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Hart KL, Pellegrini AM, Forester BP, Berretta S, Murphy SN, Perlis RH, McCoy TH. Distribution of agitation and related symptoms among hospitalized patients using a scalable natural language processing method. Gen Hosp Psychiatry 2021; 68:46-51. [PMID: 33310013 PMCID: PMC7855889 DOI: 10.1016/j.genhosppsych.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Agitation is a common feature of many neuropsychiatric disorders. OBJECTIVE Understanding the prevalence, implications, and characteristics of agitation among hospitalized populations can facilitate more precise recognition of disability arising from neuropsychiatric diseases. METHODS We developed two agitation phenotypes using an expansion of expert curated term lists. These phenotypes were used to characterize five years of psychiatric admissions. The relationship of agitation symptoms and length of stay was examined. RESULTS Among 4548 psychiatric admissions, 1134 (24.9%) included documentation of agitation based on the primary agitation phenotype. These symptoms were greater among individuals with public insurance, and those with mania and psychosis compared to major depressive disorder. Greater symptoms were associated with longer hospital stay, with ~0.9 day increase in stay for every 10% increase in agitation phenotype. CONCLUSION Agitation was common at hospital admission and associated with diagnosis and longer length of stay. Characterizing agitation-related symptoms through natural language processing may provide new tools for understanding agitated behaviors and their relationship to delirium.
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Affiliation(s)
- Kamber L. Hart
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA
| | | | - Brent P. Forester
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA,McLean Hospital, 115 Mill St, Belmont, MA 02478, USA
| | - Sabina Berretta
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; McLean Hospital, 115 Mill St, Belmont, MA 02478, USA.
| | - Shawn N. Murphy
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Roy H. Perlis
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Thomas H. McCoy
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA,Corresponding author at: Massachusetts General Hospital, 185 Cambridge Street, 6th Floor, Boston, MA 02114, USA. (T.H. McCoy)
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Dexmedetomidine facilitates extubation in children who require intubation and respiratory support after airway foreign body retrieval: a case-cohort analysis of 57 cases. J Anesth 2018; 32:592-598. [PMID: 29948375 DOI: 10.1007/s00540-018-2519-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/03/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE This study aimed to investigate whether dexmedetomidine had sedative weaning advantage for extubation after airway foreign body (FB) removal in children. METHODS A retrospective case-cohort comparison study with total of 57 critical children who required mechanical ventilation after rigid bronchoscopy was performed. After tracheal intubation, group D (received dexmedetomidine 1 µg/kg over 10 min, followed by an infusion of 0.8 µg/kg/h), and group RP (received remifentanil-propofol 6-10 µg/kg/h and 1-3 mg/kg/h, respectively). The primary outcome was successful extubation rate on first weaning trial. The minor outcomes included weaning time, emergency agitation, coughing score and the incidence of respiratory adverse complications on emergency. MAIN RESULTS All 57 patients were included in the analysis, with 30 patients in group D and 27 controlled cases in group RP. The success rate of first weaning trial in the D group was 96.7 vs 77.8% in the RP group, risk ratio (RR) 1.56, 95% CI [0.78-1.98]. Time for resuming spontaneous breathing after termination infusion was shorter in the D group (median 8 min, IQR 15 min) vs RP group (median 12 min, IQR 19 min, P = 0.02, RR 0.56, 95% CI 0.14-6.57). CONCLUSIONS In mechanical ventilation of pediatric patients following rigid bronchoscopy, in comparison to remifentanil-propofol, dexmedetomidine is proved to have high success rate for weaning strategy. WHAT IS ALREADY KNOWN?: Remifentanil is proved to be effective for weaning in ICU patients. Dexmedetomedine can provide similar rates of smooth extubation for pediatric patients who underwent airway surgery. WHAT THIS ARTICLE ADDS?: Invasive ventilation is used for patients with severe comorbidity after airway surgery, but the correct strategy for pediatric extubation after removal of airway foreign body remains unclear. For these patients with short-term mechanical ventilation, dexmedetomedine may improve the extubation rate, when compared with remifentanil-propofol.
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Mahmood S, Mahmood O, El-Menyar A, Asim M, Al-Thani H. Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit. World J Emerg Med 2018; 9:105-112. [PMID: 29576822 DOI: 10.5847/wjem.j.1920-8642.2018.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Agitation occurs frequently among critically ill patients admitted to the intensive care unit (ICU). We aimed to evaluate the frequency, predisposing factors and outcomes of agitation in trauma ICU. METHODS A retrospective analysis was conducted to include patients who were admitted to the trauma ICU between April 2014 and March 2015. Data included patient's demographics, initial vitals, associated injuries, Ramsey Sedation Scale, Glasgow Coma Scale, head injury lesions, use of sedatives and analgesics, head interventions, ventilator days, and ICU length of stay. Patients were divided into two groups based on the agitation status. RESULTS A total of 102 intubated patients were enrolled; of which 46 (45%) experienced agitation. Patients in the agitation group were 7 years younger, had significantly lower GCS and sustained higher frequency of head injuries (P<0.05). Patients who developed agitation were more likely to be prescribed propofol alone or in combination with midazolam and to have frequent ICP catheter insertion, longer ventilatory days and higher incidence of pneumonia (P<0.05). On multivariate analysis, use of propofol alone (OR=4.97; 95% CI=1.35-18.27), subarachnoid hemorrhage (OR=5.11; 95% CI=1.38-18.91) and ICP catheter insertion for severe head injury (OR=4.23; 95% CI=1.16-15.35) were independent predictors for agitation (P<0.01). CONCLUSION Agitation is a frequent problem in trauma ICU and is mainly related to the type of sedation and poor outcomes in terms of prolonged mechanical ventilation and development of nosocomial pneumonia. Therefore, understanding the main predictors of agitation facilitates early risk-stratification and development of better therapeutic strategies in trauma patients.
