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1.
Lim SY Park SY Park HK Kim M Park HY Lee B Lee JH Jung EJ Jeon K Park CM Ko MG Park MR Nam JM Won SY Jung JH Cho SH Suh GY 《Journal of critical care》2011,26(4):373-378
Purpose
The purpose of the study was to determine whether earlier clinical intervention by a medical emergency team (MET) can improve patient outcomes in an Asian country.Methods
A nonrandomized study was performed during two 6-month periods before and after the introduction of a MET.Results
The rates of cardiac arrests and “potentially preventable” cardiac arrests were lower after MET introduction, but the differences did not reach statistical significance. There was a statistically significant decrease in the incidence of cardiac arrests in the first 3 months of the academic year (2.3 vs 1.2 per 1000 admissions, P = .012). Introduction of MET reduced the time interval from physiologic derangement meeting MET activation criteria to intensive care unit (ICU) admission (“derangement-to-ICU interval”) (10.8 vs 6.3 hours, P < .001). Multivariate analysis revealed that the mortality of unplanned ICU admissions was independently associated with simplified acute physiology score 3 and “derangement-to-ICU interval.”Conclusions
Introduction of a MET reduced the number of cardiac arrests in the general ward during the first 3 months of the academic year. Introduction of MET also decreased the “derangement-to-ICU interval,” which was an independent predictor of survival in patients with unplanned ICU admissions. Therefore, MET introduction may lead to improved outcomes for hospitalized patients in a country with limited medical resources. 相似文献2.
Purpose
This study was conducted to determine the association between vasopressor requirement and outcome in medical intensive care patients in an environment where treatment is not withdrawn.Materials and Methods
This was an observational study of patients in the medical intensive care unit (ICU) over a period of 18 months to determine the correlation between vasopressor requirement and mortality. Outcome was determined for all medical ICU patients, for patients receiving “low dose” (< 40 μg/min) vasopressors (noradrenaline and/or adrenaline) or “high dose” (≥ 40 μg/min) vasopressors. Receiver operator characteristic curves were constructed for ICU and hospital mortality and high-dose vasopressor use. High-dose vasopressor use as an independent predictor for ICU and hospital mortality was also determined by multiple logistic regression analysis.Results
Patients receiving high-dose noradrenaline at any time during their ICU admission had an 84.3% mortality in ICU and 90% in hospital. The receiver operator characteristic curves for high-dose vasopressors had an area under the curve of 0.799 for ICU mortality and 0.779 for hospital mortality. High-dose vasopressor was an independent predictor of ICU mortality, with an odds ratio of 5.1 (confidence interval, 2.02-12.9; P = .001), and of hospital mortality, with an odds ratio of 3.82 (confidence interval 1.28-11.37; P = .016).Conclusions
The requirement for high-dose vasopressor therapy at any time during ICU admission was associated with a very high mortality rate in the ICU and the hospital. 相似文献3.
Christiane S. Hartog MD Ilka PeschelJ. Randall Curtis MD MPH Isabella Westermann Bjoern Kabisch Ruediger Pfeifer Albrecht Guenther Andrej Michalsen Konrad Reinhart 《Journal of critical care》2014
Purpose
The purpose of the study was to determine whether treatment preferences in patients' advance directives (ADs) are associated with life-supporting treatments received during end-of-life care in the intensive care unit (ICU).Material and methods
This is a retrospective cohort study, including patients who died in 4 ICUs of a university hospital in Germany. Patients with ADs were matched with 2 patients each without ADs using propensity scores.Results
Sixty-four (13%) of 477 patients had ADs, written a median of 109 weeks before admission. Five categories of applicability conditions were identified, most of them difficult to interpret in the ICU (eg, “advanced brain impairment” or “imminent death”). Advance directives contained a number of treatment refusals. Specifically, 63 of 64 refused “life-sustaining measures.” Compared to patients without ADs, patients with ADs were less likely to receive cardiopulmonary resuscitation (9% vs 23%, P = .029) and more likely to have do-not-resuscitate orders (77% vs 56%, P = .007). Therapy-limiting decisions and ICU length of stay did not differ between those with or without ADs.Conclusions
Patients with ADs are less likely to receive cardiopulmonary resuscitation but otherwise receive similar life-sustaining treatments compared to matched patients without ADs. More research is needed to explore reasons for potential noncompliance with patient preferences. 相似文献4.
