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1.
Medicine (Baltimore) ; 99(36): e21859, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899015

RESUMO

BACKGROUND: The purpose of this study was to evaluate the effects of adding ketamine to propofol on cognitive functions in patients undergoing sedation for colonoscopy. METHODS: In this randomized, double-blinded, and controlled study, 200 patients were randomly allocated to ketamine/propofol admixture group (Group KP, n = 100), and propofol group (Group P, n = 100). Patients in Group KP received 0.25 mg/kg of ketamine and 0.5 mg/kg of propofol. Patients in Group P received 0.5 mg/kg propofol. Cognitive functions were measured using CogState battery before and after the colonoscopy procedure. Ninety five patients in Group KP and 92 patients in Group P had completed the CogStates tests and were included in the data analysis. RESULTS: Compared with before procedure baseline, the performance on detection and identification tasks were significantly impaired after the procedure in both Group KP (P = .004, P = .001) and Group P patients (P = .005, P < .001). However, one-card learning accuracy and One-back memory was only impaired in Group KP patients (P = .006, P = .040) after the endoscopy but left intact in Group P patients. Group KP patients showed more severe impairment in one-card learning accuracy compared with Group P patients (P = .044). Group KP patients have better 5 minutes MAP (P = .005) and were also less likely to suffer from complications such as respiratory depression (P = .023) and hypotension (P = .015). OAA/S scores, BIS, MAP, complications, recovery times, and endoscopist and patient satisfaction were similar between the 2 groups. CONCLUSION: Although adding ketamine to propofol for sedation in colonoscopy provided fewer complications such as respiratory depression and hypotension, it also causes more impairment in cognitive functions.


Assuntos
Colonoscopia/métodos , Sedação Profunda/métodos , Hipnóticos e Sedativos/farmacologia , Ketamina/farmacologia , Complicações Cognitivas Pós-Operatórias/induzido quimicamente , Propofol/farmacologia , Adulto , Sedação Profunda/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Ketamina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Medicine (Baltimore) ; 99(34): e21915, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846859

RESUMO

This retrospective study aimed at identifying the predictors of oxygen desaturation (OD) (i.e., SpO2 < 95%) in patients with obstructive sleep apnea (OSA) requiring deep sedation and developing an algorithm to predict OD.We studied 66 OSA patients undergoing propofol-induced deep sedation for drug-induced sleep endoscopy (DISE). The patients were divided into prediction (n = 35) and validation (n = 31) groups. Patient characteristics and polysomnographic parameters were analyzed with receiver operating characteristic curve and Chi-squared test to identify significant predictors of OD for developing an algorithm in the prediction group. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value of the algorithm were determined in the validation group.Six polysomnographic predictors of OD were identified, including Apnea-Hypopnea Index of total sleep time (AHI-TST), AHI at the stage of rapid eye movement (AHI-REM), percentage of time with oxygen saturation <90% (mO2 < 90%), average SpO2, lowest SpO2, and desaturation index. Stepwise multiple logistic regression analysis demonstrated that low average SpO2 (<95.05%) and high AHI-REM (>16.5 events/h) were independent predictors of OD. The algorithm thus developed showed that patients with an average SpO2 < 95.05% and those with an average SpO2 ≥ 95.05% together with an AHI-REM > 16.5 events/h would be at risk of OD under sedation. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value were 84%, 100%, 83%, 100%, respectively.For patients with OSA, average SpO2 and AHI-REM may enable clinicians to predict the occurrence of oxygen desaturation under deep sedation. Future large-scale studies are needed to validate the findings.


