Severe agitation among ventilated medical intensive care unit patients: Frequency, characteristics and outcomes
To determine the frequency, characteristics and outcomes of severe agitation among ventilated medical intensive care unit (MICU) patients. Prospective cohort study. Eighteen-bed MICU in 964-bed tertiary care center. All ventilated patients, aged 18 years or older and admitted for more than 24 h betw...
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| Veröffentlicht in: | Intensive care medicine 2004-06, Vol.30 (6), p.1066-1072 |
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| creator | WOODS, Jeffery C MION, Lorraine C CONNOR, Jason T VIRAY, Florence JAHAN, Lisa HUBER, Cecilia MCHUGH, Renee GONZALES, Jeffrey P STOLLER, James K ARROLIGA, Alejandro C |
| description | To determine the frequency, characteristics and outcomes of severe agitation among ventilated medical intensive care unit (MICU) patients.
Prospective cohort study.
Eighteen-bed MICU in 964-bed tertiary care center.
All ventilated patients, aged 18 years or older and admitted for more than 24 h between January 1, 2001 and May 8, 2001.
None.
Data were collected daily by concurrent chart abstractions. Variables included sociodemographic, clinical, laboratory, pharmacologic and non-pharmacologic interventions, ventilator settings and adverse events. Severe agitation, the main outcome variable, was defined as two or more Motor Activity Assessment Scale (MAAS) scores above 4 in a 24-h period and sedative and/or narcotic doses above the established sedation and analgesia protocol or a combination of two or more sedatives.
Twenty-three (16.1%) of 143 enrolled patients exhibited severe agitation. Agitated patients were younger (hazard ratio [HR] 1.32), more likely to be admitted from an outside hospital ICU (HR 2.48), had lower pH (HR 1.55) and PaO(2)/FIO(2) less than 200 mmHg (HR 2.59). Agitated patients had longer MICU stays (median 12 versus 5 days, p |
| doi_str_mv | 10.1007/s00134-004-2193-9 |
| format | Article |
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Prospective cohort study.
Eighteen-bed MICU in 964-bed tertiary care center.
All ventilated patients, aged 18 years or older and admitted for more than 24 h between January 1, 2001 and May 8, 2001.
None.
Data were collected daily by concurrent chart abstractions. Variables included sociodemographic, clinical, laboratory, pharmacologic and non-pharmacologic interventions, ventilator settings and adverse events. Severe agitation, the main outcome variable, was defined as two or more Motor Activity Assessment Scale (MAAS) scores above 4 in a 24-h period and sedative and/or narcotic doses above the established sedation and analgesia protocol or a combination of two or more sedatives.
Twenty-three (16.1%) of 143 enrolled patients exhibited severe agitation. Agitated patients were younger (hazard ratio [HR] 1.32), more likely to be admitted from an outside hospital ICU (HR 2.48), had lower pH (HR 1.55) and PaO(2)/FIO(2) less than 200 mmHg (HR 2.59). Agitated patients had longer MICU stays (median 12 versus 5 days, p<0.0001) and more ventilator days (median 14 versus 6, p<0.0001). Agitated patients were more likely to self-extubate (26% versus 6%, p=0.002). Benzodiazepines, narcotics and neuromuscular blocking agents were administered more frequently and at higher doses, but haloperidol was not.
Severe agitation occurs commonly in critically ill patients and is associated with adverse events including longer ICU stays, duration of mechanical ventilation and self-extubation.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-004-2193-9</identifier><identifier>PMID: 14966671</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Heidelberg: Springer</publisher><subject>Adult ; Aged ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Central Nervous System Depressants - therapeutic use ; Clinical outcomes ; Cohort analysis ; Critical care ; Drug dosages ; Female ; Humans ; Intensive care ; Intensive care medicine ; Intensive Care Units - statistics & numerical data ; Length of stay ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Nursing education ; Ohio - epidemiology ; Patients ; Proportional Hazards Models ; Prospective Studies ; Psychomotor Agitation - diagnosis ; Psychomotor Agitation - epidemiology ; Psychomotor Agitation - prevention & control ; Respiration, Artificial ; Risk Factors ; Treatment Outcome ; Ventilators</subject><ispartof>Intensive care medicine, 2004-06, Vol.30 (6), p.1066-1072</ispartof><rights>2004 INIST-CNRS</rights><rights>Copyright Springer-Verlag 2004</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-378ed4140c8abd33d6f10a0cad54542efe013c318f657576b3cec0b66a2dd4193</citedby><cites>FETCH-LOGICAL-c397t-378ed4140c8abd33d6f10a0cad54542efe013c318f657576b3cec0b66a2dd4193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15803081$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14966671$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>WOODS, Jeffery C</creatorcontrib><creatorcontrib>MION, Lorraine C</creatorcontrib><creatorcontrib>CONNOR, Jason T</creatorcontrib><creatorcontrib>VIRAY, Florence</creatorcontrib><creatorcontrib>JAHAN, Lisa</creatorcontrib><creatorcontrib>HUBER, Cecilia</creatorcontrib><creatorcontrib>MCHUGH, Renee</creatorcontrib><creatorcontrib>GONZALES, Jeffrey P</creatorcontrib><creatorcontrib>STOLLER, James K</creatorcontrib><creatorcontrib>ARROLIGA, Alejandro C</creatorcontrib><title>Severe agitation among ventilated medical intensive care unit patients: Frequency, characteristics and outcomes</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><description>To determine the frequency, characteristics and outcomes of severe agitation among ventilated medical intensive care unit (MICU) patients.