5.
Purpose
The impact of delay in obtaining an intensive care unit (ICU) consult from inpatient wards is unclear. The goal of this study was to examine the effect of time to ICU consult from medical and surgical wards on mortality and length of stay (LOS).Materials and Methods
This was a retrospective study of 241 adult medical and surgical inpatients admitted at 2 tertiary care ICUs in Canada between 2007 and 2009. Neither institution has medical emergency teams (METs). Patient demographics, time when the patient would have fulfilled MET calling criteria (MET time), time of ICU consult, and ICU admission were analyzed. The main outcome variables were 30-day mortality and ICU LOS.Results
Multivariate analysis demonstrated an increase in mortality (odds ratio, 1.8; 95% confidence interval, 1.1-2.9; P = .01) with increased duration from MET time to ICU consult for medical patients. There was no effect of this period on ICU LOS in medical patients. In contrast, in surgical patients, the MET time to ICU consult duration was associated with an increased ICU LOS (coefficient, 2.1 for delay; 95% confidence interval, 0.26-3.8; P = .02) but had no effect on mortality.Conclusions
Increased duration to ICU consult from MET time is associated with adverse outcomes. These adverse outcomes are different between medical and surgical patients. 相似文献6.
Elsbeth C.M. Ten Have Mariet Hagedoorn Nicole D. Holman Raoul E. Nap Robbert Sanderman Jaap E. Tulleken 《Journal of critical care》2013
Purpose
Interdisciplinary rounds (IDRs) in the intensive care unit (ICU) are increasingly recommended to support quality improvement, but uncertainty exists about assessing the quality of IDRs. We developed, tested, and applied an instrument to assess the quality of IDRs in ICUs.Materials and Methods
Delphi rounds were done to analyze videotaped patient presentations and elaborated together with previous literature search. The IDR Assessment Scale was developed, statistically tested, and applied to 98 videotaped patient presentations during 22 IDRs in 3 ICUs for adults in 2 hospitals in Groningen, The Netherlands.Results
The IDR Assessment Scale had 19 quality indicators, subdivided in 2 domains: “patient plan of care” and “process.” Indicators were “essential” or “supportive.” The interrater reliability of 9 videotaped patient presentations among at least 3 raters was satisfactory (κ = 0.85). The overall item score correlations between 3 raters were excellent (r = 0.80-0.94). Internal consistency in 98 videotaped patient presentations was acceptable (α = .78). Application to IDRs demonstrated that indicators could be unambiguously rated.Conclusions
The quality of IDRs in the ICU can be reliably assessed for patient plan of care and process with the IDR Assessment Scale. 相似文献7.
Luba Leontieva Kimberly Horn Jim Helmkamp Michael Furbee Traci Jarrett Janet Williams 《Journal of critical care》2009
Objectives
The purpose of this paper was to explore how events that counselors endorsed occurring during an emergency department–based screening and brief intervention (SBI) for drinking discriminate patients who reported change in Alcohol Use Disorder Identification Test (AUDIT) domains at follow-up from those who did not.Method
Patients who scored “>5” on the AUDIT were eligible for SBI. At the end of each intervention, counselors completed the questionnaire indicating which parts of the intervention they just used.Results
Discriminant function analyses indicated that “Referral made” discriminated for alcohol intake change (Wilks' λ = 0.993, P < .05); “Did the patient set goals during intervention?” and “Referral made” discriminated for alcohol dependency change (Wilks' λ = 0.940 and Wilks' λ = 0.919, P < .05, respectively). “Intention to quit” (Wilks' λ = 0.984, P < .05) discriminated for alcohol-related harm change.Conclusions
Making referrals to addiction treatment during motivational intervention discriminated for alcohol intake and dependency change. Working on intention to quit is an important point in changing alcohol-related harm. When conducting the SBI in ED, counselors may be mindful in making appropriate referrals to address alcohol use and examine intention to quit to maximize the efficacy of the harm-reduction approach. 相似文献8.
