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OBJECTIVE To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002. METHODS The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain,(More)
M aintaining an optimal level of comfort and safety for critically ill patients is a universal goal for critical care practitioners. The American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine's (SCCM's) practice parameters for the optimal use of sedatives and analgesics was published in 1995 and recommended a tiered(More)
CONTEXT Gamma-aminobutyric acid receptor agonist medications are the most commonly used sedatives for intensive care unit (ICU) patients, yet preliminary evidence indicates that the alpha(2) agonist dexmedetomidine may have distinct advantages. OBJECTIVE To compare the efficacy and safety of prolonged sedation with dexmedetomidine vs midazolam for(More)
Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is(More)
OBJECTIVE Subjective scales to assess agitation and sedation in adult intensive care unit (ICU) patients have rarely been tested for validity or reliability. We revised and prospectively tested the Sedation-Agitation Scale (SAS) for interrater reliability and compared it with the Ramsay scale and the Harris scale to test construct validity. DESIGN A(More)
OBJECTIVE To compare the efficacy and safety of scheduled quetiapine to placebo for the treatment of delirium in critically ill patients requiring as-needed haloperidol. DESIGN Prospective, randomized, double-blind, placebo-controlled study. SETTING Three academic medical centers. PATIENTS Thirty-six adult intensive care unit patients with delirium(More)
OBJECTIVE ICU delirium is common and adverse. The Intensive Care Delirium Screening Checklist (ICDSC) score ranges from 0 to 8, with a score of 4 or higher indicating clinical delirium. We investigated whether lower (subsyndromal) values affect outcome. PATIENTS 600 patients were evaluated with the ICDSC every 8[Symbol: see text]h. MEASUREMENTS AND(More)
Our objective was to evaluate physician response to an educational program to increase referral of potential organ or tissue donors in an emergency department (ED). This study was a nonrandomized, controlled, before-after intervention trial at a nonuniversity teaching hospital with 45,000 annual patient visits to the ED. Two one-hour educational sessions(More)
PURPOSE To evaluate the bispectral index (BIS) and suppression ratio (SR) as very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest. METHODS Demographic data, BIS1, and SR1 were recorded from 97 patients after the first dose of neuromuscular blockade, with outcomes blinded, and compared to the discharge Cerebral(More)
BACKGROUND Nationwide benchmarks representing current critical care practice for the range of ICUs are lacking. This information may highlight opportunities for care improvement and allows comparison of ICU practice data. METHODS Data representing 243,553 adult admissions from 271 ICUs and 188 US nonfederal hospitals during 2008 were analyzed using the(More)