Prospective cohort study.
Eighteen-bed MICU in 964-bed tertiary care center.
All ventilated patients, aged 18 years or older and admitted for more than 24 h between January 1, 2001 and May 8, 2001.
None.
Data were collected daily by concurrent chart abstractions. Variables included sociodemographic, clinical, laboratory, pharmacologic and non-pharmacologic interventions, ventilator settings and adverse events. Severe agitation, the main outcome variable, was defined as two or more Motor Activity Assessment Scale (MAAS) scores above 4 in a 24-h period and sedative and/or narcotic doses above the established sedation and analgesia protocol or a combination of two or more sedatives.
Twenty-three (16.1%) of 143 enrolled patients exhibited severe agitation. Agitated patients were younger (hazard ratio [HR] 1.32), more likely to be admitted from an outside hospital ICU (HR 2.48), had lower pH (HR 1.55) and PaO(2)/FIO(2) less than 200 mmHg (HR 2.59). Agitated patients had longer MICU stays (median 12 versus 5 days, p<0.0001) and more ventilator days (median 14 versus 6, p<0.0001). Agitated patients were more likely to self-extubate (26% versus 6%, p=0.002). Benzodiazepines, narcotics and neuromuscular blocking agents were administered more frequently and at higher doses, but haloperidol was not.
Severe agitation occurs commonly in critically ill patients and is associated with adverse events including longer ICU stays, duration of mechanical ventilation and self-extubation.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Central Nervous System Depressants - therapeutic use</subject><subject>Clinical outcomes</subject><subject>Cohort analysis</subject><subject>Critical care</subject><subject>Drug dosages</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Length of stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Nursing education</subject><subject>Ohio - epidemiology</subject><subject>Patients</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Psychomotor Agitation - diagnosis</subject><subject>Psychomotor Agitation - epidemiology</subject><subject>Psychomotor Agitation - prevention & control</subject><subject>Respiration, Artificial</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><subject>Ventilators</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkUFr3DAQhUVoSLZpfkAuRQTSU51qLFm2cwuhaQuBHNKexaw8ThVsaSPJC_n31bILgZ7m8r3Hm_cYuwBxDUK035IQIFUlhKpq6GXVH7EVKFlXUMvuA1sJqepKaVWfso8pvRS61Q2csFNQvda6hRULT7SlSByfXcbsguc4B__Mt-SzmzDTwGcanMWJO5_JJ7clbrEoFu8y3xRNIdMNv4_0upC3b1-5_YsRbaboUnY2cfQDD0u2Yab0iR2POCU6P9wz9uf----7n9XD449fd7cPlZV9myvZdjQoUMJ2uB6kHPQIAoXFoVGNqmmk8rmV0I26aZtWr6UlK9ZaYz0UXS_P2Je97yaGkitlM7tkaZrQU1iSaaE00Eso4OV_4EtYoi_ZTA0aeiGlKBDsIRtDSpFGs4luxvhmQJjdFGY_hSlTmN0UZpfg88F4WZcK3xWH7gtwdQAwlX7HiN669M41nZCiA_kPXyCSbA</recordid><startdate>20040601</startdate><enddate>20040601</enddate><creator>WOODS, Jeffery C</creator><creator>MION, Lorraine C</creator><creator>CONNOR, Jason T</creator><creator>VIRAY, Florence</creator><creator>JAHAN, Lisa</creator><creator>HUBER, Cecilia</creator><creator>MCHUGH, Renee</creator><creator>GONZALES, Jeffrey P</creator><creator>STOLLER, James K</creator><creator>ARROLIGA, Alejandro C</creator><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20040601</creationdate><title>Severe agitation among ventilated medical intensive care unit patients: Frequency, characteristics and outcomes</title><author>WOODS, Jeffery C ; MION, Lorraine C ; CONNOR, Jason T ; VIRAY, Florence ; JAHAN, Lisa ; HUBER, Cecilia ; MCHUGH, Renee ; GONZALES, Jeffrey P ; STOLLER, James K ; ARROLIGA, Alejandro C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c397t-378ed4140c8abd33d6f10a0cad54542efe013c318f657576b3cec0b66a2dd4193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Central Nervous System Depressants - therapeutic use</topic><topic>Clinical outcomes</topic><topic>Cohort analysis</topic><topic>Critical care</topic><topic>Drug dosages</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Length of stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Nursing