Critical care medicine
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Critical care medicine · Feb 2010
Randomized Controlled Trial Multicenter StudyEfficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study.
To compare the efficacy and safety of scheduled quetiapine to placebo for the treatment of delirium in critically ill patients requiring as-needed haloperidol. ⋯ Quetiapine added to as-needed haloperidol results in faster delirium resolution, less agitation, and a greater rate of transfer to home or rehabilitation. Future studies should evaluate the effect of quetiapine on mortality, resource utilization, post-intensive care unit cognition, and dependency after discharge in a broader group of patients.
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Critical care medicine · Feb 2010
Randomized Controlled Trial Multicenter StudyFeasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial.
To demonstrate the feasibility of a placebo-controlled trial of antipsychotics for delirium in the intensive care unit and to test the hypothesis that antipsychotics would improve days alive without delirium or coma. ⋯ A randomized, placebo-controlled trial of antipsychotics for delirium in mechanically ventilated intensive care unit patients is feasible. Treatment with antipsychotics in this limited pilot trial did not improve the number of days alive without delirium or coma, nor did it increase adverse outcomes. Thus, a large trial is needed to determine whether use of antipsychotics for intensive care unit delirium is appropriate.
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Critical care medicine · Feb 2010
Randomized Controlled TrialPatient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist.
To compare the effect of pressure support ventilation and neurally adjusted ventilatory assist on breathing pattern, patient-ventilator synchrony, diaphragm unloading, and gas exchange. Increasing the level of pressure support ventilation can increase tidal volume, reduce respiratory rate, and lead to delayed ventilator triggering and cycling. Neurally adjusted ventilatory assist uses diaphragm electrical activity to control the timing and pressure of assist delivery and is expected to enhance patient-ventilator synchrony. ⋯ Neurally adjusted ventilatory assist can improve patient-ventilator synchrony by reducing the triggering and cycling delays, especially at higher levels of assist, at the same time preserving breathing and maintaining blood gases.
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Critical care medicine · Feb 2010
Randomized Controlled Trial Multicenter Study Comparative StudyA cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit.
To compare the intensive care unit costs and determine factors influencing these costs in mechanically ventilated patients randomized to dexmedetomidine or midazolam by continuous infusion. ⋯ Continuous sedation with dexmedetomidine results in significantly lower total intensive care unit costs compared with midazolam infusion for intensive care unit sedation, primarily due to decreased intensive care unit stay costs and reduced mechanical ventilation costs.
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Critical care medicine · Feb 2010
Meta AnalysisBundled care for septic shock: an analysis of clinical trials.
Sepsis bundles have been developed to improve patient outcomes by combining component therapies. Valid bundles require effective components with additive benefits. Proponents encourage evaluation of bundles, both as a whole and based on the performance of each component. ⋯ Bundle use was associated with consistent and significant improvement in survival and antibiotic use. Use of other bundle components changed heterogeneously across studies, making their impact on survival uncertain. However, this analysis should be interpreted cautiously as these studies were unblinded, and only one was randomized.