Assuntos
Algoritmos , Sedação Profunda/efeitos adversos , Oxigênio/sangue , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , China/epidemiologia , Sedação Profunda/métodos , Endoscopia/métodos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Polissonografia/instrumentação , Valor Preditivo dos Testes , Propofol/administração & dosagem , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Sono REM
3.
Neurophysiol Clin ; 50(3): 155-165, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32653111

RESUMO

OBJECTIVES: Although rare, neurological manifestations in SARS-CoV-2 infection are increasingly being reported. We conducted a retrospective systematic study to describe the electroencephalography (EEG) characteristics in this disease, looking for specific patterns. METHODS: EEGs performed in patients with positive PCR for SARS-CoV-2 between 25/03/2020 and 06/05/2020 in the University Hospital of Bicêtre were independently reviewed by two experienced neurologists. We used the American Clinical Neurophysiology Society's terminology for the description of abnormal patterns. EEGs were classified into five categories, from normal to critically altered. Interobserver reliability was calculated using Cohen's kappa coefficient. Medical records were reviewed to extract demographics, clinical, imaging and biological data. RESULTS: Forty EEGs were reviewed in 36 COVID-19 patients, 18 in intensive care units (ICU) and 22 in medicine units. The main indications were confusion or fluctuating alertness for 23 (57.5%) and delayed awakening after stopping sedation in ICU in six (15%). EEGs were normal to mildly altered in 23 (57.5%) contrary to the 42.5% where EEG alterations were moderate in four (10%), severe in eight (20%) and critical in five (12.5%). Generalized periodic discharges (GPDs), multifocal periodic discharges (MPDs) or rhythmic delta activity (RDA) were found in 13 recordings (32.5%). EEG alterations were not stereotyped or specific. They could be related to an underlying morbid status, except for three ICU patients with unexplained encephalopathic features. CONCLUSION: In this first systematic analysis of COVID-19 patients who underwent EEG, over half of them presented a normal recording pattern. EEG alterations were not different from those encountered in other pathological conditions.


Assuntos
Betacoronavirus , Confusão/etiologia , Infecções por Coronavirus/complicações , Recuperação Demorada da Anestesia/etiologia , Eletroencefalografia , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Nível de Alerta/fisiologia , Betacoronavirus/isolamento & purificação , Ondas Encefálicas/fisiologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Comorbidade , Confusão/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/psicologia , Sedação Profunda , Recuperação Demorada da Anestesia/fisiopatologia , Demência/complicações , Demência/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/psicologia , Reação em Cadeia da Polimerase , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Estudos Retrospectivos
4.
Med. intensiva (Madr., Ed. impr.) ; 44(5): 301-309, jun.-jul. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-ET2-5756

RESUMO

La monitorización es crucial en el cuidado del paciente crítico. Detecta disfunciones orgánicas y provee orientación en el abordaje terapéutico. Los intensivistas monitorizan habitualmente la función de varios sistemas orgánicos y el cerebro no es la excepción. La monitorización EEG continuo es una vía no invasiva e ininterrumpida para valorar la actividad eléctrica cortical con aceptable resolución espacial y excelente resolución temporal. La efectividad diagnóstica del estado epiléptico no convulsivo como causa de compromiso de la consciencia no explicable por otras causas se ha incrementado con el empleo del EEG continuo; sin embargo, no es la única indicación para valorar la actividad eléctrica cortical cerebral. Este manuscrito intenta resumir las indicaciones, modos de empleo y metodología para el empleo del monitoreo electroencefalográfico continuo en la unidad de cuidados intensivos con la finalidad que el intensivista se familiarice con el mismo


Monitoring is a crucial part of the care of the critically ill patient. It detects organ dysfunction and provides guidance on the therapeutic approach. Intensivists closely monitor the function of various organ systems, and the brain is no exception. Continuous EEG monitoring is a noninvasive and uninterrupted way of assessing cerebral cortical activity with good spatial and excellent temporal resolution. The diagnostic effectiveness of non-convulsive status epilepticus as a cause of unexplained consciousness disorder has increased the use of continuous EEG monitoring in the neurocritical care setting. However, non-convulsive status epilepticus is not the only indication for the assessment of cerebral cortical activity. This study summarizes the indications, usage and methodology of continuous EEG monitoring in the intensive care unit, with the aim of allowing practitioners to become familiarized the technique


