TITLE

Cognitive improvement during continuous sedation in critically ill, awake and responsive patients: the Acute Neurological ICU Sedation Trial (ANIST)

AUTHOR(S)
Mirski, Marek A.; Lewin III, John J.; LeDroux, Shannon; Thompson, Carol; Murakami, Peter; Zink, Elizabeth K.; Griswold, Michael
PUB. DATE
September 2010
SOURCE
Intensive Care Medicine;Sep2010, Vol. 36 Issue 9, p1505
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Most anxiolytics and sedative regimens in the intensive care unit (ICU) impair intellectual function, reducing patient autonomy, and often add to patient morbidity. Using an ICU-validated cognitive assessment tool Adapted Cognitive Exam (ACE), we performed a comparison between dexmedetomidine (DEX) and propofol (PRO) to evaluate which sedative regimen offered the least decrement in intellectual capacity. This was a prospective, randomized, double-blinded study of 30 awake and intubated brain-injured (BI, n = 18) and non-BI (12) ICU patients. Each patient received fentanyl/PRO and fentanyl/DEX titrated to a calm, awake state using a crossover design. Cognitive testing was performed at each study period using the validated 100-point Hopkins ACE cognitive battery. Sedation with PRO diminished adjusted ACE scores (100-point exam) by a mean of −12.4 (95% CI −8.3 to −16.5, p < 0.001) while DEX, in contrast, improved ACE scores (6.8, 95% CI 1.2–12.4, p < 0.018). The difference in the change of ACE score between DEX versus PRO, our primary endpoint, was 19.2 (95% CI 12.3–26.1 p < 0.001) in favor of an improved ACE score on DEX. Patients with BI required less sedative, but effects of PRO and DEX on cognition were not changed. No serious adverse events occurred. Modest bradycardia was noted post hoc with DEX (−7.7 bpm, p < 0.01). ICU patients may be offered sedation without necessarily compromising arousal or cognition. Alleviation of anxiety and agitation can singly and effectively improve mental engagement and performance if overt forebrain dysfunction is avoided. Higher ACE scores with DEX may be a consequence of the intellect-sparing yet calming effect of this drug.
ACCESSION #
52858879

 

Related Articles

  • Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial. Wanzuita, Raquel; Poli-de-Figueiredo, Luiz F; Pfuetzenreiter, Felipe; Cavalcanti, Alexandre Biasi; Westphal, Glauco Adrieno // Critical Care;2012, Vol. 16 Issue 1, pR49 

    Introduction: Patients undergoing mechanical ventilation (MV) are frequently administered prolonged and/or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV. We tested the hypothesis that the introduction of enteral methadone...

  • Dexmedetomidine sedation in ICU. Soo-Bong Yu // Korean Journal of Anesthesiology;May2012, Vol. 62 Issue 5, p405 

    Dexmedetomidine (DEX), a highly selective α2-adrenergic receptor agonist, is the newest agent introduced for sedation in intensive care unit (ICU). The sedation strategy for critically ill patients has stressed light sedation with daily awakening and assessment for neurologic, cognitive, and...

  • The accurate recognition of delirium in the ICU: the emperor's new clothes? Devlin, John; Fraser, Gilles; Joffe, Aaron; Riker, Richard; Skrobik, Yoanna // Intensive Care Medicine;Dec2013, Vol. 39 Issue 12, p2196 

    The article discusses the accurate recognition of delirium experienced by patients in the intensive care unit (ICU). It presents several reports on the use of a tool-based approach to diagnose delirium among critically ill patients. Medical personnel are warned about the negative effect of...

  • Impact of Sedation on Cognitive Function in Mechanically Ventilated Patients. Porhomayon, Jahan; El-Solh, Ali; Adlparvar, Ghazaleh; Jaoude, Philippe; Nader, Nader // Lung;Feb2016, Vol. 194 Issue 1, p43 

    The practice of sedation dosing strategy in mechanically ventilated patient has a profound effect on cognitive function. We conducted a comprehensive review of outcome of sedation on mental health function in critically ill patients on mechanical ventilation in the intensive care unit (ICU). We...

  • Automated sedation outperforms manual administration of propofol and remifentanil in critically ill patients with deep sedation: a randomized phase II trial. Guen, Morgan; Liu, Ngai; Bourgeois, Eric; Chazot, Thierry; Sessler, Daniel; Rouby, Jean-Jacques; Fischler, Marc // Intensive Care Medicine;Mar2013, Vol. 39 Issue 3, p454 

    Purpose: To compare automated administration of propofol and remifentanil guided by the Bispectral index (BIS) versus manual administration of short-acting drugs in critical care patients requiring deep sedation. The primary outcome was the percentage of BIS values between 40 and 60 (BIS)....

  • Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC. Haenggi, Matthias; Blum, Sina; Brechbuehl, Ruth; Brunello, Anna; Jakob, Stephan; Takala, Jukka // Intensive Care Medicine;Dec2013, Vol. 39 Issue 12, p2171 

    Purpose: We hypothesized that reduced arousability (Richmond Agitation Sedation Scale, RASS, scores −2 to −3) for any reason during delirium assessment increases the apparent prevalence of delirium in intensive care patients. To test this hypothesis, we assessed delirium using the...

  • Effect of using Richmond Agitation Sedation Scale on duration of mechanical ventilation, type and dosage of sedation on hospitalized patients in intensive care units. Yousefi, Hojatollah; Toghyani, Farzaneh; Yazdannik, Ahmad Reza; Fazel, Kamran // Iranian Journal of Nursing & Midwifery Research;Nov/Dec2015, Vol. 20 Issue 6, p700 

    Background: Mechanical ventilation is one of the supporting treatments that are used for different reasons. To reduce patients' inconvenience caused due to using tracheal tube and ventilator, sedation is routinely used. Using scales for the sedation, for example, Richmond Agitation Sedation...

  • Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial. Barraud, Damien; Blard, Claire; Hein, François; Marçon, Olivier; Cravoisy, Aurélie; Nace, Lionel; Alla, François; Bollaert, Pierre-Edouard; Gibot, Sébastien // Intensive Care Medicine;Sep2010, Vol. 36 Issue 9, p1540 

    Probiotics have been shown to be able to restore a non-pathogenic digestive flora, to prevent digestive colonization by pathogenic bacteria, and to modulate immunity. The aim of this study was to assess the effects of prophylactic probiotic administration in patients ventilated for up to 2 days....

  • Responsiveness of the frontal EMG for monitoring the sedation state of critically ill patients. Walsh, T. S.; Lapinlampi, T. P.; Ramsay, P.; Särkelä, M. O. K.; Uutela, K.; Viertiö-Oja, H. E. // BJA: The British Journal of Anaesthesia;Nov2011, Vol. 107 Issue 5, p710 

    Background Excessive sedation is associated with adverse patient outcomes during critical illness, and a validated monitoring technology could improve care. We developed a novel method, the responsiveness index (RI) of the frontal EMG. We compared RI data with Ramsay clinical sedation...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics