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2. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline.

Author

Sahetya, Sarina, Munshi, Laveena, Summers, Charlotte, Abrams, Darryl, Beitler, Jeremy, Bellani, Giacomo, Brower, Roy, Burry, Lisa, Chen, Jen-Ting, Hodgson, Carol, Hough, Catherine, Lamontagne, Francois, Law, Anica, Papazian, Laurent, Pham, Tai, Rubin, Eileen, Siuba, Matthew, Telias, Irene, Patolia, Setu, Chaudhuri, Dipayan, Walkey, Allan, Rochwerg, Bram, Fan, Eddy, and Qadir, Nida

Subjects
acute respiratory distress syndrome, corticosteroids, extracorporeal membrane oxygenation, neuromuscular blockade, positive end-expiratory pressure, Adult, Humans, Adrenal Cortex Hormones, Lung, Neuromuscular Blocking Agents, Positive-Pressure Respiration, Respiratory Distress Syndrome
Abstract

Background: This document updates previously published Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure (PEEP). Methods: We summarized evidence addressing four PICO questions (patient, intervention, comparison, and outcome). A multidisciplinary panel with expertise in ARDS used the Grading of Recommendations, Assessment, Development, and Evaluation framework to develop clinical recommendations. Results: We suggest the use of: 1) corticosteroids for patients with ARDS (conditional recommendation, moderate certainty of evidence), 2) venovenous extracorporeal membrane oxygenation in selected patients with severe ARDS (conditional recommendation, low certainty of evidence), 3) neuromuscular blockers in patients with early severe ARDS (conditional recommendation, low certainty of evidence), and 4) higher PEEP without lung recruitment maneuvers as opposed to lower PEEP in patients with moderate to severe ARDS (conditional recommendation, low to moderate certainty), and 5) we recommend against using prolonged lung recruitment maneuvers in patients with moderate to severe ARDS (strong recommendation, moderate certainty). Conclusions: We provide updated evidence-based recommendations for the management of ARDS. Individual patient and illness characteristics should be factored into clinical decision making and implementation of these recommendations while additional evidence is generated from much-needed clinical trials.

Published
2024

6. Strategies for lung- and diaphragm-protective ventilation in acute hypoxemic respiratory failure: a physiological trial.

Author

Dianti, Jose, Fard, Samira, Wong, Jenna, Chan, Timothy, Del Sorbo, Lorenzo, Fan, Eddy, Amato, Marcelo, Granton, John, Burry, Lisa, Reid, W, Zhang, Binghao, Ratano, Damian, Keshavjee, Shaf, Slutsky, Arthur, Brochard, Laurent, Ferguson, Niall, and Goligher, Ewan

Subjects
Diaphragm-protective ventilation, Hypoxemic respiratory failure, Lung-protective ventilation, Mechanical ventilation, Diaphragm, Humans, Lung, Positive-Pressure Respiration, Respiration, Artificial, Respiratory Insufficiency
Abstract

BACKGROUND: Insufficient or excessive respiratory effort during acute hypoxemic respiratory failure (AHRF) increases the risk of lung and diaphragm injury. We sought to establish whether respiratory effort can be optimized to achieve lung- and diaphragm-protective (LDP) targets (esophageal pressure swing - 3 to - 8 cm H2O; dynamic transpulmonary driving pressure ≤ 15 cm H2O) during AHRF. METHODS: In patients with early AHRF, spontaneous breathing was initiated as soon as passive ventilation was not deemed mandatory. Inspiratory pressure, sedation, positive end-expiratory pressure (PEEP), and sweep gas flow (in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO)) were systematically titrated to achieve LDP targets. Additionally, partial neuromuscular blockade (pNMBA) was administered in patients with refractory excessive respiratory effort. RESULTS: Of 30 patients enrolled, most had severe AHRF; 16 required VV-ECMO. Respiratory effort was absent in all at enrolment. After initiating spontaneous breathing, most exhibited high respiratory effort and only 6/30 met LDP targets. After titrating ventilation, sedation, and sweep gas flow, LDP targets were achieved in 20/30. LDP targets were more likely to be achieved in patients on VV-ECMO (median OR 10, 95% CrI 2, 81) and at the PEEP level associated with improved dynamic compliance (median OR 33, 95% CrI 5, 898). Administration of pNMBA to patients with refractory excessive effort was well-tolerated and effectively achieved LDP targets. CONCLUSION: Respiratory effort is frequently absent  under deep sedation but becomes excessive when spontaneous breathing is permitted in patients with moderate or severe AHRF. Systematically titrating ventilation and sedation can optimize respiratory effort for lung and diaphragm protection in most patients. VV-ECMO can greatly facilitate the delivery of a LDP strategy. TRIAL REGISTRATION: This trial was registered in Clinicaltrials.gov in August 2018 (NCT03612583).