Assuntos
Humanos , Eletroencefalografia/métodos , Cuidados Críticos , Isquemia Encefálica/diagnóstico por imagem , Encefalopatias/diagnóstico por imagem , Ondas Encefálicas/efeitos da radiação , Isquemia Encefálica/fisiopatologia , Sedação Profunda , Morte Encefálica/diagnóstico por imagem
6.
Med. intensiva (Madr., Ed. impr.) ; 44(4): 239-247, mayo 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-190576

RESUMO

La sedación es necesaria en el tratamiento de los pacientes críticos, tanto para aliviar el sufrimiento como para curar a los pacientes con enfermedades que precisan el ingreso en unidades de cuidados intensivos. Esta sedación debe ser la adecuada a las necesidades del paciente en cada momento de su evolución clínica, ni por debajo (infrasedación) ni por encima (sobresedación). Una sedación adecuada influye en la comodidad, la seguridad, la supervivencia, la calidad de vida posterior, la rotación de camas de las unidades de críticos y los costes. La infrasedación se detecta y corrige rápidamente. Sin embargo, la sobresedación es silente y difícil de prevenir sin unas pautas de actuación, una concienciación colectiva y un trabajo en equipo. El proyecto «Sobresedación Zero» del Grupo de Trabajo de Sedación, Analgesia y Delirium de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias pretende ser una herramienta docente, práctica y de concienciación colectiva de comodidad, seguridad y gestión para maximizar el resultado clínico y minimizar los efectos perjudiciales de la sedación excesiva. Se basa en un paquete de medidas que se incluye monitorizar el dolor, la analgesia, la agitación, la sedación, el delirium y el bloqueo neuromuscular, mantener a los pacientes sin dolor, realizar una sedación dinámica según objetivos clínicos, consensuar el protocolo multidisciplinar a seguir y evitar la sedación profunda no indicada clínicamente


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. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated


Assuntos
Humanos , Sedação Profunda , Gestão da Segurança/normas , Analgesia/normas , Segurança do Paciente , Unidades de Terapia Intensiva , Gestão da Segurança/métodos , Conforto do Paciente , Número de Leitos em Hospital , Projetos , Cuidados Críticos
7.
Anaesth Crit Care Pain Med ; 39(3): 341-343, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32360979
8.
Emergencias (Sant Vicenç dels Horts) ; 32(2): 118-121, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188160

RESUMO

Objetivo: Describir las características y manejo de los pacientes con sedación paliativa (SP) en 11 servicios de urgencias hospitalarios (SUH) catalanes. Método: Estudio prospectivo descriptivo de pacientes que recibieron SP entre abril y julio de 2018. Se recogieron variables demográficas, enfermedades del paciente, índice de Charlson (IC), procedencia, tiempos en urgencias y fármacos utilizados. Resultados: Se incluyeron 323 pacientes (48,9% varones) con una edad media de 84 (DE 12) años. El IC fue significativamente mayor en hospitales de primer nivel. La SP se consideró primera opción de tratamiento en el 27% y se inició en una media de 18 (DE 28) horas tras su llegada, significativamente diferente en hospitales de segundo nivel. Fallecieron mayoritariamente en el SUH (74,2%). Conclusiones: Los pacientes que reciben SP en los SUH son ancianos con comorbilidad grave, y en su mayoría reciben tratamiento con intención curativa como primera opción terapéutica. Existen diferencias significativas del tiempo transcurrido hasta el inicio de la SP según la complejidad del centro