education</topic><topic>Ohio - epidemiology</topic><topic>Patients</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Psychomotor Agitation - diagnosis</topic><topic>Psychomotor Agitation - epidemiology</topic><topic>Psychomotor Agitation - prevention & control</topic><topic>Respiration, Artificial</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>WOODS, Jeffery C</creatorcontrib><creatorcontrib>MION, Lorraine C</creatorcontrib><creatorcontrib>CONNOR, Jason T</creatorcontrib><creatorcontrib>VIRAY, Florence</creatorcontrib><creatorcontrib>JAHAN, Lisa</creatorcontrib><creatorcontrib>HUBER, Cecilia</creatorcontrib><creatorcontrib>MCHUGH, Renee</creatorcontrib><creatorcontrib>GONZALES, Jeffrey P</creatorcontrib><creatorcontrib>STOLLER, James K</creatorcontrib><creatorcontrib>ARROLIGA, Alejandro C</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>WOODS, Jeffery C</au><au>MION, Lorraine C</au><au>CONNOR, Jason T</au><au>VIRAY, Florence</au><au>JAHAN, Lisa</au><au>HUBER, Cecilia</au><au>MCHUGH, Renee</au><au>GONZALES, Jeffrey P</au><au>STOLLER, James K</au><au>ARROLIGA, Alejandro C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe agitation among ventilated medical intensive care unit patients: Frequency, characteristics and outcomes</atitle><jtitle>Intensive care medicine</jtitle><addtitle>Intensive Care Med</addtitle><date>2004-06-01</date><risdate>2004</risdate><volume>30</volume><issue>6</issue><spage>1066</spage><epage>1072</epage><pages>1066-1072</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>To determine the frequency, characteristics and outcomes of severe agitation among ventilated medical intensive care unit (MICU) patients.
Prospective cohort study.
Eighteen-bed MICU in 964-bed tertiary care center.
All ventilated patients, aged 18 years or older and admitted for more than 24 h between January 1, 2001 and May 8, 2001.
None.
Data were collected daily by concurrent chart abstractions. Variables included sociodemographic, clinical, laboratory, pharmacologic and non-pharmacologic interventions, ventilator settings and adverse events. Severe agitation, the main outcome variable, was defined as two or more Motor Activity Assessment Scale (MAAS) scores above 4 in a 24-h period and sedative and/or narcotic doses above the established sedation and analgesia protocol or a combination of two or more sedatives.
Twenty-three (16.1%) of 143 enrolled patients exhibited severe agitation. Agitated patients were younger (hazard ratio [HR] 1.32), more likely to be admitted from an outside hospital ICU (HR 2.48), had lower pH (HR 1.55) and PaO(2)/FIO(2) less than 200 mmHg (HR 2.59). Agitated patients had longer MICU stays (median 12 versus 5 days, p<0.0001) and more ventilator days (median 14 versus 6, p<0.0001). Agitated patients were more likely to self-extubate (26% versus 6%, p=0.002). Benzodiazepines, narcotics and neuromuscular blocking agents were administered more frequently and at higher doses, but haloperidol was not.
Severe agitation occurs commonly in critically ill patients and is associated with adverse events including longer ICU stays, duration of mechanical ventilation and self-extubation.</abstract><cop>Heidelberg</cop><cop>Berlin</cop><pub>Springer</pub><pmid>14966671</pmid><doi>10.1007/s00134-004-2193-9</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Central Nervous System Depressants - therapeutic use Clinical outcomes Cohort analysis Critical care Drug dosages Female Humans Intensive care Intensive care medicine Intensive Care Units - statistics & numerical data Length of stay Male Medical sciences Middle Aged Multivariate Analysis Nursing education Ohio - epidemiology Patients Proportional Hazards Models Prospective Studies Psychomotor Agitation - diagnosis Psychomotor Agitation - epidemiology Psychomotor Agitation - prevention & control Respiration, Artificial Risk Factors Treatment Outcome Ventilators |
| title | Severe agitation among ventilated medical intensive care unit patients: Frequency, characteristics and outcomes |
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