Rationale
Emergency department (ED) patients in need of an intensive care unit (ICU) admission are very sick. Reducing the length of time to get these patients into ICU beds is associated with improved outcomes.Objective
To reduce the ED length of stay for patients requiring admission to the medical ICU or coronary care unit through the implementation of the “active bed management” (ABM) intervention.Methods
A pre-post study design compared data from November 2006 to February 2007 with those from those same months in the prior year at Johns Hopkins Bayview Medical Center in Baltimore. The ABM intervention was carried out by hospitalist physicians and involved: (i) making triage decisions for patients to be admitted and facilitating their transfer from ED to the appropriate care setting and (ii) having proactive management of Department of Medicine resources, which included twice-daily ICU bed management rounds and regular visits to the ED to assess flow.Measurement
Throughput time for patients presenting to the ED requiring ICU admission was analyzed.Main Results
The ED census was higher during the intervention period as compared with the control period, 17?573 versus 16?148 patients. Throughput from ED to coronary care unit and medical ICU beds was reduced by 99 (±14) minutes (from 353 minutes in the control period to 254 minutes in the 4 months after the initiation of ABM, P < .0001). Staffing, length of stay, case mix index, ICU transfer rates, and ICU death rates were stable across the 2 periods, all P = not significant.Conclusion
Conscientious management of hospital beds, in this case by hospitalist physicians providing ABM, can have a positive and substantial impact on the ED throughput of critically ill patients admitted to ICU beds. This efficiency is likely to positively have impacted on patient satisfaction and safety. 相似文献9.
Emmanuel Sègnon Sogbossi Jean-Louis Thonnard Charles Sèbiyo Batcho 《Archives of physical medicine and rehabilitation》2014
Objective
To calibrate and validate the Benin version of ABILOCO, a Rasch-built scale developed to assess locomotion ability in stroke patients.Design
Prospective study and questionnaire development.Setting
Rehabilitation centers.Participants
Stroke patients (N=230; mean age ± SD, 51.1±11.6y; 64.3% men).Intervention
Not applicable.Main Outcome Measures
Participants completed a preliminary list of 36 items including the 13 items of ABILOCO. Items were scored as “impossible,” “difficult,” or “easy.” The mobility subdomain of FIM (FIM-mobility), the Functional Ambulation Classification (FAC), the 6-minute walk test (6MWT), and the 10-meter walk test (10MWT) were used to evaluate and elucidate the validity of the ABILOCO-Benin scale.Results
Successive Rasch analyses led to the selection of 15 items that define a unidimensional, invariant, and linear measure of locomotion ability in stroke patients. This modified version of the ABILOCO scale, named ABILOCO-Benin, showed an excellent internal consistency, with a Person Separation Index of .93, and excellent test-retest reliability with high intraclass correlation coefficients of .95 (P<.001) for item difficulty and .93 (P<.001) for subject measures. It also presented good construct validity compared with FAC, FIM-mobility, 6MWT, and 10MWT (r≥.75, P<.001).Conclusions
ABILOCO-Benin presents good psychometric properties. It allows valid, reliable, and objective measurements of locomotion ability in stroke patients. 相似文献10.
