Delirium Patients in the ICU

Delirium Patients in the ICU Delirium Patients in the ICU Please follow the grading rubric. The paper should be 900 words APA format, based on the attached outline, and about the subject mentioned in the PICO question. The outline and annotated bibliography documents from down below will help you write this paper with ease. Research Paper on Delirium Patients in the ICU You have to be very specific to the PICO question! P: Adult critical care patients. I: Implement policies and interventions to reduce and eliminate ICU delirium. C: Patients who are not on sedation drugs in the ICU. O: Decrease the incidence or even eliminate delirium in ICU patients and decrease the length of stay of patients in the ICU. Delirium Patients in the ICU PICO Question Does limited use of sedation drugs with limited length of stay in critical care reduce delirium in critically ill patients compared to patient who are not on sedation drugs in the ICU? annotated_bibliography.docx grade_rubric_for_intro_methods_results.docx outline_for_introduction_methods_results.docx search_method_final_d Delirium Patients in the ICU. Beni Costa Literature Review Matrix NURS 6990-D02 Middle Tennessee State University February 10, 2019 P: Adult critical care patients. I: Implement policies and interventions to reduce and eliminate ICU delirium. C: Patients who are not on sedation drugs in the ICU. O: Decrease the incidence or even eliminate delirium in ICU patients and decrease the length of stay of patients in the ICU. PICO Question Does limited use of sedation drugs with limited length of stay in critical care reduce delirium in critically ill patients compared to patient who are not on sedation drugs in the ICU? Author / Article title Year of Publ icati on Qualitative: Concepts or phenomena Quantitative: Citation Key Variables Hypothesis Research Question Awissi, D. 2018 Assessing impact of K., Bégin, sedation, C., Moisan, analgesia, and delirium J., protocols Lachaine, evaluated in the intensive J., & care unit Skrobik, Theoret ical Framew ork Purpose Design Sa mpl e (N) Instru ments Findings/Res ults Controve rsies, disagree ments with other authors Limitatio ns Implications Orem, Dorothy —Self Care Deficit Theory Evaluate the Experim 413 tests The number of patients manifesting subsyndromal delirium was significantly less in the POST group. The rate of delirium was similar. More patients remained cognitively intact, i.e., had an ICDSC score of 0 No short-term outcomes like delirium and longterm outcomes such as PTSD and 1-year mortality were not sufficientl y investigate d as endpoints in most of the studies Recommends use of dexmedetomidine rather than benzodiazepines management of ental specific, distinct, and measurable clinical entities: pain, Y.I-SAVE agitation, and study: delirium. impact of sedation, analgesia, and delirium protocols evaluated in the intensive care unit: an Designs controvers ies with other authors economic evaluation. Annals of Pharmacot herapy, 46( 1), 21-28. Girard, T. There are no Roper, outcomes are Logan associated with and Fuchs, B. delirium in Tierney D., adult ICU model D., Kress, J. P., Thomason, J. W., Schweicker t, W. D., Pun, B. T., … & Jackson, J. C. Efficacy and safety of a paired sedation 2017 patients To revise the “Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult” published in Critical Care Medicine in 2002. QuasiExperim ental Design 220 Survey and intervie ws The use of sedation scales, sedation protocols designed to minimize sedative use, and the use of nonbenzodiaz epine medications are associated with improved ICU patient outcomes, including a shortened duration of mechanical ventilation, ICU and hospital LOS, This research had not controvers y or conflict with existing literatures. moderatequality study (439) required a 1:1 nurseto-patient ratio and the availabilit y of patient “sitters,” and no rigorous pubSpecial Article Critical Care Medicine www.ccm journal.or g 291 Further research on effect of High doses of sedative agents and mechanical ventilation in disrupting sleep patterns in critically ill patients and and decreased incidences of delirium and long-term cognitive dysfunction ventilator weaning protocol lished studies have specificall y compared analgesiafirst sedation with conventio nal GABAbased sedation strategies for mechanical ly ventilated patients in intensive care (Awakenin g and Breathing Controlled trial): a randomised controlled trial. Research Paper on Delirium Patients in the ICU Delirium Patients in the ICU. Girard, T. D., Kress, J. P., 2018 No sedation of critically ill patients receiving mechanical Orem, Dorothy —Self Care to establish whether duration of casecontrol study, 428 Tests Agitated and delirium was survey more frequent concernin g aspect is the choice of sedation A noteworth y limitation that A conservative approach of less sedation does not appear to cause harm in critically Fuchs, B. D., Thomason, J. W., Schweicker t, W. D., Pun, B. T., … & Jackson, J. C. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanical ly ventilated patients in ventilation is Deficit associated with Theory an increase in days without ventilation. A multicentre study is needed to establish whether this effect can be reproduced in other facilities. mechanical in the ventilation intervention could be group than in reduced with a the control protocol of no group sedation versus daily interruption of sedation. agent in the control arm. Propofol was switched to midazola m which, has a longer clearance time especially in the setting of liver or renal failure and increase duration of mechanica l ventilation challenges the generaliza bility of this study is the use of 1:1 nurse to patient ratio and patient comforters . This suggests that successful completio n of this protocol requires more staff presence, which is often not available in most ICUs. ill mechanically ventilated patients. This is an important proof of concept study. Larger, multicenter trials are necessary to determine the feasibility and safety of this approach. intensive care (Awakenin g and Breathing Controlled trial): a randomised controlled trial. The Lancet, Ely, E. W., Inouye, S. K., Bernard, 2017 Roper, Logan and Tierney —A model for nursing based on a model of living To develop and validate an instrument for Prospec tive cohort study. 30 Tests ICU nurses and physicians use in the who use the intensive care CAM-ICU unit to can detect accurately delirium diagnose deliri reliably and & Hart, R. um in critically with a high P. Delirium ill patients who degree of in are often G. R., Gordon, S., Francis, J., May, L., … There are no controvers ies or conflict between this research and existing body of knowledg e The findings of 100% sensitivity and specificity in this group are based on a small number of patients and deserve further analysis Future studies of delirium in the ICU setting should use larger populations of patients both during and after mechanical ventilation. Another focus for future investigations would include more intensive neuropsychologic testing of patients mechanical nonverbal sensitivity and ly because specificity. ventilated of mechanical patients: ventilation on a larger after their ICU scale. stay validity and reliability of the confusion assessment method for the intensive care unit (CAMICU). Wiatrowski 2016 Analgosedatio Myra Levine — Conserv ation Model examination of Quasi- , R., n can decrease Norton, C., the risk of & Giffen, drug-related D. adverse events, the ICU; trends Analgosed increase pain in sedation 196 Intervie the problem of Experi ws and pain mental tests management in Design Studies demonstrate the viability of analgesiafirst regimens and the potential to avoid or reduce the use The research has no conflict with other authors since it is mainly reviewing None of the analgosed ation studies looked directly at important considerat Further research must examine whether analgosedation improves or worsens nurse workload ation: control, practices, improving decrease length including light patient of mechanical sedation and outcomes ventilation and the daily in ICU its associated interruption of sedation risks, and sedation; and a and pain decrease the literature manageme length of ICU review of nt. Research Paper on Delirium Patients in the ICU ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Delirium Patients in the ICU. Pain stay analgosedation of sedativehypnotic and anesthetic medications in many mechanically ventilated ICU patients. existing knowledg e Tests results The ions like nurse workload, whether or not analgosed ation allows for earlier implement ation of patient mobility, and the total cost of the sedation practice compared with another practice. The The sub-sedative Manageme nt Su, X., 2016 Meng, Z. T., Wu, X. H., Cui, F., Li, H. L., Wang, D. X., & Ma, D. (2016). Dexmedeto midine for prevention For patients aged over 65 years who are admitted to the Orem, Dorothy —Self Care Deficit Theory investigated randomi 700 whether sed, using suggest that a authors authors dose of prophylactic double- comput prophylactic declared had no dexmedetomidine low-dose blind, er- low-dose no controver can be safely used intensive care dexmedetomidi parallel- generat dexmedetomi competing sy or for elderly ICU unit after non- ne, a highly arm ed dine infusion interests conflict patients after cardiac selective ?2 placebo random significantly with the surgery, both with of delirium in elderly patients after noncardiac surgery: a randomised , double blind, placebocontrolled trial. Kaplan, J. 2019 surgery, adrenoceptor controll ization decreases the existing and without prophylactic agonist, could ed trial sequenc incidence of researche endotracheal low-dose safely decrease e s. intubation, to dexmedetomidi the incidence the first 7 reduce the ne significantly of delirium in days after likelihood of decreases the elderly patients surgery in postoperative occurrence of after non- elderly delirium. delirium cardiac patients during the first surgery. admitted to delirium in 7 days after the ICU after surgery. The non-cardiac therapy is safe surgery • Fewer Meleis, Afaf – Transiti ons Theory. The objective A single of this study 345 Intervie The nursing- There center, ws and driven are no was to retrospe surveys sedation conflicts determine the ctive protocol for in this study mechanically research. B., patients Eiferman, received D. S., continuous Porter, K., infusion impact of a MacDermo benzodiazepine nursing-driven ventilated tt, J., s and opioids ASP with patients in the Brumbaug • Protocol criteria for SICU was h, J., & patients had infusion associated Murphy, C. more with more Limitation s of using the selfreported numeric rating score pain scale in ICU patients and lack of objective assessmen t tool, we Larger randomized controlled trials utilizing a nursing-driven sedation and analgesia protocol should be performed in a SICU population V. (2019). documented initiation in the time free of ?Impact of sedation scores SICU. mechanical a nursing- in target range ventilation. driven Lower sedation benzodiazepin protocol e utilization with and fewer criteria for pain and infusion sedative initiation in continuous the surgical infusions may intensive allow for care unit. timelier were unable to evaluate the impact of the protocol on pain control. to validate these limited literature on pain assessmen t in the PICU; the available studies Guides finding extubation and reduce incidence of ICU delirium. Harris, J., 2016 This position Ramelet, statement A. S., van provides Dijk, M., clinical Pokorna, recommendatio Myra Levine — Conserv ation Model provides Prospect 700 Questi : An ESPNIC clinical ive oners position recommendatio cohort statement was ns for the drafted which assessment of study. provides The authors declared no competing interests professionals in the assessment and reassess- ment of P., ns for the pain, level of clinical Wielenga, assessment of sedation, recommendati J., Tume, pain, level of iatrogenic ons on L., & Ista, sedation, withdrawal assessment of E. Clinical iatrogenic syndrome and pain (n = 5), recommen withdrawal delirium in distress and/or dations for syndrome and critically ill level of withdrawal pain, delirium in infants and sedation (n = syndrome and sedation, critically ill children 4), iatrogenic delirium. Research Paper on Delirium Patients in the ICU Delirium Patients in the ICU. withdrawal patients. withdrawal and syndrome (n = delirium 3) and assessment delirium (n = in critically 3). These ill infants recommendati and ons were children: based on the an ESPNIC available position evidence and statement consensus for amongst the healthcare experts and concern the validation of instrument s such as the COMFOR T scale the effectiveness of treatment interventions for pain, distress, inadequate sedation, professiona other ls. Intensiv members of e care ESPNIC medicine, GRADING RUBRIC FOR INTRODUCTION, METHODS, AND RESULTS GRADED CONTENT POINTS AVAILABLE Introduction 1. Background of your proposed topic • 20 A brief summary of the review of the literature (5 points) • Summary of what is missing or unknown in the research literature (5 points) • An overview of the scientific theory, nursing theory, or conceptual model(s) that framed the topic (5 points) 2. Clear purpose statement • Statement or research question/problem (5 points) Methods Literature Searching • Explanation of databases used to retrieve literature (5 points) • Explanation of any revisions made to search strategies (5 points) • Inclusion/exclusion criteria for the articles chosen (5 points) • Time frame for the publications used (5 20 POINTS EARNED GRADING RUBRIC FOR INTRODUCTION, METHODS, AND RESULTS points) Results Describe characteristics of the articles included (5 20 points) Formulate themes in the literature that respond to the PICO question (5 points) Construct evidence in a logical manner (5 points) Synthesize existing and new knowledge on the topic under review (5 points) Correct APA formatting, grammar, spelling, and punctuation (up to 10 points will be deducted for violations) Late policy: All students are expected to turn in work on time. Late assignments will be penalized 10% per day (or any portion of the day) unless prior arrangements have been made with the instructor. TOTAL 60 Running head: OUTLINE Outline for my Intro-Methods Results Beni Costa NURS 6990- D02 Middle Tennessee State University February 19, 2019 2 OUTLINE Effect of Limited Sedation on Delirium Introduction ? Delirium is a primary adverse event in ventilated patients who receive long-term treatment. ? Too much sedation is associated with a longer duration of mechanical ventilation and a longer intensive care unit (ICU) stay. ? Limited sedation may reduce these adverse effects. ? Previous studies demonstrated that