Daily interruptions of sedation: a clinical approach to improve outcomes in critically ill patients.
ABSTRACT The continuous infusion of sedative agents is often necessary for critically ill patients. However, it has been associated with several disadvantages. Numerous interventions to reduce these risks have been evaluated, including the practice of interrupting sedative infusions on a daily basis. A literature search was conducted, and 7 studies were reviewed to evaluate the safety and effectiveness of daily interruption of sedative infusions and its outcomes. The implementation of daily sedation interruptions was suggested to minimize multiple complications associated with continuous sedative infusions and was not associated with intensive care-related complications or long-term psychological effects. Additional studies have revealed perceived barriers to the implementation of daily sedation interruptions. Further randomized controlled trials enrolling larger, more diverse samples are needed to provide more evidence regarding the safety and effectiveness of this intervention.
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ABSTRACT: How nurses respond when faced with the dilemma of providing patient-centered care in the absence of patient-centered practice guidelines remains relatively unreported. Standards may not be available to guide nurses or may not be realistic for implementation at the point of care. Nurses may be forced to react creatively to meet the needs of their patients. The purpose was to understand nursing care when standard practice guidelines did not meet patient-specific care needs and to develop various viewpoints related to the use of positive deviance in providing patient-centered care. Complexity theory and the framework of a wicked question were used to guide a 3-round online national Delphi study from November 2011 to February 2012. The panel was accessed through the American Association of Critical Care Nurses to expose the care provided when standard practice guidelines were lacking. Findings support the presence of positive deviance and expose care provided by nurses when standard practice guidelines lacked the ability to provide patient-centered care. Dominant themes of positive deviance are recommended as priorities for future research. Better guidelines are needed that work for nurses, instead of against them, that would not force a nurse into actions that are not patient centered. Guidelines should guide practice and assist in allowing nurses to provide care that is centered on the best needs of the patient in the specific care situation.Dimensions of critical care nursing: DCCN 33(3):142-50.
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ABSTRACT: Delirium is a common manifestation of acute, reversible, brain dysfunction in critically ill patients. It is associated with increased morbidity and mortality in the intensive care unit (ICU). Detection and prevention of risk factors for delirium is critical. Daily assessment for delirium should be part of the treatment strategies. Although, non-pharmacologic treatment have been successful, often, pharmacologic intervention is necessary. Currently, there are no approved medications indicated for the treatment of ICU delirium. The objective of this review article is to provide a comprehensive overview of non-pharmacologic and pharmacologic options for the treatment of ICU delirium. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.Journal of Pharmacy and Pharmaceutical Sciences 09/2012; 15(4):499-509. · 2.20 Impact Factor