Otavio T. Ranzani Fernando Godinho Zampieri Leandro Utino Taniguchi Daniel Neves Forte Luciano César Pontes Azevedo Marcelo Park 《Journal of critical care》2014
Purpose
The impact of the intermediate care unit (IMCU) on post–intensive care unit (ICU) outcomes is controversial.Materials and Methods
We analyzed admissions from January 2003 to December 2008 from a mixed ICU in a teaching hospital in Brazil with a high patient-to-nurse ratio (3.5:1 on the ICU, 11:1 on the IMCU, 20-25:1 on the ward). A retrospective propensity-matched analysis was performed with data from 690 patients who were discharged after at least 3 days of ICU stay.Results
Of the 690 patients, 160 (23%) were discharged to the IMCU. A total of 399 propensity-matched patients were compared: 298 were discharged to the ward and 101 were discharged to the IMCU. Ninety-day mortality rate was similar between the IMCU and ward patients (22% vs 18%, respectively, P = .37), as was the unplanned ICU readmission rate (P = .63). In a multivariate logistic regression, discharge to the IMCU had no effect on the 90-day mortality rate (P = .27).Conclusions
In a resource-limited setting with a high patient-to-nurse ratio, discharge to IMCU had no impact on 90-day mortality rate and on unplanned readmission rate. The impact of discharge to the IMCU on the outcome for critically ill patients should be evaluated in further studies. 相似文献11.
Joonas Tirkkonen Jari Ylä-Mattila Klaus T. Olkkola Heini Huhtala Jyrki Tenhunen Sanna Hoppu 《Resuscitation》2013
Aim
We used the Utstein template, with special reference to patients having automated patient monitoring, and studied the factors which are associated with delayed medical emergency team (MET) activation and increased hospital mortality.Design and setting
A prospective observational study in a tertiary hospital with 45 of 769 general ward beds (5.9%) equipped with automated monitoring.Cohort
569 MET reviews for 458 patients.Results
Basic MET review characteristics were comparable to literature. We found that 41% of the reviews concerned monitored ward patients. These patients’ vitals had been more frequently documented during the 6 h period preceding MET activation compared to patients in normal ward areas (96% vs. 74%, p < 0.001), but even when adjusted to the documentation frequency of vitals, afferent limb failure (ALF) occurred more often among monitored ward patients (81% vs. 53%, p < 0.001). In MET population, factors associated with increased hospital mortality were non-elective hospital admission (OR 6.25, 95% CI 2.77–14.11), not-for-resuscitation order (3.34, 1.78–6.35), ICD XIV genitourinary diseases (2.42, 1.16–5.06), ICD II neoplasms (2.80, 1.59–4.91), age (1.02, 1.00–1.04), preceding length of hospital stay (1.04, 1.01–1.07), ALF (1.67, 1.02–2.72) and transfer to intensive care (1.85, 1.05–3.27).Conclusions
Documentation of vital signs before MET activation is suboptimal. Documentation frequency seems to increase if automated monitors are implemented, but our results suggest that benefits of intense monitoring are lost without appropriate and timely interventions, as afferent limb failure, delay to call MET when predefined criteria are fulfilled, was independently associated to increased hospital mortality. 相似文献12.