Published
2022

10. Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials

Author

Sharif, Sameer, Kang, Jasmine, Sadeghirad, Behnam, Rizvi, Fayyaz, Forestell, Ben, Greer, Alisha, Hewitt, Mark, Fernando, Shannon M., Mehta, Sangeeta, Eltorki, Mohamed, Siemieniuk, Reed, Duffett, Mark, Bhatt, Maala, Burry, Lisa, Perry, Jeffrey J., Petrosoniak, Andrew, Pandharipande, Pratik, Welsford, Michelle, and Rochwerg, Bram

Published
2024
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11. Design of Clinical Trials Evaluating Sedation in Critically Ill Adults Undergoing Mechanical Ventilation: Recommendations From Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research (SCEPTER) Recommendation III

Author

Ward, Denham S, Absalom, Anthony R, Aitken, Leanne M, Balas, Michele C, Brown, David L, Burry, Lisa, Colantuoni, Elizabeth, Coursin, Douglas, Devlin, John W, Dexter, Franklin, Dworkin, Robert H, Egan, Talmage D, Elliott, Doug, Egerod, Ingrid, Flood, Pamela, Fraser, Gilles L, Girard, Timothy D, Gozal, David, Hopkins, Ramona O, Kress, John, Maze, Mervyn, Needham, Dale M, Pandharipande, Pratik, Riker, Richard, Sessler, Daniel I, Shafer, Steven L, Shehabi, Yahya, Spies, Claudia, Sun, Lena S, Tung, Avery, and Urman, Richard D

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Prevention, Clinical Trials and Supportive Activities, Clinical Research, Patient Safety, Generic health relevance, Quality Education, Congresses as Topic, Consensus, Delphi Technique, District of Columbia, Humans, Hypnotics and Sedatives, Respiration, Artificial, Time Factors, clinical trial, intensive care, outcome assessments, research methodology, sedation, Nursing, Public Health and Health Services, Emergency & Critical Care Medicine, Clinical sciences
Abstract

ObjectivesClinical trials evaluating the safety and effectiveness of sedative medication use in critically ill adults undergoing mechanical ventilation differ considerably in their methodological approach. This heterogeneity impedes the ability to compare results across studies. The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations convened a meeting of multidisciplinary experts to develop recommendations for key methodologic elements of sedation trials in the ICU to help guide academic and industry clinical investigators.DesignA 2-day in-person meeting was held in Washington, DC, on March 28-29, 2019, followed by a three-round, online modified Delphi consensus process.ParticipantsThirty-six participants from academia, industry, and the Food and Drug Administration with expertise in relevant content areas, including two former ICU patients attended the in-person meeting, and the majority completed an online follow-up survey and participated in the modified Delphi process.Measurements and main resultsThe final recommendations were iteratively refined based on the survey results, participants' reactions to those results, summaries written by panel moderators, and a review of the meeting transcripts made from audio recordings. Fifteen recommendations were developed for study design and conduct, subject enrollment, outcomes, and measurement instruments. Consensus recommendations included obtaining input from ICU survivors and/or their families, ensuring adequate training for personnel using validated instruments for assessments of sedation, pain, and delirium in the ICU environment, and the need for methodological standardization.ConclusionsThese recommendations are intended to assist researchers in the design, conduct, selection of endpoints, and reporting of clinical trials involving sedative medications and/or sedation protocols for adult ICU patients who require mechanical ventilation. These recommendations should be viewed as a starting point to improve clinical trials and help reduce methodological heterogeneity in future clinical trials.

