Anesthesiology clinics
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Protocolized target-based sedation and analgesia is central to effective management of sedation. Important components include identifying goals and specific targets,using valid and reliable tools to measure pain, agitation, and sedation, and titrating a logically selected combination of sedatives and analgesics to defined end-points. A variety of approaches to structured management have been tested in controlled trials with major categories of (1) sedation algorithms and protocols and (2) daily interruption of sedation. ⋯ The somewhat discrepant results illustrate, however, that various approaches,such as DIS, may not be optimal for all patients. Further research will be necessary to define these patients and examine alternative strategies. Finally, implementation of structured approaches to sedation management is a challenging, time-consuming process for clinicians that must be supported with sufficient resources to be successful.
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Little is known of nonpharmacologic and pharmacologic delirium prevention and treatment in the critical care setting. Trials emphasizing early mobilization suggest that this nonpharmacologic approach is associated with an improvement in delirium incidence. ⋯ No nonpharmacologic approach or drug has been shown to be beneficial once delirium is established. Considering the importance and the consequences of delirium in the critical care setting, studies to further address prevention and rigorous trials addressing pharmacologic intervention are urgently needed.
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Anesthesiology clinics · Dec 2011
Altering intensive care sedation paradigms to improve patient outcomes.
Providing sedation and comfort for intensive care patients has evolved in the last 30 years but remains difficult for clinicians. As research has focused on this challenging area, the authors have identified ways to improve practice, including providing analgesia before sedation, strategies to help recognize dangerous adverse effects associated with the medications that are used, and better ways to monitor pain and delirium in patients. Dexmedetomidine and propofol have become the preferred sedatives for many ICU situations, and creative ways to administer them, such as linking awakening and breathing trials, are emerging. Finally, screening survivors for cognitive impairments may allow clinicians to refer them for the focused rehabilitation they require.
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Anesthesiology clinics · Sep 2011
ReviewClinical research using an information system: the multicenter perioperative outcomes group.
Clinical research using electronic medical record (EMR) data is an emerging source of scientific progress. Increasingly, researchers are using retrospective observational data acquired from EMRs as the substrate for their clinical research into comorbidities, procedures, situations, and outcomes that have historically presented significant challenges. Although EMR data collection is perceived to require fewer resources than manual chart review, there are many specific regulatory, privacy, data quality, and technique issues unique to clinical research using EMR data. This article discusses the use of EMRs for observational research.