Med Eng Phys
Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
Published: January 2006
Agitation-sedation cycling in critically ill patients, characterized by oscillations between states of agitation and over-sedation, damages patient health and increases length of stay and cost. A model that captures the essential dynamics of the agitation-sedation system and is physiologically representative is developed, and validated using data from 37 critical care patients. It is more physiologically representative than a previously published agitation-sedation model, and captures more realistic and complex dynamics. The median time in the 90% probability band is 90%, and the total drug dose, relative to recorded drug dose data, is a near ideal 101%. These statistical model validation metrics are 5-13% better than a previously validated model. Hence, this research provides a platform to develop and test semi-automated sedation management controllers that offer the significant clinical potential of improved agitation management and reduced length of stay in critical care.
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http://dx.doi.org/10.1016/j.medengphy.2005.03.005 | DOI Listing |
Cureus
November 2024
Department of Anaesthesiology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN.
Introduction Monitored anesthesia care (MAC) is an anesthesia management method in which anesthesiologists use the minimum necessary intravenous anesthetics to achieve sedation and pain relief while maintaining spontaneous breathing. The challenge for the anesthesiologist is to find the correct balance between inhibiting the patient's stress response to invasive treatment, maintaining intraoperative hemodynamic stability, and doing so as quickly as possible. We hypothesized that diluting remifentanil (D-remi) to 10 μg/mL and increasing the rate of administration would increase the responsiveness of the syringe pump and allow for better control of anesthetic depth.
View Article and Find Full Text PDFCrit Care Med
May 2024
Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO.
Objectives: Ventilator dyssynchrony may be associated with increased delivered tidal volumes (V t s) and dynamic transpulmonary pressure (ΔP L,dyn ), surrogate markers of lung stress and strain, despite low V t ventilation. However, it is unknown which types of ventilator dyssynchrony are most likely to increase these metrics or if specific ventilation or sedation strategies can mitigate this potential.
Design: A prospective cohort analysis to delineate the association between ten types of breaths and delivered V t , ΔP L,dyn , and transpulmonary mechanical energy.
BMC Palliat Care
January 2024
3rd Department of Medicine, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Background: Intranasal (i.n.) drug application is a widely known and low-invasive route of administration that may be able to achieve rapid symptom control in terminally ill patients.
View Article and Find Full Text PDFJ Clin Anesth
February 2021
Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4031 Basel, Switzerland. Electronic address:
Study Objective: Delirium is frequently observed in the postoperative and intensive care unit (ICU) population. Due to the multifactorial origin of delirium and according to international guidelines (e.g.
View Article and Find Full Text PDFMed Intensiva (Engl Ed)
May 2020
Servicio de Medicina Intensiva, Hospital QuironSalud Palmaplanas, Palma, Illes Balears, España.
Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs.
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