A5009689725- Intensive Care Unit Cognitive Disorders
- Anesthesia and Sedative Agents
- Anesthesia and Neurotoxicity Research
- Frailty in Older Adults
- Family and Patient Care in Intensive Care Units
- Healthcare Decision-Making and Restraints
- Cardiac, Anesthesia and Surgical Outcomes
- Traumatic Brain Injury and Neurovascular Disturbances
- Respiratory Support and Mechanisms
- Sepsis Diagnosis and Treatment
- Neuroinflammation and Neurodegeneration Mechanisms
- Geriatric Care and Nursing Homes
- Epilepsy research and treatment
- Pharmaceutical Practices and Patient Outcomes
- Estrogen and related hormone effects
- Hip and Femur Fractures
- Steroid Chemistry and Biochemistry
- S100 Proteins and Annexins
- Organic Chemistry Cycloaddition Reactions
- Oral health in cancer treatment
- Electroconvulsive Therapy Studies
- Pediatric Pain Management Techniques
- Physical Activity and Health
- Long-Term Effects of COVID-19
- Sleep and Wakefulness Research
University of Nebraska Medical Center
2024-2025
Vanderbilt University Medical Center
2009-2023
University of Maine
2023
Vanderbilt University
2013-2022
Cancer Research And Biostatistics
2011-2018
John Radcliffe Hospital
2010-2017
Geriatric Research Education and Clinical Center
2008-2017
VA Tennessee Valley Healthcare System
2016-2017
Osaka University
2015
Intermountain Medical Center
2014
Survivors of critical illness often have a prolonged and disabling form cognitive impairment that remains inadequately characterized.We enrolled adults with respiratory failure or shock in the medical surgical intensive care unit (ICU), evaluated them for in-hospital delirium, assessed global cognition executive function 3 12 months after discharge use Repeatable Battery Assessment Neuropsychological Status (population age-adjusted mean [±SD] score, 100±15, lower values indicating worse...
4][5][6] Because delirium is an independent risk factor for prolonged length of stay, greater neuropsychological dysfunction, and increased mortality, 7-10 efforts must be made to reduce this manifestation organ dysfunction within the context providing adequate sedation patients.Lorazepam currently recommended by Society Critical Care Medicine (SCCM) in its clinical prac-tice guidelines 1 sustained mechanically ventilated ICU patients.Although recent trials have shown that protocols with...
Pandharipande, Pratik P.; Girard, Timothy D.; Jackson, James C.; Morandi, Alessandro; Thompson, Jennifer L.; Pun, Brenda T.; Brummel, Nathan E.; Hughes, Christopher G.; Vasilevskis, Eduard Shintani, Ayumi K.; Moons, Karel Geevarghese, Sunil Canonico, Angelo; Hopkins, Ramona O.; Bernard, Gordon R.; Dittus, Robert S.; Ely, E. W. for the BRAIN-ICU (Bringing to Light Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors) Study Investigators Author Information
To test the hypothesis that duration of delirium in intensive care unit is an independent predictor long-term cognitive impairment after critical illness requiring mechanical ventilation.Prospective cohort study.Medical a large community hospital United States.Mechanically ventilated medical patients who were assessed daily for while and underwent comprehensive assessments 3 12 mos discharge.Of 126 eligible patients, 99 survived>or=3 months illness; outcomes obtained 77 (78%) patients....
Objective: Decades-old, common ICU practices including deep sedation, immobilization, and limited family access are being challenged. We endeavoured to evaluate the relationship between ABCDEF bundle performance patient-centered outcomes in critical care. Design: Prospective, multicenter, cohort study from a national quality improvement collaborative. Setting: 68 academic, community, federal ICUs collected data during 20-month period. Patients: 15,226 adults with at least one day....
Although known to be an independent predictor of poor outcomes in medical intensive care unit (ICU) patients, limited data exist regarding the prevalence and risk factors for delirium among surgical (SICU) trauma ICU (TICU) patients. The purpose this study was analyze patients.SICU TICU patients requiring mechanical ventilation (MV) >24 hours were prospectively evaluated using Richmond Agitation Sedation Scale (RASS) Confusion Assessment Method (CAM-ICU). Those with baseline dementia,...
There are conflicting data on the effects of antipsychotic medications delirium in patients intensive care unit (ICU).
Objective: To demonstrate the feasibility of a placebo-controlled trial antipsychotics for delirium in intensive care unit and to test hypothesis that would improve days alive without or coma. Design: Randomized, double-blind, trial. Setting: Six tertiary medical centers US. Patients: One hundred one mechanically ventilated surgical patients. Intervention: Patients were randomly assigned receive haloperidol ziprasidone placebo every 6 hrs up 14 days. Twice each day, frequency study drug...
To describe the frequency of co-occurring newly acquired cognitive impairment, disability in activities daily livings, and depression among survivors a critical illness to evaluate predictors being free post-intensive care syndrome problems.Prospective cohort study.Medical surgical ICUs from five U.S. centers.Patients with respiratory failure or shock, excluding those preexisting impairment livings.None.At 3 12 months after hospital discharge, we assessed patients for disability, depression....