Published
2021

17. Effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review and meta-analysis

Author

Chapman, Martin, Scales, Damon, Nardi, Julie, Linseman, Beth, Lau, Phil, Yakubov, Boris, Carrier, François M., Charbonney, Emmanuel, Chassé, Michaël, Girard, Martin, Halwagi, Antoine, Plourde, Guillaume, Wang, Han T., Lafrance, Dominique, Corsilli, Danielle, Sokoloff, Catalina, D'Aragon, Frédérick, Tissot-Therrien, Maxime, Lamontagne, François, Bérard, Dominique, Cavayas, Yiorgos A., Albert, Martin, Bernard, Francis, Serri, Karim, Williamson, David, Williams, Virginie, Barrios, Patricia M., De Franca, Sabrina A., Couture, Etienne J., Côté, Adreanne, Simon, Mathieu, Lépine, Pierre-Alexis, Gleeton, Dave, Basmaji, John, Slessarev, Marat, Hegazy, Ahmed, Bentall, Tracey, Campbell, Eileen, Stephens, Michelle, Winterburn, Tim, Hatzakorzian, Roupen, Khwaja, Kosar, Goldberg, Peter, Shahin, Jason, Grushka, Jeremy R., Hooper, Jonathan, Microys, Sherissa, Meggison, Hilary, Leilipovitz, David, Haines, Jessica, Watpool, Irene, Porteous, Rebecca, Dunster, Stephanie, Bourbonnais, Sylvie, Goligher, Ewan, Del Sorbo, Lorenzo, Ferguson, Niall, Graham, Philip, Long, Michael, Yan, Tina, Morris, Denise, Kobylecky, Maria, Abdelhady, Hesham, Romagnuolo, Tina, Randall, Ian, Wilcox, Elizabeth, Jacka, Michael, Rewa, Oleksa, Lau, Vincent, Bagshaw, Sean, Baig, Nadia, Cuninghame, Sean, Jerath, Angela, Gorsky, Kevin, Sivajohan, Asaanth, Francoeur, Conall, Withington, Davinia, Burry, Lisa, Cuthbertson, Brian H., Orser, Beverley A., Martin, Claudio, and Owen, Adrian M.

Published
2023
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18. Critical Care Staffing in Pandemics and Disasters: A Consensus Report From a Subcommittee of the Task Force for Mass Critical Care – Systems Strategies to Sustain the Health Care Workforce

Author

Sprung, Charles L., Devereaux, Asha V., Ghazipura, Marya, Burry, Lisa D., Hossain, Tanzib, Hamele, Mitchell T., Gist, Ramon E., Dempsey, Timothy M., Dichter, Jeffrey R., Henry, Kiersten N., Niven, Alexander S., Alptunaer, Timur, Huffines, Meredith, Bowden, Kasey R., Martland, Anne Marie O., Felzer, Jamie R., Mitchell, Steven H., Tosh, Pritish K., Persoff, Jason, Mukherjee, Vikramjit, Downar, James, Báez, Amado A., and Maves, Ryan C.

Published
2023
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20. International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU*

