The annual congress of the Society of Critical Care Medicine was held from Feb. 4 to 8 in Houston, and attracted more than 5,500 participants from around the world, including nurses, pharmacists, physicians, respiratory therapists, students, and other health care practitioners. The conference highlighted recent advances in critical care medicine, with presentations and abstracts mainly focused on the management of critically ill patients.
In a single-center study, Alexis Topjian, M.D., of the Children's Hospital of Philadelphia, and colleagues found that levetericetam, phenobarbital, and phenytoin were the most frequently used anticonvulsants (ACs) to treat electrographic seizures in critically ill patients.
The researchers found no difference in first AC efficacy even when controlling for age and acute neurologic disorder. The researchers also found no difference in mortality or short-term neurologic outcomes based on first AC used.
"Many critically ill patients with electrographic seizures and electrographic status epilepticus can be managed with one medication," Topjian said. "There was no clear superior agent for termination of electrographic seizures and electrographic status epilepticus."
In another study, Lioudmila Karnatovskaia, M.D., of the Mayo Clinic in Jacksonville, Fla., and colleagues found that pre-hospital use of systemic corticosteroids did not influence development of acute lung injury (ALI), need for mechanical ventilation, or in-hospital mortality.
"Pre-hospital use of systemic corticosteroids does not appear to mitigate development of ALI nor affect the need for mechanical ventilation or in-hospital mortality," Karnatovskaia said. "This is an important finding for patients, clinicians, and possible future ALI prevention trials."
Linda Chlan, Ph.D., R.N., of the University of Minnesota School of Nursing in Minneapolis, and colleagues found that listening to preferred, relaxing music while receiving mechanical ventilatory support reduced anxiety in patients.
"Music is free of adverse effects and can easily be integrated into the medical plan-of-care for these patients. Because these findings are from a randomized clinical trial conducted in a highly controlled manner, work is needed to determine how best to integrate the patient-initiated music listening protocol into the intensive care unit environment. Studies are needed to translate this integrative intervention into intensive care unit practice," Chlan said.
In an evidence based quality improvement initiative, Hildy Schell-Chaple, Ph.D., R.N., of the University of California in San Francisco, and colleagues implemented a program which asked patients questions regarding their sleep habits when they were placed in the intensive care unit and then incorporated the answers to the questions into practice, in an effort to individualize sleep practices for patients.
The investigators also changed the timing of when nurses worked with the patients in the intensive care unit, such as making sure that all baths were completed by 10 p.m., and if a patient wanted the lights dim or needed ear plugs or eye shades, these requests were met.
"In order to assess whether this was helpful for patients, we asked patients if they remembered being asked about sleep preferences and if they were implemented. We did find an increase in implementation of patient's sleep requests," Schell-Chaple said. "We also queried nurses [as to] whether they were implementing these requests and changing their practice, and 91 percent had implemented these changes into their routine. Nurses were more aware and thoughtful regarding patient sleep. We also found that delirium decreased during the period but it is unclear if it was due to the implementation of [this] protocol."
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