Incidence and predictors of new-onset atrial fibrillation in noncardiac intensive care unit patients
Stamatis S. Makrygiannis Anastasia Margariti Despina Rizikou Manolis Lampakis Spyros Vangelis Olga S. Ampartzidou Konstantina Katsifa Paraskevi Tselioti Stefanos G. Foussas Athanasios A. Prekates 《Journal of critical care》2014
Background
Atrial fibrillation (AF) is thought to be a relatively common arrhythmia in the setting of noncardiac intensive care unit (ICU). However, data concerning AF deriving from such populations are scarce. In addition, it is unclear which of the wide spectrum of AF predictors are relevant to the ICU setting.Objectives
The aim of our study was to evaluate the incidence of new-onset AF and investigate the factors that contribute to its occurrence in ICU patients.Methods
We prospectively studied all patients admitted to our ICU during a 1-year period. Patients admitted for brief postoperative monitoring and patients with chronic or intermittent AF and AF present upon admission were excluded. A number of conditions incriminated as AF risk factors or “triggers” from demographics, medical history, present disease, and cardiac echocardiography as well as circumstances of AF onset were recorded.Results
The study population consisted of 133 patients (90 males). Atrial fibrillation was observed in 15% of them. Age older than 65 years (P = .001), arterial hypertension (P = .03), systemic inflammatory response syndrome (P < .001), sepsis (P = .001), left atrial dilatation (P = .01), and diastolic dysfunction (P = .04) were significantly associated with the occurrence of AF. By multivariate analysis, it was demonstrated that only older than 65 years (odds ratio, 7.0; 95% confidence interval, 2.0-24.6; P = .003) and sepsis (odds ratio, 6.5; 95% confidence interval, 2.0-21.1; P = .002) independently predict new-onset AF. Patients manifesting AF were frequently hypovolemic (30%) and had electrolyte disorders (40%) as well as elevated and rising serum C-reactive protein (70%).Conclusion
A significant fraction of ICU patients manifest AF. The predictors of interest for the ICU patients might be considerably different than those of the general population and other subgroups with systemic inflammation possibly having a pivotal role. 相似文献13.
M. Roudesli B. Steenstrup J. Beaufils D. Debeaumont F. Duparc 《Journal de Traumatologie du Sport》2013
Introduction
Hip osteoarthritis and femoroacetabular impingement frequently affect sportsmen and are origins of permanent incapacity. The therapic behaviour before surgery step is not yet established. Physiotherapy is often suggested but it is still difficult to prescribe it correctly. The main goal of our study is to show superiority, both in terms of decrease of pain and increase of sportive activity, of the process “PROTOCOX” including both physiotherapy and manual therapy in comparison with a physiotherapy process “CONTROLE”.Method
Twenty-six sportive patients of the “Institut régional de médecine du sport de Haute Normandie (IRMSHN)” have been included in the study in an 18-month period. Our secondary aims are to show improvement of life quality and range of motion. Several data including HOOS and Lequesne index have been harvested before and after the six sessions and after 3 months.Results
For patients (n = 11) of the “PROTOCOX” group (P = 0.034), a significant improvement of the HOOS index, mainly on pain (P = 0.04) and allowing an increase of sportive activity (P = 0.007). After 3 months, there was still a transitory improvement allowing an increase of sportive activity for 75% of the patients (n = 8) of the “PROTOCOX” group in comparison of 18.2% for the “CONTROLE” patients.Conclusion
The “PROTOCOX” process is simple and practicable in liberal sector, and gives benefits in terms of decrease of pain and sportive activity increase with a reduce number of sessions and its transitory efficiency stays at mid term. 相似文献14.
Background
Dynamic alignment of “knee-in & toe-out” is a risk factor for anterior cruciate ligament injury and is possibly influenced by static knee alignment, range of tibial rotation and tibial plateau geometry.Methods
Twenty-eight healthy women were classified into valgus, neutral and varus groups based on static alignment of their knees. A 3-dimensional motion analysis was carried out for a single limb drop landing. The range of tibial rotation and posterior tibial slope angle was measured by MRI. Comparison among the 3 groups and correlation between the angles was analyzed during motion.Findings
The differences between the medial and lateral posterior tibial slope angles were greater (P = 0.019), also range of internal tibial rotation for the valgus group (P = 0.017) and, for the varus group, the “knee-in” angle (P = 0.048). The “knee-in” angle correlated significantly with the tibial rotation angle (R = − 0.39, P = 0.038), and the range of tibial rotation correlated with the variations between the medial and lateral posterior tibial slope angles (R = 0.90, P = 0.003).Interpretation
The range of tibial rotation, posterior tibial slope and “knee-in” angle varied according to whether the knee was in valgus or varus with the range of tibial rotation dependent on the posterior tibial slope angle. The greater the “knee-in” angle became, the smaller the internal tibial rotation was, acting in a kinetic chain. The results suggest that static alignment of the knee may be utilized as a predictor for potential problems that occur during motion. 相似文献15.