Author

Bolesta, Scott, Burry, Lisa, Perreault, Marc M., Gélinas, Céline, Smith, Kathryn E., Eadie, Rebekah, Carini, Federico C., Saltarelli, Katrianna, Mitchell, Jennifer, Harpel, Jamie, Stewart, Ryan, Riker, Richard R., Fraser, Gilles L., Erstad, Brian L., Alcántara, Sara, Aldardeer, Namareq, Alhammad, Abdullah, Almohaish, Sulaiman, Ammar, Mahmoud, Arroyo-Novoa, Carmen Mabel, Awassi, Don-Kelena, Badano, Mariana, Badman, Belinda, Barnes, Sanchia, Bertozzi, Matias, Botros, Shady, Brophy, Gretchen, Brown, Caitlin, Brown, Glen, Buckley, Mitchell, Burgess, Sarah, Campbell, Joshua, Carothers, Chancey, Celario, Patricio, Chambers, Lauren, Chanques, Gérald, Contreras, Sofia, d’Hebron, Vall, Cortes, Jennifer, Cozzi, Gabrielle, Cucci, Michaelia, Cunto, Eleonora, Dao, Denis, Defayette, Aubrey, Dey, Alexandra, Diaz, Anatilde, Dixit, Deepali, Dube, Jean-Noel, Duceppe, Marc-Alexandre, Dzierba, Amy, Farrell, Odran, Ferranti, Pietro, Flannery, Alexander, Fontaine, Gabriel, Forehand, Christy, Nelson, Nydia Funes, Gillet, Manon, Gonzalez, Gustavo Nicolas, Graham-Clarke, Emma, Green, Sarah, Groth, Christine, Hamid, Hytham, Hamilton, Leslie, Hanley, Joanne, Jackson, Jessica, Johnston, Jackie, Kanji, Salmaan, Katzman, Sam, Kenes, Michael, Kinney, Justin, Kohler, Claire, Kovacic, Nicole, Kuroski, Julia, Landolf, Kaitlin, Laotheerachao, Rosalynn, Largana, Samuel, Lebrun, Genevieve, Leonardo, Kate, Levins, Elizabeth, Lewis-Wolfson, Temeka, Mailman, Jonathan, Man, Anna, Mandich, Veronica, McCullagh, Iain, McDonald, Jill, Gil, Antonella Milano, Ng, Wing Sum (Winny), Nguyen, Hang, O’Hare, Madeline, saleh, Jesus eduardo Ochoa, Oswald, Christopher, Patanwala, Asad, Payen, Jean-Francois, Phan, Brian, Radosevich, John, Reiter, Tamara, Remmington, Christopher, Reyes, Viviana, Roberts, Russel, Sagardia, Judith, Sall, Jas, Sanchez, Diego, Shoulders, Bethany, Sneyers, Barbara, Thiboutot, Zoe, Thompson, Melissa, Timmins, Alan, Tolosa, Carina Fernanda, Tolosa, Carina, Junin, Sanatorio, Torres, Valentin Gabriel, Tran, Sandy, Trinh, Thu Ha, Tynan, Sinead, Vu, Lan, Wilson, Franki, Cook, Aaron, Ciolek, Alana, Haines, Aleina, Rodriguez, Alejandra, Cheung, Alexandra, Leong, Amanda, Nisnik, Ana Laura, Mancilla, Ana Maria, Rinehimer, Brandon, Sloan, Brett, Bissell, Brittany, Kulilg, Caitlin, Coombe, Cassandra, Dominguez, Cecilia, Wampole, Chelsea, Rodriguez de la Quintana, Cristhian, Mulodjanov, Darina, Tsoller, Darina, Bowen, David, Gagnon, David, Purkayastha, Debanjali, Ali, Dina, Saidahmed, Elfayadh, Lewandowski, Emily, Schranz, Emily, MacNeil, Erin, Hanks, Fraser, Kassab, Hager, Brokmeier, Hannah, Kaur, Jaspreet, Huntress, Jeff, Clark, Jenna, Falvey, Jennifer, De Giacomo, Jessica, Smith, Jonathan, Ibarzabal, Juan, Niland, Judith, Muir, Justin, Gosek, Kasia, Maynard, Kaylee, Kooda, Kirstin, Pandya, Komal, Kaupp, Kristin, Ebitt, Laura, Bordon, Lucas, Chiscano, Lusi, Sosa, Manuel, Cosep, Marc, Lobo, Marcelo, Monte, Marco Flores, Sandler, Melissa, Bastin, Melissa Thompson, Armahizer, Michael, Wang, Michelle, Eshaghian, Miriam, Rizwan, Mohammad, Patel, Mona, Pistillo, Nestor, Harris, Nicole, Torella, Pau, Phongsamran, Paula, Woo, Priscilla, Garcia, Rhiannon, Sabelli, Rosana Gregori, Grant, Ryan, Delibert, Samantha, Parli, Sara, Wilson, Sharon, Yeung, Siu Yan Amy, Putruele, Sofia, Rappaport, Stephen, Welch, Susan, Moitra, Vivek, and Chediack, Viviana

Published
2023
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26. Impact of supply chain disruptions and drug shortages on drug utilization: A scoping review protocol.

