Journal of intensive care medicine
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J Intensive Care Med · Nov 2008
Case ReportsBradycardia during dexmedetomidine and therapeutic hypothermia.
Dexmedetomidine is a centrally acting alpha2-adrenergic agonist which is currently Food and Drug Administration-approved for the short-term (less than 24 hours) sedation of adults during mechanical ventilation. Given its beneficial physiologic effects and limited adverse effect profile, there is growing interest regarding its potential applications in the Pediatric intensive care unit patient including sedation during mechanical ventilation, procedural sedation, the treatment of withdrawal, and prevention of emergence agitation. ⋯ We report 2 pediatric patients with traumatic brain injury who had good long-term neurologic outcomes, but developed clinically significant bradycardia when therapeutic hypothermia was added to a sedation regimen that included dexmedetomidine and remifentanil. The role of dexmedetomidine as a neuroprotective agent is explored as well as a review presented of previous reports of bradycardia related to dexmedetomidine.
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J Intensive Care Med · Nov 2008
Review of a large clinical series: sedation and analgesia usage with airway pressure release and assist-control ventilation for acute lung injury.
Our objective was to compare sedative and analgesic doses, agents, and sedation status in patients with airway pressure release ventilation (APRV) versus assist-control (AC) ventilation on the first day after acute lung injury diagnosis. ⋯ APRV may be associated with decreased sedation and analgesia medications and improved sedation status. Differences in the patients receiving APRV versus AC ventilation may have contributed to this conclusion. Further investigation is needed.
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J Intensive Care Med · Nov 2008
Clinical TrialCerebral oximetry monitoring with near infrared spectroscopy detects alterations in oxygenation before pulse oximetry.
The monitoring of oxygenation may be imperative to ensure patient safety and optimal outcome. We anecdotally noted that monitoring cerebral oxygenation (rSO2) using near infrared spectroscopy may provide an earlier warning of changes in oxygenation than pulse oximetry. ⋯ Cerebral oxygenation monitoring using near infrared spectroscopy detects changes in oxygenation earlier than standard pulse oximetry.
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As of August 2007, 96 900 people are awaiting organ transplantation in the United States, while only 28 930 transplants were performed in 2006. With such a large gap between organ need and organ availability, it is inevitable that many will die while awaiting transplantation. ⋯ The use of these standardized and aggressive donor management protocols has been shown to increase the number of transplanted organs and prevent the number of donors lost due to medical failures. A protocol-driven approach by a dedicated organ donor management team should be considered a key component of any program designed to bridge the gap between organ supply and demand.