Abstract Introduction Benzodiazepines and α 2 adrenoceptor agonists exert opposing effects on innate immunity mortality in animal models of infection. We hypothesized that sedation with dexmedetomidine (an agonist), as compared lorazepam (a benzodiazepine), would provide greater improvements clinical outcomes among septic patients than non-septic patients. Methods In this a priori -determined subgroup analysis vs from the MENDS double-blind randomized controlled trial, adult medical/surgical...
Background: Millions of patients who survive medical and surgical general intensive care unit every year experience newly acquired long-term cognitive impairment profound physical functional disabilities. To overcome the current reality in which receive inadequate rehabilitation, we devised a multifaceted, in-home, telerehabilitation program implemented using social workers psychology technicians with goal improving outcomes. Methods: This was single-site, feasibility, pilot, randomized...
Objective: Survivors of critical illness are frequently left with long-lasting disability. The association between delirium and disability in critically ill patients has not been described. We hypothesized that the duration ICU would be associated subsequent worse physical health status following a illness. Design: Prospective cohort study nested within randomized controlled trial paired sedation ventilator weaning strategy. Setting: A single-center tertiary-care hospital. Patients: One...
Objective: Delirium duration is predictive of long-term cognitive impairment in intensive care unit survivors. Hypothesizing that a neuroanatomical basis may exist for the relationship between delirium and impairment, we conducted this exploratory investigation associations duration, brain volumes, impairment. Design, Setting, Patients: A prospective cohort medical surgical survivors with respiratory failure or shock. Measurements: Quantitative high resolution 3-Tesla magnetic resonance...
The prevalence of frailty (diminished physiologic reserve) and its effect on outcomes for those aged 18 years older with critical illness is unclear.We hypothesized greater would be associated subsequent mortality, disability, cognitive impairment, regardless age.At enrollment, we measured using the Clinical Frailty Scale (range, 1 [very fit] to 7 [severely frail]). At 3 12 months post-discharge, assessed vital status, instrumental activities daily living, basic cognition. We used...
Delirium, an acute organ dysfunction, is common among critically ill patients leading to significant morbidity and mortality; its epidemiology in a mixed cardiology cardiac surgery ICU not well established. We sought determine the prevalence risk factors for delirium patients.Prospective observational study.Twenty-seven-bed medical-surgical ICU.Two hundred consecutive with expected length of stay >24 hrs.None.Baseline demographic data daily assessments using validated reliable Confusion...
Delirium assessments in critically ill infants and young children pose unique challenges due to evolution of cognitive language skills. The objectives this study were determine the validity reliability a fundamentally objective developmentally appropriate delirium assessment tool for preschool-aged prevalence.Prospective, observational cohort validation PreSchool Confusion Assessment Method ICU tertiary medical center PICU.Participants aged 6 months 5 years admitted PICU regardless admission...
Rationale: Studies have shown that reducing sedation of critically ill patients shortens time on the ventilator and in intensive care unit (ICU). Little is known, however, how such strategies affect long-term cognitive, psychological, functional outcomes.Objectives: To determine effects a wake up breathe protocol interrupts reduces sedative exposure ICU.Methods: In this priori planned substudy conducted at one tertiary hospital during Awakening Breathing Controlled Trial, multicenter...
Functional magnetic resonance imaging (MRI) using two language-comprehension tasks was evaluated to determine its ability lateralize language processing and identify regions that must be spared in surgery.Two parallel cognitive tasks, one auditory input the other visual input, were tested a group of control subjects temporal lobe epilepsy patients who candidates for surgical intervention. The patient studies provide an opportunity compare functional MRI localization with obtained Wada...
Objective: Evidence is emerging that delirium duration a predictor of long-term cognitive impairment in intensive care unit survivors. Relationships between 1) and brain white matter integrity, 2) integrity are poorly understood could be explored using magnetic resonance imaging. Design, Setting, Patients: A two-center, prospective cohort study incorporating monitoring, neuroimaging, testing Measurements: Delirium was evaluated with the Confusion Assessment Method for Intensive Care Unit...
Delirium affects 60 to 80% of ventilated patients and is associated with worse clinical outcomes including death. Unfortunately, there are limited data regarding the prevalence risk factors delirium in critically ill burn patients. The objectives this study were evaluate patients, using validated instruments, identify its factors. Adult at two tertiary centers prospectively evaluated for Confusion Assessment Method Intensive Care Unit (CAM-ICU) 30 days or until intensive care unit discharge....
Objectives: Standard sleep scoring criteria may be unreliable when applied to critically ill patients. We sought quantify typical and atypical polysomnographic findings in patients begin development reliability testing of methodology characterize the tracings that confound standard criteria. Design: Prospective convenience sample. Setting: Two academic, tertiary care medical centers. Patients: Thirty-seven ill, mechanically ventilated, ICU Interventions: None. Measurements Main Results:...