Objective: To describe the clinical management of palliative sedation and the characteristics of sedated patients in 11 Catalan hospital emergency departments. Methods: Prospective descriptive study of a cohort of patients given palliative sedation between April and July 2018. We registered patient demographic and disease data, the Charlson comorbidity index (CCI), patient’s point of origin before emergency department arrival, times related to emergency care, and medications used. Results: We included 323 patients (48.9% men) with a mean (SD) age of 84 (12) years. The CCIs were significantly higher in patients attended in level-I hospitals. Palliative sedation was the first option in 27% and was initiated within 18 (28) hours of arrival on average, an interval that was significantly shorter in level-II hospitals. Most patients (74.2%) died in the emergency department. Conclusions: Patients treated with palliative sedation in hospital emergency departments are older and have serious concomitant conditions. Most patients are first treated with intention to cure. Time until the start of palliative sedation differs significantly according to hospital level


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Sedação Profunda , Serviços Médicos de Emergência , Cuidados Paliativos/métodos , Estudos de Coortes , Estudos Prospectivos , Análise Estatística , Projetos Piloto
10.
Med. intensiva (Madr., Ed. impr.) ; 44(3): 171-184, abr. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190563

RESUMO

Dada la importancia del manejo de la sedación, analgesia y delirium en las unidades de cuidados intensivos, y con el fin de actualizar las guías publicadas anteriormente, se decidió elaborar una nueva guía de práctica clínica con los soportes, manejos e intervenciones más relevantes acordes con las publicaciones recientes. Para elaborar esta guía, se reunió un grupo de 24 intensivistas procedentes de 9 países de la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva. Se acogió la propuesta del Grading of Recommendations Assessment, Development and Evaluation Working Group para emitir el grado de recomendación y evaluar la calidad de la evidencia. Se realizó una búsqueda sistemática de la literatura utilizándose: MEDLINE, las siguientes bases de datos de la biblioteca Cochrane: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects, National Health Service Economic Evaluation Database, y la base de datos de Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). Finalmente, se seleccionaron 438 referencias, permitiendo realizar 47 recomendaciones fuertes con evidencia alta y moderada, 14 recomendaciones condicionales con evidencia moderada y 65 recomendaciones condicionales con evidencia baja. Se confirma la importancia del manejo inicial y multimodal del dolor, se hace énfasis en la disminución de los niveles de sedación y la utilización de sedación profunda solo en casos específicos. Aumenta la evidencia y recomendaciones para el uso de medicamentos como dexmedetomidina, remifentanil, ketamina, entre otros


Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented


Assuntos
Humanos , Delírio/terapia , Analgesia/métodos , Estado Terminal , Sedação Profunda , Unidades de Terapia Intensiva , Manejo da Dor , Dexmedetomidina , Remifentanil , Ketamina , Abordagem GRADE/normas
11.
Med Clin North Am ; 104(3): 539-560, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312414

RESUMO

Some patients with terminal and degenerative illnesses request assistance to hasten death when suffering is refractory to palliative care, or they strongly desire to maximize their autonomy and dignity and minimize suffering. Palliative sedation (PS), voluntarily stopping eating and drinking (VSED), and physician-assisted death (PAD) are possible options of last resort. A decision to choose PS can be made by an informed surrogate decision maker, whereas intact decision-making capacity is required to choose VSED or PAD. For all palliative treatments of last resort, the risk of harm is minimized by the use of checklists, and establishment of policies and procedures.


Assuntos
Sedação Profunda/métodos , Eutanásia Ativa Voluntária/ética , Cuidados Paliativos/ética , Suicídio Assistido/ética , Idoso , Idoso de 80 Anos ou mais , Comunicação , Tomada de Decisões , Comportamento de Ingestão de Líquido/fisiologia , Eutanásia Ativa Voluntária/psicologia , Comportamento Alimentar/psicologia , Humanos , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Cuidados Paliativos/tendências , Médicos/tendências , Estados Unidos/epidemiologia
13.
Medicine (Baltimore) ; 99(9): e19001, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118711