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Affiliation(s)
- Saeed Mahmood
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Department of Surgery, HGH, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Department of Surgery, HGH, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
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de Almeida TML, de Azevedo LCP, Nosé PMG, de Freitas FGR, Machado FR. Risk factors for agitation in critically ill patients. Rev Bras Ter Intensiva 2016; 28:413-419. [PMID: 28099638 PMCID: PMC5225916 DOI: 10.5935/0103-507x.20160074] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/21/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To evaluate the incidence of agitation in the first 7 days after intensive care unit admission, its risk factors and its associations with clinical outcomes. METHODS: This single-center prospective cohort study included all patients older than 18 years with a predicted stay > 48 hours within the first 24 hours of intensive care unit admission. Agitation was defined as a Richmond Agitation Sedation Scale score ≥ +2, an episode of agitation or the use of a specific medication recorded in patient charts. RESULTS: Agitation occurred in 31.8% of the 113 patients. Multivariate analysis showed that delirium [OR = 24.14; CI95% 5.15 - 113.14; p < 0.001], moderate or severe pain [OR = 5.74; CI95% 1.73 - 19.10; p = 0.004], mechanical ventilation [OR = 10.14; CI95% 2.93 - 35.10; p < 0.001], and smoking habits [OR = 4.49; CI95% 1.33 - 15.17; p = 0.015] were independent factors for agitation, while hyperlactatemia was associated with a lower risk [OR = 0.169; CI95% 0.04 - 0.77; p = 0.021]. Agitated patients had fewer mechanical ventilation-free days at day 7 (p = 0.003). CONCLUSION: The incidence of agitation in the first 7 days after admission to the intensive care unit was high. Delirium, moderate/severe pain, mechanical ventilation, and smoking habits were independent risk factors. Agitated patients had fewer ventilator-free days in the first 7 days.
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Affiliation(s)
- Thiago Miranda Lopes de Almeida
- Anesthesiology, Pain and Intensive Care Department,
Escola Paulista de Medicina, Universidade Federal de São Paulo - Sao
Paulo (SP), Brazil
| | - Luciano Cesar Pontes de Azevedo
- Anesthesiology, Pain and Intensive Care Department,
Escola Paulista de Medicina, Universidade Federal de São Paulo - Sao
Paulo (SP), Brazil
| | - Paulo Maurício Garcia Nosé
- Anesthesiology, Pain and Intensive Care Department,
Escola Paulista de Medicina, Universidade Federal de São Paulo - Sao
Paulo (SP), Brazil
| | - Flavio Geraldo Resende de Freitas
- Anesthesiology, Pain and Intensive Care Department,
Escola Paulista de Medicina, Universidade Federal de São Paulo - Sao
Paulo (SP), Brazil
| | - Flávia Ribeiro Machado
- Anesthesiology, Pain and Intensive Care Department,
Escola Paulista de Medicina, Universidade Federal de São Paulo - Sao
Paulo (SP), Brazil
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Kesmati M, Mard-Soltani M, Khajehpour L. Anxiogenic Effects of Acute Injection of Sesame oil May be Mediated by β-1 Adrenoceptors in the Basolateral Amygdala. Adv Pharm Bull 2013; 4:35-42. [PMID: 24409407 PMCID: PMC3885366 DOI: 10.5681/apb.2014.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/24/2013] [Accepted: 08/08/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE A few studies have indicates that the sesame oil influences anxiety, but many reports show that β-1 adrenoceptors (ARs) of the basolateral amygdala (BLA) plays a pivotal role in this regard. Therefore, in this study the effect of acute injection of sesame oil on anxiety-like behavior in the presence and absence of the BLA β-1 ARs in the male Wistar rats were investigated. METHODS Guide cannulas, for seven groups of rats, were implanted bilaterally into the BLA. Two weeks after the stereotaxic surgery, anxiety-like behaviors (the OAT%, OAE % and locomotor activity) were evaluated by Elevated Plus-Maze (EPM) for all groups. 3 groups received different volumes of sesame oil (i.p.) and they were compared with control group (received saline via i.p.), and the anxiogenic volume of sesame oil (1.5ml/kg) was determined. Then, 3 other groups received constant effective volume of sesame oil (1.5ml/kg) along with 3 different doses of betaxolol, selective β-1 ARs antagonist, intra BLA microinjection in order to be compared with sesame oil group (1.5 ml/kg). RESULTS The acute injection of sesame oil with the volume dependent manner showed an anxiogenic effect with reduction of the OAT% and OAE% which the maximum effect of sesame oil was observed in the dose of 1.5mg/kg. Also, betaxolol with dose dependent manner attenuated the anxiogenic effects of sesame oil (1.5mg/kg), but this reduction could not remove the anxiety effects completely. CONCLUSION It seems that the sesame oil acute (i.p.) injection induces anxiety, and this effect is attenuated by inhibition of β-1ARs in the BLA.