Author

Santhireswaran, Araniy, Ho, Martin, Fuller, Kaitlin, Gaudette, Etienne, Burry, Lisa, and Tadrous, Mina

Subjects
DRUG accessibility, DRUG bioavailability, NONPRESCRIPTION drugs, SUPPLY chain disruptions, GREY literature, DRUG utilization
Abstract

Objective: This proposed scoping review aims to examine studies assessing the impact of drug shortages on population-level drug utilization trends. The objectives of this review are to a) assess which drugs have been studied and describe associated drug characteristics, b) determine jurisdictions and healthcare settings that have conducted these studies, and c) describe how changes in drug use and the extent of shortage impacts are reported in literature. Introduction: Drug shortages continue to impair drug access and delivery of quality care across the world. However, the impact of drug supply disruptions on availability and drug use are understudied in current literature. This proposed scoping review will identify this gap and inform future research initiatives aimed at determining the real-world impacts of drug shortages. Inclusion criteria: Published and unpublished observational studies reporting on the effects of drug supply chain disruptions (shortages, discontinuations, and safety-based withdrawals) on consequent utilization trends faced by pharmaceutical products (i.e. prescription drugs, over-the-counter drugs, vaccines, therapy products, pharmaceutical solutions). Literature reviews, meta-analyses, randomized control trials, case series, case reports, and opinion pieces will be excluded. Methods: The search strategy will combine two key search concepts: drug shortages and drug utilization. The search will be conducted in MEDLINE and EMBASE. This will be followed by an extensive grey literature search in grey literature databases, targeted websites and Google. Furthermore, reference lists of included articles will be searched. Articles will be independently screened, selected and extracted by two reviewers. Data will be descriptively analyzed and presented in tables. Trial registration: Review registration number: Open Science Framework, https://osf.io/2p6e5. [ABSTRACT FROM AUTHOR]

Published
2024
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27. Intensive care unit interventions to promote sleep and circadian biology in reducing incident delirium: a scoping review.

Author

Wilcox, M. Elizabeth, Burry, Lisa, Englesakis, Marina, Coman, Briar, Daou, Marietou, van Haren, Frank M. P., Ely, E. Wes, Bosma, Karen J., and Knauert, Melissa P.

Subjects
SLEEP duration, CORONARY care units, FREE flaps, SLEEP interruptions, LENGTH of stay in hospitals, POLYSOMNOGRAPHY, MONITOR alarms (Medicine), COMA, HYPERSOMNIA
Published
2024
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29. Mass Critical Care Surge Response During COVID-19: Implementation of Contingency Strategies – A Preliminary Report of Findings From the Task Force for Mass Critical Care

Author

Al-Awadhi, Anwar, Alptunaer, Timur, Baldisseri, Marie, Barfield, Wanda, Baum, Karyn D., Benditt, Joshua, Bowden, Kasey, Branson, Richard, Burry, Lisa D., Christian, Michael, Devereaux, Asha V., Dichter, Jeffrey R., Dominguez-Cherit, Guillermo, Downar, James, Dries, David, Einav, Sharon, Etienne, Mill, Evans, Laura, Feldman, Henry J., Geiling, James, Ghazipura, Marya, Gist, Ramon, Griffin, Kelly, Halpern, Neil, Hamele, Mitchell T., Henry, Kiersten, Hertelendy, Attila, Hick, John, Huffines, Meredith, Hupert, Nathaniel, Hossain, Tanzib, Ingbar, David, Kadri, Sameer S., Kesler, Sarah, King, Mary A., Kissoon, Niranjan, Koenig, Kristi, Lamana, Joseph, Leif, Lindsay, Levy, Deborah, Livinsky, Alicia, Martin, Christie, Martland, Anne Marie, Maves, Ryan C., Mitchell, Steven, Mukherjee, Vikramjit, Narasimhan, Mangala, Niven, Alexander, Ochoa, Juan, Ornoff, Doug, Parrish, J. Scott, Persoff, Jason, Powell, Tia, Reed, M.J., Rodriguez, Dario, Seda, Gilbert, Singh, Jaspal, Solar, Julie, Sprung, Charles L., Toner, Eric, Tosh, Pritish K., Uppal, Amit, Von-Maszewski, Marian, Ornoff, Douglas, Henry, Kiersten N., Bowden, Kasey R., Martland, Anne Marie O., Hick, John L., and Christian, Michael D.