RESUMO

BACKGROUND: Intranasal dexmedetomidine is a relatively new way to sedate young children undergoing nonpainful diagnostic procedures. We performed a meta-analysis to compare the efficacy and safety of intranasal dexmedetomidine in young children with those of oral chloral hydrate, which has been a commonly used method for decades. METHODS: We searched PubMed, Embase, and the Cochrane Library for all randomized controlled trials that compared intranasal dexmedetomidine with oral chloral hydrate in children undergoing diagnostic procedures. Data on success rate of sedation, onset time, recovery time, and adverse effects were extracted and respectively analyzed. RESULTS: Five studies with a total of 720 patients met the inclusion criteria. Intranasal dexmedetomidine provided significant higher success rate of sedation (relative risk [RR], 1.12; 95% confidence interval [CI], 1.02 to 1.24; P = .02; I = 74%) than oral chloral hydrate. Furthermore, it experienced significantly shorter onset time (weight mean difference [WMD], -1.79; 95% CI, -3.23 to -0.34; P = .02; I = 69%). Nevertheless, there were no statistically differences in recovery time (WMD, -10.53; 95% CI, -24.17 to 3.11; P = .13; I = 92%) and the proportion of patients back to normal activities (RR, 1.11; 95% CI, 0.77-1.60; P = .57; I = 0%). Intranasal dexmedetomidine was associated with a significantly lower incidence of nausea and vomiting (RR, 0.05; 95% CI, 0.01-0.22; P < .0001; I = 0%) than oral chloral hydrate. Although adverse events such as bradycardia, hypotension and hypoxia were not synthetized due to lack of data, no clinical interventions except oxygen supplementation were required in any patients. CONCLUSION: Our meta-analysis revealed that intranasal dexmedetomidine is possibly a more effective and acceptable sedation method for infants and toddlers undergoing diagnostic procedures than oral chloral hydrate. Additionally, it shows similar safety profile and could be a potential alternative to oral chloral hydrate.


Assuntos
Hidrato de Cloral/administração & dosagem , Sedação Profunda/métodos , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Administração Intranasal , Administração Oral , Pré-Escolar , Hidrato de Cloral/efeitos adversos , Dexmedetomidina/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Lactente
14.
Rev Med Suisse ; 16(685): 512-513, 2020 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-32167257
15.
Int J Cardiovasc Imaging ; 36(5): 855-863, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32040685

RESUMO

Transesophageal echocardiography (TEE) under general anesthesia (GA) or intracardiac echocardiography (ICE) under sedation is usually used for echocardiographic guidance during transcatheter atrial septal defect (ASD) closure. However, appropriate selection of guidance has not been fully established. Our study aimed to evaluate whether selection of guidance depending on anatomic ASD features and TEE tolerability under sedation contributes to procedure success. On the basis of anatomic ASD characteristics and TEE tolerability under sedation during the pre-procedural TEE, we selected either TEE, ICE, or combined TEE and ICE under moderate-to-deep sedation or TEE under GA for guidance. Anatomic characteristics of the defect, medical costs, complications, and primary outcomes for these four different types of guidance were analyzed. A total of 154 patients were classified into four guidance groups depending on the results of diagnostic TEE under sedation; 11 patients were scheduled for the procedure under GA in advance. Procedures were successfully completed in all but two patients in whom closure guided by TEE under sedation was attempted for an extremely large defect or extensive superior rim deficiency. Two patients who underwent TEE or combined TEE and ICE guidance under sedation were converted to ICE-only guidance due to desaturation or excessive body movement. Device dislodgement was not observed during the procedure or during median follow-up of 1188 days [interquartile range 577-1831]. Appropriate selection of guidance might contribute to successful transcatheter ASD closure.