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Affiliation(s)
- Mahnaz Kesmati
- Department of Biology, Faculty of Science, Shahid Chamran University, Ahvaz, Iran
| | - Maysam Mard-Soltani
- Department of Biology, Faculty of Science, Shahid Chamran University, Ahvaz, Iran
| | - Lotfolah Khajehpour
- Department of Biology, Faculty of Science, Shahid Chamran University, Ahvaz, Iran
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Pinder S, Christensen M. Sedation breaks: are they good for the critically ill patient? A review. Nurs Crit Care 2008; 13:64-70. [PMID: 18289184 DOI: 10.1111/j.1478-5153.2007.00257.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tradition has led us to believe that a heavily sedated patient is a comfortable, settled, compliant patient for whom sedation will improve outcome. The current move witnessed in clinical practice today of limiting sedation has led health care in recent years to question the benefit and necessity of routine, continuous sedation for all patients requiring mechanical ventilation. However, as a result there has been a rise in the amount of agitation being reported as being experienced by patients with the daily withdrawal of sedation. AIMS The purpose of this paper is to review current arguments for and against perserving with agitation versus re-sedating, when it presents during the daily sedation breaks. FINDINGS Of the literature reviewed, the question to re-sedate the mechanically ventilated agitated patient during sedation breaks remains an issue of contention. Although there is evidence focusing on the psychological effects of long-term sedation and sedation breaks specifically, the complex nature of critical illness in some cases means that individualized care is of paramount importance and in-depth assessment is crucial when deciding to re-sedate in the face of undetermined agitation. Agitation has been closely linked with several incidents that can be detrimental to patient safety, such as removal of lines and unplanned self-extubation. CONCLUSION The recommendations of this review are that nurses should re-commence sedation if the patient becomes agitated following a sedation break.
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Affiliation(s)
- Sally Pinder
- Intensive Care Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, UK
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Milbrandt EB, Angus DC. Bench-to-bedside review: critical illness-associated cognitive dysfunction--mechanisms, markers, and emerging therapeutics. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 10:238. [PMID: 17118217 PMCID: PMC1794449 DOI: 10.1186/cc5078] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cognitive dysfunction is common in critically ill patients, not only during the acute illness but also long after its resolution. A large number of pathophysiologic mechanisms are thought to underlie critical illness-associated cognitive dysfunction, including neuro-transmitter abnormalities and occult diffuse brain injury. Markers that could be used to evaluate the influence of specific mechanisms in individual patients include serum anticholinergic activity, certain brain proteins, and tissue sodium concentration determination via high-resolution three-dimensional magnetic resonance imaging. Although recent therapeutic advances in this area are exciting, they are still too immature to influence patient care. Additional research is needed if we are to understand better the relative contributions of specific mechanisms to the development of critical illness-associated cognitive dysfunction and to determine whether these mechanisms might be amenable to treatment or prevention.
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Affiliation(s)
- Eric B Milbrandt
- CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 641 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA.
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Milbrandt EB, Angus DC. Potential mechanisms and markers of critical illness-associated cognitive dysfunction. Curr Opin Crit Care 2006; 11:355-9. [PMID: 16015116 DOI: 10.1097/01.ccx.0000170508.63067.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To review the current understanding of the potential mechanisms of critical illness-associated cognitive dysfunction and to provide insight into markers that could be used to evaluate the influence of specific mechanisms in individual patients. RECENT FINDINGS Cognitive dysfunction is common in critically ill patients, not only during the acute illness but also long after its resolution. Several pathophysiologic mechanisms are thought to underlie critical illness-associated cognitive dysfunction, including neurotransmitter abnormalities and occult diffuse brain injury. Markers that could be used to evaluate the influence of specific mechanisms in individual patients include serum anticholinergic activity, certain brain proteins, and tissue sodium concentration determination by way of high-resolution three-dimensional magnetic resonance imaging. SUMMARY Although recent advances in this area are exciting, they are still too immature to influence patient care. Additional research is needed to provide a better understanding of the relative contribution of specific mechanisms to the development of critical illness-associated cognitive dysfunction and to determine whether these mechanisms might be amenable to treatment or prevention.
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Affiliation(s)
- Eric B Milbrandt
- The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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Crippen D. High-tech assessment of patient comfort in the intensive care unit: time for a new look. Crit Care Med 2002; 30:1919-20. [PMID: 12163824 DOI: 10.1097/00003246-200208000-00049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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