol (p = 0.016), hemotransfusion during hospitalization (p = 0.036), and mechanical ventilation time (p = 0.002). Conclusion After multivariate analysis, the factors associated with intra-hospital mortality in TBI patients admitted to the intensive care unit were the administration of hemocomponents and mechanical ventilation time.

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Fever in Trauma Patients: Evaluation of Risk Factors, Including Traumatic Brain Injury

American Journal of Critical Care ◽

10.4037/ajcc2015856 ◽

2015 ◽

Vol 24 (2) ◽

pp. e1-e5 ◽

Cited By ~ 6

Author(s):

Victoria Bengualid ◽

Goutham Talari ◽

David Rubin ◽

Aiham Albaeni ◽

Ronald L. Ciubotaru ◽

...

Keyword(s):

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Head Trauma ◽

White Blood Cells ◽

Trauma Patients ◽

Source Of Infection ◽

Cell Counts

Background The role of fever in trauma patients remains unclear. Fever occurs as a response to release of cytokines and prostaglandins by white blood cells. Many factors, including trauma, can trigger release of these factors. Objectives To determine whether (1) fever in the first 48 hours is related to a favorable outcome in trauma patients and (2) fever is more common in patients with head trauma. Method Retrospective study of trauma patients admitted to the intensive care unit for at least 2 days. Data were analyzed by using multivariate analysis. Results Of 162 patients studied, 40% had fever during the first 48 hours. Febrile patients had higher mortality rates than did afebrile patients. When adjusted for severity of injuries, fever did not correlate with mortality. Neither the incidence of fever in the first 48 hours after admission to the intensive care unit nor the number of days febrile in the unit differed between patients with and patients without head trauma (traumatic brain injury). About 70% of febrile patients did not have a source found for their fever. Febrile patients without an identified source of infection had lower peak white blood cell counts, lower maximum body temperature, and higher minimum platelet counts than did febrile patients who had an infectious source identified. The most common infection was pneumonia. Conclusions No relationship was found between the presence of fever during the first 48 hours and mortality. Patients with traumatic brain injury did not have a higher incidence of fever than did patients without traumatic brain injury. About 30% of febrile patients had an identifiable source of infection. Further studies are needed to understand the origin and role of fever in trauma patients. (American Journal of Critical Care. 2015; 24:e1–e5)

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The incidence and risk factors of ventilator-associated pneumonia in patients with severe traumatic brain injury

Medicinski pregled ◽

10.2298/mpns1108403m ◽

2011 ◽

Vol 64 (7-8) ◽

pp. 403-407 ◽

Cited By ~ 2

Author(s):

Vesna Marjanovic ◽

Vesna Novak ◽

Ljubinka Velickovic ◽

Goran Marjanovic

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Intensive Care ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Prolonged Mechanical Ventilation ◽

Chest Injury ◽

Ventilator Associated Pneumonia

Introduction. Patients with severe traumatic brain injury are at a risk of developing ventilator-associated pneumonia. The aim of this study was to describe the incidence, etiology, risk factors for development of ventilator- associated pneumonia and outcome in patients with severe traumatic brain injury. Material and Methods. A retrospective study was done in 72 patients with severe traumatic brain injury, who required mechanical ventilation for more than 48 hours. Results. Ventilator-associated pneumonia was found in 31 of 72 (43.06%) patients with severe traumatic brain injury. The risk factors for ventilator-associated pneumonia were: prolonged mechanical ventilation (12.42 vs 4.34 days, p<0.001), longer stay at intensive care unit (17 vs 5 days, p<0.001) and chest injury (51.61 vs 19.51%, p< 0.009) compared to patients without ventilator-associated pneumonia.. The mortality rate in the patients with ventilator-associated pneumonia was higher (38.71 vs 21.95%, p= 0.12). Conclusion. The development of ventilator-associated pneumonia in patients with severe traumatic brain injury led to the increased morbidity due to the prolonged mechanical ventilation, longer stay at intensive care unit and chest injury, but had no effect on mortality.

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Computed Tomography–Estimated Specific Gravity at Hospital Admission Predicts 6-Month Outcome in Mild-to-Moderate Traumatic Brain Injury Patients Admitted to the Intensive Care Unit

Anesthesia & Analgesia ◽

10.1213/ane.0b013e318249fe7a ◽

2012 ◽

Vol 114 (5) ◽

pp. 1026-1033 ◽

Cited By ~ 5

Author(s):

Vincent Degos ◽

Thomas Lescot ◽

Christian Icke ◽

Yannick Le Manach ◽

Katherin Fero ◽

...

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Specific Gravity ◽

Hospital Admission ◽

Moderate Traumatic Brain Injury

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Computed Tomography-Estimated Specific Gravity at Hospital Admission Predicts 6-Month Outcome in Mild-to-Moderate Traumatic Brain Injury Patients Admitted to the Intensive Care Unit

Survey of Anesthesiology ◽

10.1097/sa.0b013e3182751fcb ◽

2012 ◽

Vol 56 (6) ◽

pp. 290-291

Author(s):

Vincent Degos ◽

Thomas Lescot ◽

Christian Icke ◽

Yannick Le Manach ◽

Katherin Fero ◽

...

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Specific Gravity ◽

Hospital Admission ◽

Moderate Traumatic Brain Injury

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Secondary stroke in patients with polytrauma and traumatic brain injury treated in an Intensive Care Unit, Karlovac General Hospital, Croatia

Injury ◽

10.1016/j.injury.2015.10.057 ◽

2015 ◽

Vol 46 ◽

pp. S31-S35 ◽

Cited By ~ 1

Author(s):

M. Belavić ◽

E. Jančić ◽

P. Mišković ◽

A. Brozović-Krijan ◽

B. Bakota ◽

...

Keyword(s):

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

General Hospital

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Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽

10.1093/qjmed/hcab086.039 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed N Al Shafi'i ◽

Doaa M. Kamal El-din ◽

Mohammed A. Abdulnaiem Ismaiel ◽

Hesham M Abotiba

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Positive Pressure Ventilation ◽

Invasive Mechanical Ventilation ◽

Noninvasive Positive Pressure Ventilation ◽

Positive Pressure ◽

Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

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