Memory in relation to depth of sedation in adult mechanically ventilated intensive care patients

Samuelson, Karin; Lundberg, Dag; Fridlund, Bengt

doi:10.1007/s00134-006-0105-x

Cited by 124 publications

(88 citation statements)

References 39 publications

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“…However, the incidence of cognitive impairment in both young and elderly participants implies that there is a greater problem than dementia that must be investigated. Furthermore, increasing data on cognitive impairment [9,13,[26][27][28][29] underscores the immediacy with which it should be addressed. It is therefore imperative that although elderly people are more susceptible to cognitive impairment because of their physiological status, younger people (<65 years) should be assessed as they are equally susceptible [6] This study's finding of elderly participants who suffered VF arrest and experienced cognitive impairment confirmed anecdotal evidence that VF arrest is associated with cognitive impairment due to cerebral hypoxia resulting from hypotension, decreased blood flow and oxygen delivery to the brain [4,17].…”

Section: Discussionmentioning

confidence: 99%

The experience of cognitive impairment in critically ill patients in and beyond intensive care: findings from a larger phenomenological study

Tembo¹

2015

J Nurs

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Background: Although Daily Sedation Interruption (DSI) is associated with better physical outcomes, many intensive care (ICU) survivors continue to suffer from cognitive impairment in and beyond ICU; neither has the meaning patients attach to the experience of cognitive impairment been extensively explored in the context of DSI. Objective: To gain an understanding of and uncover the experience of critical illness in ICU and beyond in the context of DSI. To establish whether or not DSI improves the experience of critical illness in ICU and beyond. Design: A hermeneutic phenomenological study using purposive sampling. Setting: Single centre 16 bed ICU in a 500 bed regional tertiary referral Hospital in Australia. Participants: Fifteen potential participants were approached. Two refused to participate, one died a week before the first interview, and 12 were enrolled into the study. Two participants withdrew from the study after the first interview, one was lost to follow-up and one was hospitalised. Inclusion criteria was patients aged 18 years and above who were mechanically ventilated and underwent DSI for at least 24 hours and were all able to speak English and give informed consent to participate in the study. Patients were excluded from the study if they had a poor prognosis, were less than 18 years old, unable to speak English, not ventilated and sedated for at least 24 hours. Methods: Participants were interviewed using open ended questions at two weeks after discharge from ICU and at six to eleven months following the initial interview. Interviews were tape recorded, transcribed and thematically analysed by highlighting themes using a phenomenological approach. Results: All the participants suffered some form of cognitive impairment resulting in the overarching theme of 'Being in Limbo' with three major themes of 'Being Disrupted', Being Imprisoned' and 'Being trapped'. The major themes 'Being Disrupted and 'Being Trapped' highlighted the prevalence of cognitive impairment. Conclusion: Although DSI is associated with better physical ICU outcomes, it does not improve the experience of critical illness and it does not decrease the incidence of cognitive impairment in and beyond ICU. What is already known about the topic. Daily sedation interruption is associated with improved physical outcomes. Critical illness is associated with cognitive impairment. What this paper adds This research shows that despite DSI the experience of critical illness in ICU and beyond is that of being in limbo during and after critical illness. DSI does not decrease the incidence of cognitive impairment in ICU survivors.

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Section: Discussionmentioning

confidence: 99%

The experience of cognitive impairment in critically ill patients in and beyond intensive care: findings from a larger phenomenological study

Tembo¹

2015

J Nurs

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“…Observou-se associação significativa entre as variáveis causa de admissão na UTI e presença de memória (p = 0,019 10 investigaram a relação entre memória e sedação em pacientes submetidos à ventilação mecânica. Dos 250 pacientes avaliados, 82% relataram memórias da UTI, sendo que 96% deles tinham memória de fatos reais, com uma média de sete eventos recordados, 88% apresentaram memórias emocionais e 41%, memórias de ilusão.…”

