Effects of daily sedation interruption in intensive care unit patients undergoing mechanical ventilation: A meta‐analysis of randomized controlled trials

Chen, Ting Jhen; Chung, Yi Wei; Chen, Pin Yuan; Hu, Sophia; Chang, Chuen Chau; Hsieh, Shu Hua; Wang, Bo Cyuan; Chiu, Hsiao‐Yean

doi:10.1111/ijn.12948

Cited by 21 publications

(13 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 , 30 Furthermore, a variety of approaches to overcome barriers have been suggested. 31 For example, optimal use of analgesia and sedation, 32 close monitoring of delirium, 33 interrupted sedation, 34 and a combination of these 23 would be helpful to overcome barriers related to consciousness, which are high among patients with MV. Mobilization practices should be optimized according to situations and barriers, irrespective of COVID-19 infection, the kind of disease, and its severity.…”

Section: Discussionmentioning

confidence: 99%

Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Liu

Nakamura

Kudchadkar

et al. 2022

J Intensive Care Med

View full text Add to dashboard Cite

Background Mobilization and acute rehabilitation are essential in the intensive care unit (ICU), with substantial evidence supporting their benefits. This study aimed to characterize ICU mobilization practices during the COVID-19 pandemic for patients with and without COVID-19. Methods This was a secondary analysis of an international point prevalence study. All ICUs across the world were eligible to participate and were required to enroll all patients in each ICU on the survey date, 27 January 2021. The primary outcome was the achievement of mobilization at the level of sitting over the edge of the bed. Independent factors associated with mobilization, including COVID-19 infection, were analyzed by multivariable analysis. Results A total of 135 ICUs in 33 countries participated, for inclusion of 1229 patients. Among patients who were not receiving mechanical ventilation (MV), those with COVID-19 infection were mobilized more than those without COVID-19 (60% vs. 34%, p < 0.001). Among patients who were receiving MV, mobilization was low in both groups (7% vs. 9%, p = .56). These findings were consistent irrespective of ICU length of stay. Multivariable analysis showed that COVID-19 infection was associated with achievement of mobilization in patients without (adjusted odds ratio [aOR] = 4.48, 95% confidence interval [CI] = 2.71-7.42) and with MV (aOR = 2.13, 95% CI = 1.00-4.51). Factors that prevented mobilization were prone positioning in patients without MV and continuous use of neuromuscular blockade and sedation agents in patients with MV, whereas facilitating factors were the presence of targets/goals in both groups. Conclusion Mobilization rates for ICU patients across the globe are severely low, with the greatest immobility observed in mechanically ventilated patients. Although COVID-19 is not an independent barrier to the mobilization of patients with or without MV, this study has highlighted the current lack of mobility practice for all ICU patients during the COVID-19 pandemic. (299 words)

show abstract

Section: Discussionmentioning

confidence: 99%

Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Liu

Nakamura

Kudchadkar

et al. 2022

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…So far, many studies have been focused on the physical health of the elderly (1)(2)(3). With the increase of age, the deterioration of physical function will lead to multiple diseases and physical problems, such as non-communicable diseases (4).…”

Section: Introductionmentioning

confidence: 99%

Mental health status and associated contributing factors among the Hakka elderly in Fujian, China

Liu

Ruan

et al. 2022

Front. Public Health

View full text Add to dashboard Cite

PurposeLittle is known about the mental health of the Hakka elderly. This study explores the status of, and factors associated with mental health among Hakka elderly populations from Fujian, China.MethodsThis is a cross-sectional, community-based survey study containing a total of 1,262 valid samples. The Chinese version Symptom Checklist-90-R (SCL-90-R) was used to assess the mental health status of the Hakka elderly. We used t-tests to compare the differences for 10 dimensions of SCL-90-R scores between the Chinese national norm and the Hakka elderly. Univariate and multivariate analysis were performed by using linear regression analysis to identify the main socio-demographic factors that were most predictive of the total score of SCL-90-R in the Hakka elderly.ResultsThe scores of somatization (1.78 ± 0.55 vs. 1.40 ± 0.46, P < 0.001) and phobic anxiety (1.21 ± 0.36 vs. 1.17 ± 0.31, P < 0.001) for the Hakka elderly in Fujian appeared to be significantly higher than the Chinese norm. The higher total scores of SCL-90-R were found among females (β = 0.030, P = 0.044), widowed persons (β = 0.053, P = 0.021), those with parent(s) alive (β = 0.047, P = 0.019), and those with poorer self-rated health status (β = 0.110, P < 0.001). The lower total scores of SCL-90-R were found among those who were currently living in town, those with lower education level, those with higher average annual household incomes, and those who were living with spouse or children.ConclusionThe worse mental health conditions of the Hakka elderly in somatization and phobic anxiety were detected. The overall mental health status was shown to be worse among females, widowed persons, those who were living in village, those with lower education, and those with father or/and mother alive.

show abstract

“…A systematic review of 13 studies showed that the implementation of a ventilator bundle significantly reduced mortality (odds ratio 0.90, 95%CI 0.84–0.97) [ 48 ]. Another systematic review of 45 randomized clinical trials involving 5493 participants showed that daily sedation interruption significantly reduced mechanical ventilation duration, ICU stay, sedation duration, tracheostomy and VAP risks [ 49 ]. In another improvement collaborative, the implementation of the ABCDEF bundle was associated with lower likelihood of hospital death within 7 days [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of a national collaborative project to improve the care of mechanically ventilated patients

et al. 2023

View full text Add to dashboard Cite

This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007–1.064, p = 0.0148; 1.021, 95% CI 1.010–1.032, p = 0.0003; and 1.019, 95%CI 1.009–1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953–0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6–18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985–1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4–33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973–0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).

show abstract

Effects of daily sedation interruption in intensive care unit patients undergoing mechanical ventilation: A meta‐analysis of randomized controlled trials

Cited by 21 publications

References 39 publications

Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Mental health status and associated contributing factors among the Hakka elderly in Fujian, China

Impact of a national collaborative project to improve the care of mechanically ventilated patients

Contact Info

Product

Resources

About