Published
2022
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30. Measures for the Core Outcome Set for Research Evaluating Interventions to Prevent and/or Treat Delirium in Critically Ill Adults: An International Consensus Study (Del-COrS)

Author

Rose, Louise, Blackwood, Bronagh, Needham, Dale M., Devlin, John W., Clarke, Mike, Burry, Lisa D., Agar, Meera, Boland, Jason, Bush, Shirley, Campbell, Noll L., Featherstone, Imogen, Fornear, Leslie, Hosie, Annmarie, Johnson, Miriam, Jones, Richard N., Lawlor, Peter, Lee, Jacques, Marshall, John, Siddiqi, Najma, and Page, Valerie

Published
2023
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31. Cognitive and Motor Function Effects of Antipsychotics in Traumatic Brain Injury: A Systematic Review of Pre-Clinical Studies

Author

Cataford, Gabrielle, primary, Monton, Laurie-Anne, additional, Karzon, Stephanie, additional, Livernoche-Leduc, Camille, additional, Saavedra-Mitjans, Mar, additional, Potvin, Marie-Julie, additional, Bernard, Francis, additional, Burry, Lisa, additional, Arbour, Caroline, additional, and Williamson, David R., additional

Published
2024
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32. Effect of oral chlorhexidine de-adoption and implementation of an oral care bundle on mortality for mechanically ventilated patients in the intensive care unit (CHORAL): a multi-center stepped wedge cluster-randomized controlled trial

Author

Dale, Craig M., Rose, Louise, Carbone, Sarah, Pinto, Ruxandra, Smith, Orla M., Burry, Lisa, and Fan, Eddy

Subjects
Bacterial pneumonia -- Research -- Patient outcomes, Mortality -- Ontario -- Canada, Pneumonia -- Research -- Patient outcomes, Hospital patients -- Patient outcomes, Evidence-based medicine -- Analysis -- Usage -- Research, Health care industry
Abstract

Purpose Oral chlorhexidine is used widely for mechanically ventilated patients to prevent pneumonia, but recent studies show an association with excess mortality. We examined whether de-adoption of chlorhexidine and parallel implementation of a standardized oral care bundle reduces intensive care unit (ICU) mortality in mechanically ventilated patients. Methods A stepped wedge cluster-randomized controlled trial with concurrent process evaluation in 6 ICUs in Toronto, Canada. Clusters were randomized to de-adopt chlorhexidine and implement a standardized oral care bundle at 2-month intervals. The primary outcome was ICU mortality. Secondary outcomes were time to infection-related ventilator-associated complications (IVACs), oral procedural pain and oral health dysfunction. An exploratory post hoc analysis examined time to extubation in survivors. Results A total of 3260 patients were enrolled; 1560 control, 1700 intervention. ICU mortality for the intervention and control periods were 399 (23.5%) and 330 (21.2%), respectively (adjusted odds ratio [aOR], 1.13; 95% confidence interval [CI] 0.82 to 1.54; P = 0.46). Time to IVACs (adjusted hazard ratio [aHR], 1.06; 95% CI 0.44 to 2.57; P = 0.90), time to extubation (aHR 1.03; 95% CI 0.85 to 1.23; P = 0.79) (survivors) and oral procedural pain (aOR, 0.62; 95% CI 0.34 to 1.10; P = 0.10) were similar between control and intervention periods. However, oral health dysfunction scores (- 0.96; 95% CI - 1.75 to - 0.17; P = 0.02) improved in the intervention period. Conclusion Among mechanically ventilated ICU patients, no benefit was observed for de-adoption of chlorhexidine and implementation of an oral care bundle on ICU mortality, IVACs, oral procedural pain, or time to extubation. The intervention may improve oral health., Author(s): Craig M. Dale [sup.1] [sup.2] [sup.3], Louise Rose [sup.4] [sup.5], Sarah Carbone [sup.1], Ruxandra Pinto [sup.6], Orla M. Smith [sup.1] [sup.7] [sup.8], Lisa Burry [sup.5] [sup.9] [sup.10], Eddy Fan [...]