Background
The incidence of shivering in cardiac arrest survivors who undergo therapeutic hypothermia (TH) is varied. Its occurrence is dependent on the integrity of multiple peripheral and central neurologic pathways. We hypothesized that cardiac arrest survivors who develop shivering while undergoing TH are more likely to have intact central neurologic pathways and thus have better neurologic outcome as compared to those who do not develop shivering during TH.Methods
Prospectively collected data on consecutive adult patients admitted to a tertiary center from 1/1/2007 to 11/1/2010 that survived a cardiac arrest and underwent TH were retrospectively analyzed. Patients who developed shivering during the cooling phase of TH formed the “shivering” group and those that did not formed the “non-shivering” group. The primary end-point: Pittsburgh Cerebral Performance Category (CPC) scale; good (CPC 1–2) or poor (CPC 3–5) neurological outcome prior to discharge from hospital.Results
Of the 129 cardiac arrest survivors who underwent TH, 34/94 (36%) patients in the “non-shivering” group as compared to 21/35 (60%) patients in the “shivering” group had good neurologic outcome (P = 0.02). After adjusting for confounders using binary logistic regression, occurrence of shivering (OR: 2.71, 95% CI 1.099–7.41, P = 0.04), time to return of spontaneous circulation (OR: 0.96, 95% CI 0.93–0.98, P = 0.004) and initial presenting rhythm (OR: 4.0, 95% CI 1.63–10.0, P = 0.002) were independent predictors of neurologic outcome.Conclusion
The occurrence of shivering in cardiac arrest survivors who undergo TH is associated with an increased likelihood of good neurologic outcome as compared to its absence. 相似文献16.
N. Lefevre S. Klouche N. Doumbouya M. Chambaz C. Devaux R. Thomas S. Herman Y. Bohu 《Journal de Traumatologie du Sport》2014
Introduction
In France, the median duration of hospitalization for a reconstruction of the anterior cruciate ligament (ACL) is 3 days. The purpose of this study was to evaluate the feasibility and acceptability of hospitalization for one day for this surgery.Patients and methods
A prospective study conducted in 2011 included patients who underwent surgery for an ACL rupture. Exclusion criteria were age > 60 years, scores ASA3-4 and patients unmanageable in short-stay. Two groups of patients were formed: “short-stay” with an output at D1 and “conventional hospitalization” with an output at D3. The postoperative analgesia protocol included analgesics I-II, morphine on demand during hospitalization. “Short-stay” group received a telephone follow-up (D1–D4). The primary outcome was patient satisfaction at D3. The secondary endpoints were postoperative pain assessed on a visual analogue scale at D3 and adverse events. Thirty patients were included in each group, 34 men and 26 women, mean age 29 ± 5 years.Results
Patients in group “short-stay” were on average more satisfied than the “conventional hospitalization” group, P = 0.01. The pain was significantly less pronounced in the “short-stay” group, P = 0.00001. No complications occurred.Conclusion
Inpatients short-stay were significantly more satisfied and less painful than those in conventional hospitalization group. Future studies should evaluate the feasibility of ambulatory surgery for ACL reconstruction. 相似文献17.
