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Heily M, Gerdtz M, Jarden RJ, Yap CY, Darvall J, Coventry AE, Rogers A, Vernon J, Bellomo R. Agitation during anaesthetic emergence: An observational study of adult cardiac surgery patients in two Australian intensive care units. Aust Crit Care 2024; 37:67-73. [PMID: 37919133 DOI: 10.1016/j.aucc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Anaesthetic emergence agitation among adult patients being recovered after open cardiac and/or thoracic aorta surgery has not been described. OBJECTIVES The objective of this study was to characterise emergence agitation in terms of incidence, clinical features, and consequences in a cohort of cardiac surgery patients being recovered in the intensive care unit (ICU). METHODS A prospective, observational pilot study was implemented. Over a 5-week period, the study was conducted in two metropolitan hospitals in Victoria, Australia. The cohort comprised all patients admitted to the ICUs aged ≥18 years, who had undergone cardiac surgery via an open sternotomy with general anaesthetic, and whose emergence was directly observed. Emergence agitation was defined as a Richmond Agitation and Sedation Scale score of ≥+2. RESULTS Fifty patients were observed. Emergence agitation occurred in 24/50 (48%) of patients. Patients with emergence agitation experienced more clinical consequences than patients with calm emergence, including a significantly greater number of episodes of airway compromise (12/24, 50%, p < 0.001); ventilator dyssynchrony (23/24, 96%, p = 0.004); and hypertension (13/24, 54%, p = 0.004). Significant treatment interference (potentially dangerous patient movements such as pulling tubes) occurred with 23/24 patients (96%, p < 0.0001). Patients who underwent emergence agitation required significantly more interventions during anaesthetic emergence than patients who underwent a calm emergence. Interventions included extra nursing measures (16/24, 67%, p = 0.001) administration of sedative and/or opioid intravenous boluses (22/24, 92%, p = 0.001) and vasoactive agents (15/24, 63%, p = 0.05). CONCLUSIONS In patients recovering from cardiac surgery in the ICU, emergence agitation was clinically important. Immediate interventions were required to prevent and manage complications.
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Affiliation(s)
- Meredith Heily
- Intensive Care Unit, The Royal Melbourne Hospital, Grattan St, Parkville 3050, Australia; Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry St, Carlton, 3010, Australia.
| | - Marie Gerdtz
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry St, Carlton, 3010, Australia.
| | - Rebecca J Jarden
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry St, Carlton, 3010, Australia; Austin Health, Melbourne, Australia.
| | - Celene Yl Yap
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry St, Carlton, 3010, Australia.
| | - Jai Darvall
- Intensive Care Unit & Department of Anaesthetics, The Royal Melbourne Hospital, Grattan St, Parkville, 3050, Australia; Department of Critical Care, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Grattan St, Parkville, 3010, Australia.
| | - Andrew Ej Coventry
- Intensive Care Unit, The Royal Melbourne Hospital, Grattan St, Parkville 3050, Australia.
| | - Amy Rogers
- Intensive Care Unit, The Royal Melbourne Hospital, Grattan St, Parkville 3050, Australia.
| | - Julie Vernon
- Intensive Care Unit, The Royal Melbourne Hospital, Grattan St, Parkville 3050, Australia.
| | - Rinaldo Bellomo
- Intensive Care Unit, The Royal Melbourne Hospital, Grattan St, Parkville 3050, Australia; Department of Critical Care, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Grattan St, Parkville, 3010, Australia; Intensive Care Unit, Austin Health, Australia.
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Liao J, Kui C, Zhou Y, Huang L, Zuo D, Huang Y, Pan R. Effect of Programmed Comprehensive Nursing for Postoperative Delirium in Intensive Care Unit Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:1227659. [PMID: 35600946 PMCID: PMC9117019 DOI: 10.1155/2022/1227659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022]
Abstract
Background This study is to evaluate the effect of programmed comprehensive nursing for postoperative delirium in intensive care unit (ICU) patients. Methods A total of 90 cases of ICU surgery patients admitted to our hospital from July 2019 to July 2020 were recruited and assigned via the random number table method (1 : 1) to receive either conventional nursing (control group) or programmed comprehensive nursing (experimental group). The delirium assessment method was used to record the incidence of delirium events at different time points after the intervention. Outcome measures included delirium events, the Visual Analogue Scale (VAS) scores, the Pittsburgh sleep quality index (PSQI) scores, the activities of daily living (ADL) scale scores, nursing satisfaction, and total nursing efficiency. Results Programmed comprehensive nursing was associated with significantly better nursing satisfaction, ADL scores, VAS scores, PSQI scores, and nursing efficiency than conventional nursing (all P < 0.05). Programmed comprehensive nursing resulted in a significantly lower incidence of postoperative delirium than conventional nursing (P < 0.05). Conclusion The application of programmed comprehensive nursing for postoperative delirium in ICU patients shows a promising efficiency, effectively alleviates the clinical symptoms of patients, and optimizes various clinical indicators of patients; hence, it is worthy of further application and promotion.
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Affiliation(s)
- Juanjuan Liao
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Chuanran Kui
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Yangchun Zhou
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Li Huang
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Dandan Zuo
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Yuqin Huang
- Department of Intensive Care Unit, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Ruihong Pan
- Department of Nursing, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
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