Published
2021
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33. Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a systematic review and network meta-analysis

Author

Burry, Lisa D., Cheng, Wei, Williamson, David R., Adhikari, Neill K., Egerod, Ingrid, Kanji, Salmaan, and Martin, Claudio M.

Subjects
Mortality -- Ontario -- United Kingdom -- Canada, Dexmedetomidine -- Rankings, Antipsychotic drugs -- Analysis, Delirium -- Analysis, Health care industry
Abstract

Purpose To compare the effects of prevention interventions on delirium occurrence in critically ill adults. Methods MEDLINE, Embase, PsychINFO, CINAHL, Web of Science, Cochrane Library, Prospero, and WHO international clinical trial registry were searched from inception to April 8, 2021. Randomized controlled trials of pharmacological, sedation, non-pharmacological, and multi-component interventions enrolling adult critically ill patients were included. We performed conventional pairwise meta-analyses, NMA within Bayesian random effects modeling, and determined surface under the cumulative ranking curve values and mean rank. Reviewer pairs independently extracted data, assessed bias using Cochrane Risk of Bias tool and evidence certainty with GRADE. The primary outcome was delirium occurrence; secondary outcomes were durations of delirium and mechanical ventilation, length of stay, mortality, and adverse effects. Results Eighty trials met eligibility criteria: 67.5% pharmacological, 31.3% non-pharmacological and 1.2% mixed pharmacological and non-pharmacological interventions. For delirium occurrence, 11 pharmacological interventions (38 trials, N = 11,993) connected to the evidence network. Compared to placebo, only dexmedetomidine (21/22 alpha.sub.2 agonist trials were dexmedetomidine) probably reduces delirium occurrence (odds ratio (OR) 0.43, 95% Credible Interval (CrI) 0.21-0.85; moderate certainty). Compared to benzodiazepines, dexmedetomidine (OR 0.21, 95% CrI 0.08-0.51; low certainty), sedation interruption (OR 0.21, 95% CrI 0.06-0.69; very low certainty), opioid plus benzodiazepine (OR 0.27, 95% CrI 0.10-0.76; very low certainty), and protocolized sedation (OR 0.27, 95% CrI 0.09-0.80; very low certainty) may reduce delirium occurrence but the evidence is very uncertain. Dexmedetomidine probably reduces ICU length of stay compared to placebo (Ratio of Means (RoM) 0.78, CrI 0.64-0.95; moderate certainty) and compared to antipsychotics (RoM 0.76, CrI 0.61-0.98; low certainty). Sedative interruption, protocolized sedation and opioids may reduce hospital length of stay compared to placebo, but the evidence is very uncertain. No intervention influenced mechanical ventilation duration, mortality, or arrhythmia. Single and multi-component non-pharmacological interventions did not connect to any evidence networks to allow for ranking and comparisons as planned; pairwise comparisons did not detect differences compared to standard care. Conclusion Compared to placebo and benzodiazepines, we found dexmedetomidine likely reduced the occurrence of delirium in critically ill adults. Compared to benzodiazepines, sedation-minimization strategies may also reduce delirium occurrence, but the evidence is uncertain., Author(s): Lisa D. Burry [sup.1] [sup.2] [sup.3], Wei Cheng [sup.4], David R. Williamson [sup.5] [sup.6], Neill K. Adhikari [sup.7] [sup.8], Ingrid Egerod [sup.9], Salmaan Kanji [sup.10] [sup.11], Claudio M. Martin [...]