Abdul Moiz Hafiz Srihari S. Naidu Joshua DeLeon Shahidul Islam Basil Alkhatib Miguel Lorenz Alexis D’Elia Barry Rosenthal Kevin Marzo 《The American journal of emergency medicine》2013
Objectives
To determine effect of first medical contact type on symptom onset–to-door time (SODT).Background
Shorter total ischemic time is associated with improved outcomes in ST-elevation myocardial infarction.Methods
From 2005 to 2009, we reviewed records of all consecutive patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction at our tertiary care teaching hospital (median follow-up 3.85 years). We compared SODT in patients whose first medical contact was a private physician (in person or via telephone) vs patients who presented to the emergency department (ED) directly (in person or via Emergency Medical Services).Results
Of 366 patients, 84 (23%) contacted a physician (group A) while 282 (77.6%) did not (group B). Group A had higher median SODT (239.5 vs 130 minutes, P = .0043) and significantly higher mortality (log rank P = .0392, Cox Proportional Hazard Model risk factors: physician contact first [P < .013], age [P < .0001] and peripheral vascular disease [P < .035]). Two factors associated with prolonged SODT: (1) contacting a physician first P = .002 and (2) personal mode of transportation, P = .002. Patients presenting during “on-hours” (weekdays) were more likely to first contact a physician compared with those presenting during “off-hours” (weeknights and weekends) (66.67% in group A vs 45.04% in group B, P < .001).Conclusions
Patients whose first medical contact was a physician had greater pre-hospital delays and worse survival compared to those who sought emergent medical care directly. This pattern occurred more often during “on-hours.” Educational efforts aimed at both patient and physician office practices are warranted. 相似文献18.
Margaret A. Pisani Terrence E. Murphy Katy L.B. Araujo Peter H. Van Ness 《Journal of critical care》2010
Purpose
This study was designed to identify factors associated with persistent delirium in an older medical intensive care unit (ICU) population.Materials and Methods
This is a prospective cohort study of 309 consecutive medical ICU patients 60 years or older. Persistent delirium was defined as delirium occurring in the ICU and continuing upon discharge to the ward. The Confusion Assessment Method was used to assess for delirium. Patient demographics, severity of illness, and medication data were collected. Univariate and multivariate analysis were used to assess factors associated with persistent delirium.Results
Of 309 consecutive admissions to the ICU, 173 patients had ICU delirium, survived the ICU stay, and provided ward data. One-hundred patients (58%) had persistent delirium. In a multivariable logistic regression model, factors significantly associated with persistent delirium included age more than 75 years (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.23-5.16), opioid (morphine equivalent) dose greater than 54 mg/d (OR, 2.90; 95% CI, 1.15-7.28), and haloperidol (OR, 2.88; 95% CI, 1.38-6.02); change in code status to “do not resuscitate” (OR, 2.62; 95% CI 0.95-7.35) and dementia (OR, 1.93; 95% CI 0.95-3.93) had less precise associations.Conclusions
Age, use of opioids, and haloperidol were associated with persistent delirium. Further research is needed regarding the use of haloperidol and opioids on persistent delirium. 相似文献19.
Thomas Mitterlechner Peter Paal Lukas Kuehnelt-Leddhin Alexander M. Strasak Günther Putz Nikolaus Gravenstein Achim von Goedecke Volker Wenzel 《The American journal of emergency medicine》2013
Introduction
The aim of the study was to assess the effects of positioning the head on a support on “head position angles” to optimally open the upper airway during bag-valve mask ventilation.Methods
We ventilated the lungs of anesthetized adults with a bag-valve mask and the head positioned with (n = 30) or without a support (n = 30). In both groups, head position angles and ventilation parameters were measured with the head positioned in (1) neutral position, (2) in a position deemed optimal for ventilation by the investigator, and (3) in maximal extension.Results
Between groups (“head with/without a support”) and between head positions within each group, head position angles and ventilation parameters differed (P < .0001, respectively). However, head position angles and ventilation parameters between head positions differed less “with a support” (P < .001), and ventilation parameters improved with a support compared with the head-without-a-support group (P < .001).Conclusions
In the head-with-a-support group, when compared with the head-without-a-support group, head position angles differed less, indicating a decreased potential for failure during bag-valve mask ventilation with the head on a support. Moreover, in the head-with-a-support group, ventilation parameters differed less between head positions, and ventilation improved. These findings suggest a potential benefit of positioning the head on a support during bag-valve mask ventilation. 相似文献20.