Section: Aplicabilidade E Validade Semânticaunclassified

“…A incidência de sonhos foi de 21,1% e, desses, 9,9% relataram sonhos desagradáveis, sendo classificados pelos pacientes como pesadelos, e 36,6% relataram alucinações. Já os resultados do estudo de Samuelson et al 10 apresentaram altas taxas de memórias de ilusão. Entre os 65 pacientes com memórias de ilusão, 61% relataram pesadelos, 59%, alucinações e 16%, delírios.…”

Section: Aplicabilidade E Validade Semânticaunclassified

“…Vivências de sonhos, alucinações e pesadelos são fontes de desconforto, estresse e ansiedade para pacientes após a alta da UTI 9 . Por essa razão, as recordações apresentadas pelos pacientes após a alta dessa unidade poderão ter um impacto na sua recuperação e alguns pacientes podem continuar afetados por vários meses [10][11] . Por outro lado, pacientes sem recordações de fatos reais de sua permanência na UTI e apenas com memórias ilusórias (alucinações, sonhos, pesadelos) apresentam alterações emocionais significativas após a alta hospitalar 12 .…”

Section: Introductionunclassified

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Elaboração e avaliação de um instrumento para identificar memórias referentes à Unidade de Terapia Intensiva

Costa

Marcon

2009

J. bras. psiquiatr.

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resumo objetivo: Descrever o desenvolvimento de um instrumento para identificar as recordações de pacientes internados em Unidade de Terapia Intensiva (UTI) e verificar a validade de conteúdo e a aplicabilidade do instrumento. método: Estudo de desenvolvimento metodológico, fundamentado na teoria de elaboração de escalas psicológicas de Pasquali (1998). Para elaboração do instrumento, foram percorridas três etapas, a construção dos itens, a análise da validade de conteúdo e aparência por um painel de experts e, por fim, a realização de um estudo-piloto para verificar a aplicabilidade do instrumento na população-alvo. resultados: Houve pouca discordância entre os experts na análise das questões de acordo com os domínios do construto. Os itens foram avaliados positivamente, recebendo uma pontuação acima de 80%, valor este que obedece ao critério de validação do instrumento. Dessa forma, os itens foram considerados consistentes em relação aos domínios e ao construto, possibilitando identificar recordações das experiências vividas pelos pacientes durante sua permanência em UTI. conclusões: Os itens propostos mostraram-se compreensíveis, claros e com uma adequada estrutura de apresentação. O instrumento apresenta validade de conteúdo atestada por um painel de experts, demonstrando possuir características teóricas para identificar memórias de pacientes internados em UTI a curto e longo prazo.

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“…The effect of sedation on neuropsychological outcomes has been investi-gated by several groups. [10][11][12][13] Based on these studies there is conflicting evidence whether or not the depth of sedation impacts long-term neuropsychological outcomes. Neuromuscular blocking agents (NMBAs) are used in the ICU to improve patient-ventilator synchrony, enhance gas exchange, and diminish the risk of barotrauma.…”

Section: Introductionmentioning

confidence: 99%

Sedation and ParalysisDiscussion

et al. 2013

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Sedation is used almost universally in the care of critically ill patients, especially in those who require mechanical ventilatory support or other life-saving invasive procedures. This review will focus on the sedation strategies for critically ill patients and the pharmacology of commonly used sedative agents. The role of neuromuscular blocking agents in the ICU will be examined and the pharmacology of commonly used agents is reviewed. Finally a strategy for rational use of these sedative and neuromuscular blocking agents in critically ill patients will be proposed.

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Memory in relation to depth of sedation in adult mechanically ventilated intensive care patients

Abstract: Heavy sedation increases the risk of having no recall, and longer ICU stay increases the risk of delusional memories. The depth of sedation during total ICU stay as recorded with the MAAS may predict the probability of having memories of the ICU.

Cited by 124 publications

References 39 publications

The experience of cognitive impairment in critically ill patients in and beyond intensive care: findings from a larger phenomenological study

The experience of cognitive impairment in critically ill patients in and beyond intensive care: findings from a larger phenomenological study

Elaboração e avaliação de um instrumento para identificar memórias referentes à Unidade de Terapia Intensiva

Sedation and ParalysisDiscussion

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