Published
2021
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35. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

Author

Evans, Laura, Rhodes, Andrew, Alhazzani, Waleed, Antonelli, Massimo, Coopersmith, Craig M., French, Craig, Machado, Flávia R., Mcintyre, Lauralyn, Ostermann, Marlies, Prescott, Hallie C., Schorr, Christa, Simpson, Steven, Wiersinga, W. Joost, Alshamsi, Fayez, Angus, Derek C., Arabi, Yaseen, Azevedo, Luciano, Beale, Richard, Beilman, Gregory, Belley-Cote, Emilie, Burry, Lisa, Cecconi, Maurizio, Centofanti, John, Coz Yataco, Angel, De Waele, Jan, Dellinger, R. Phillip, Doi, Kent, Du, Bin, Estenssoro, Elisa, Ferrer, Ricard, Gomersall, Charles, Hodgson, Carol, Møller, Morten Hylander, Iwashyna, Theodore, Jacob, Shevin, Kleinpell, Ruth, Klompas, Michael, Koh, Younsuck, Kumar, Anand, Kwizera, Arthur, Lobo, Suzana, Masur, Henry, McGloughlin, Steven, Mehta, Sangeeta, Mehta, Yatin, Mer, Mervyn, Nunnally, Mark, Oczkowski, Simon, Osborn, Tiffany, Papathanassoglou, Elizabeth, Perner, Anders, Puskarich, Michael, Roberts, Jason, Schweickert, William, Seckel, Maureen, Sevransky, Jonathan, Sprung, Charles L., Welte, Tobias, Zimmerman, Janice, and Levy, Mitchell

Published
2021
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38. Use of actigraphy for monitoring agitation and rest-activity cycles in patients with acute traumatic brain injury in the ICU.

Author

Saavedra-Mitjans, Mar, Van der Maren, Solenne, Gosselin, Nadia, Duclos, Catherine, Frenette, Anne Julie, Arbour, Caroline, Burry, Lisa, Williams, Virginie, Bernard, Francis, and Williamson, David R.

Subjects
WRIST, REPEATED measures design, STATISTICAL correlation, PEARSON correlation (Statistics), CRITICALLY ill, PATIENTS, ACTIGRAPHY, AGITATION (Psychology), DESCRIPTIVE statistics, LONGITUDINAL method, INTENSIVE care units, CIRCADIAN rhythms, SLEEP, PATIENT monitoring, BRAIN injuries, DATA analysis software, TIME
Abstract

In traumatic brain injury patients (TBI) admitted to the intensive care unit (ICU), agitation can lead to accidental removal of catheters, devices as well as self-extubation and falls. Actigraphy could be a potential tool to continuously monitor agitation. The objectives of this study were to assess the feasibility of monitoring agitation with actigraphs and to compare activity levels in agitated and non-agitated critically ill TBI patients. Actigraphs were placed on patients' wrists; 24-hour monitoring was continued until ICU discharge or limitation of therapeutic efforts. Feasibility was assessed by actigraphy recording duration and missing activity count per day. Data from 25 patients were analyzed. The mean number of completed day of actigraphy per patient was 6.5 ± 5.1. The mean missing activity count was 20.3 minutes (±81.7) per day. The mean level of activity measured by raw actigraphy counts per minute over 24 hours was higher in participants with agitation than without agitation. This study supports the feasibility of actigraphy use in TBI patients in the ICU. In the acute phase of TBI, agitated patients have higher levels of activity, confirming the potential of actigraphy to monitor agitation. [ABSTRACT FROM AUTHOR]

Published
2024
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44. Physicians’ beliefs and perceived importance of traumatic brain injury-associated agitation in critically ill patients: a survey of Canadian intensivists

Author

Saavedra-Mitjans, Mar, primary, Frenette, Anne Julie, additional, McCredie, Victoria A., additional, Burry, Lisa, additional, Arbour, Caroline, additional, Mehta, Sangeeta, additional, Charbonney, Emmanuel, additional, Wang, Han Ting, additional, Albert, Martin, additional, Bernard, Francis, additional, and Williamson, David, additional

Published
2023
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