Assuntos
Cateterismo Cardíaco , Ecocardiografia Transesofagiana , Comunicação Interatrial/terapia , Adolescente , Adulto , Idoso , Anestesia Geral , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/economia , Cateterismo Cardíaco/instrumentação , Criança , Pré-Escolar , Tomada de Decisão Clínica , Sedação Consciente , Sedação Profunda , Ecocardiografia Transesofagiana/economia , Feminino , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/economia , Comunicação Interatrial/fisiopatologia , Custos Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Dispositivo para Oclusão Septal , Resultado do Tratamento , Adulto Jovem
17.
Einstein (Sao Paulo) ; 18: eAO5168, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31994609

RESUMO

OBJECTIVE: To understand the use of tools, protocols and comfort measures related to sedation/analgesia, and to screen the occurrence of delirium in pediatric intensive care units. METHODS: A survey with 14 questions was distributed by e-mail to Brazilian critical care pediatricians. Eight questions addressed physician and hospital demographics, and six inquired practices to assess sedation, analgesia, and delirium in pediatric intensive care units. RESULTS: Of 373 questionnaires sent, 61 were answered (16.3%). The majority of physicians were practicing in the Southeast region (57.2%). Of these, 46.5% worked at public hospitals, 28.6% of which under direct state administration. Of respondents, 57.1% used formal protocols for sedation and analgesia, and the Ramsay scale was the most frequently employed (52.5%). Delirium screening scores were not used by 48.2% of physicians. The Cornell Assessment of Pediatric Delirium was the score most often used (23.2%). The majority (85.7%) of physicians did not practice daily sedation interruption, and only 23.2% used non-pharmacological measures for patient comfort frequently, with varied participation of parents in the process. CONCLUSION: This study highlights the heterogeneity of practices for assessment of sedation/analgesia and lack of detection of delirium among critical care pediatricians in Brazil.


Assuntos
Analgesia/métodos , Sedação Profunda/métodos , Delírio/diagnóstico , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pediatras/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Analgesia/efeitos adversos , Analgesia/estatística & dados numéricos , Brasil , Sedação Profunda/efeitos adversos , Sedação Profunda/estatística & dados numéricos , Delírio/etiologia , Humanos , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Inquéritos e Questionários
18.
BMC Health Serv Res ; 20(1): 28, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914990

RESUMO

BACKGROUND: Moderate and deep sedation are well-established techniques in many developed countries, and several guidelines have been published. However, they have received attention in China only in recent years. The aim of this study is to investigate current paediatric sedation practices in tertiary children's hospitals and tertiary maternity and children hospitals in China. METHODS: All tertiary children's hospitals and tertiary maternity and children hospitals registered with the National Health Commission of the People's Republic of China were invited to participate in an electronic survey, which included information on the sedation caseload, facility availability, staff structure, clinical skill requirements for sedation providers, fasting guidelines, patient-monitoring practices, and choice of sedatives. RESULTS: Fifty-eight of the 63 hospitals that completed the survey (92.1%) provided moderate and deep sedation. Dedicated sedation rooms and post-sedation recovery rooms were found in 14 (24.1%) and 19 (32.8%) hospitals, respectively. Sedation for non-invasive procedures was primarily performed by anaesthesiologists (69.0%); however, 75.9% of the sedation providers had not received paediatric basic or advanced life-support training. Children were asked to fast from clear liquids for at least 2 h in 44.8% of hospitals and up to 6 h in 5.2% of hospitals; they were asked to fast from solid food/milk for at least 4 h in 27.6% of hospitals and more than 8 h in 1.7% of hospitals. The most commonly used sedative in all groups was chloral hydrate. For rescue, propofol was the most widely used sedative, particularly for children older than 4 years. CONCLUSIONS: Moderate and deep sedation practices vary widely in tertiary children's hospitals and tertiary maternity and children hospitals in China. Optimised practices should be established to improve the quality of moderate and deep sedation.


Assuntos
Sedação Consciente/estatística & dados numéricos , Sedação Profunda/estatística & dados numéricos , Maternidades/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Criança , Pré-Escolar , China , Pesquisas sobre Serviços de Saúde , Humanos , Lactente
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