patients under mechanical ventilation exhibit a higher risk of experiencing delirium than non-mechanically ventilated patients. ? This study will evaluate risk factors for delirium in limited sedation patients Methods a. Patients ? In this planned study patients will be selected from a previous study ? Patients who underwent sequential sedation will be enrolled. b. Clinical Data. Patient demographic characteristics included age, gender, body mass index (BMI), allergic history, drinking and smoking status, and medical history, including the presence or absence of hypertension. c. Delirium Assessment. The primary endpoint of this study will be the occurrence of delirium. d. Statistical Analysis. Statistical analyses were performed using SPSS Results 3 OUTLINE Table will be used to presents demographic data and baseline characteristics of patients with or without delirium. Data will be used to evaluate risk factors for delirium in sequential sedation patients ? Univariate and multivariate Cox proportional hazards regressions will be used to predict risk factors. ? Clinical data will include the use of sedative and analgesic medications, mechanical ventilation status, and sequential sedation characteristics. ? It will involve Delirium Assessment among the patients. ? The results of this study should demonstrate that sequential sedation with dexmedetomidine was a protective method to prevent delirium. ? Results should show that management strategies may sometimes require alteration to reduce the incidence and severity of delirium in sequential sedation patients. Research Paper on Delirium Patients in the ICU Delirium Patients in the ICU. Conclusion: ? The results used demonstrated that limited sedation is a protective method to prevent delirium. ? Results should suggest that management strategies may sometimes require alteration to reduce the incidence and severity of delirium in sequential sedation patients. 4 OUTLINE References Djaiani, G., Silverton, N., Fedorko, L., Carroll, J., Styra, R., Rao, V., & Katznelson, R. (2016). Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery a randomized controlled trial. Anesthesiology: The Journal of the American Society of Anesthesiologists, 124(2), 362-368. Jackson, P., & Khan, A. (2015). Delirium in critically ill patients. Critical care clinics, 31(3), 589-603. Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53 CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. American Journal of Respiratory and Critical Care Medicine, 195. Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53 CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. American Journal of Respiratory and Critical Care Medicine, 195. Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients on The Wards. American Journal of Respiratory and Critical Care Medicine, 193, 1. 5 OUTLINE Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients On The Wards. American Journal of Respiratory and Critical Care Medicine, 193, 1. Salluh, J. I., Wang, H., Schneider, E. B., Nagaraja, N., Yenokyan, G., Damluji, A., … & Stevens, R. D. (2015). Outcome of delirium in critically ill patients: systematic review and meta-analysis. bmj, 350, h2538. Traube, C., Silver, G., Reeder, R. W., Doyle, H., Hegel, E., Wolfe, H. A., … & Buttram, S. D. (2017). Pediatric delirium in critically-ill children: An international point prevalence study. Critical care medicine, 45(4), 584. Vallabhajosyula, S., Kanmanthareddy, A., Morrow, L. E., & Esterbrooks, D. J. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: Role Of Statins in Delirium Prevention In Critically Ill And Cardiovascular Surgery Patients: A MetaAnalysis. American Journal of Respiratory and Critical Care Medicine, 193, 1. Search Methods Draft Beni Costa Middle Tennessee State University Scholarly Synthesis NURS 6990-D02 Spring 2019 NURS 6990 Scholarly Synthesis Search activity My research question: In critically ill patients in the ICU (P), with limited use of sedation drugs (I), compared to not using sedation drugs (C), reduce delirium (P)? Places to search for information: School online library, and google scholar List of sources searched: Date of search 1. Lee, J., Choi, S., Park, Y., 13 February 2019 Search strategy used, Total number of results including any limits found Boolean operators 15,700 Comments Using the AND operator Lee, C. H., Lee, S. M., was very useful in Yim, J. J., … & Kim, Y. narrowing the research to (2017). C53 CRITICAL only include sedation use CARE: DELIRIUM AND and delirium. THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. American Journal of Respiratory and Critical Care Medicine, 195. 2. Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients On The Wards. American Journal of Respiratory and Critical Care Medicine, 193, 1. 3. Djaiani, G., Silverton, N. …Research Paper on Delirium Patients in the ICU Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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