Use Of Sedation Research Articles

Monitorización del índice biespectral para sedación en colonoscopias electivas de pacientes adultos: ensayo controlado aleatorizado

BackgroundPatients should be closely monitored during procedures under sedation outside the operating room, but it is unclear which type of monitoring is best. We investigated the efficacy and safety of BIS monitoring vs conventional monitoring for sedation during colonoscopy. MethodsWe performed a double-blind clinical trial in 180 patients undergoing elective colonoscopy. Patients were randomized to 1)the BIS group or 2)a control group, in which sedation was monitored with a BIS monitor or the Ramsay Sedation Score, respectively. The primary outcome was the rate of sedation-induced adverse events in both groups. Secondary outcomes were the characteristics of patients who developed adverse events, and duration of colonoscopy when these events occurred, propofol and remifentanil dosage, and patient satisfaction. ResultsUnivariate analysis showed fewer cardiopulmonary complications in the BIS group (41.11% vs 57.78% in controls; P=.02). Multivariate analysis found a significantly higher risk of adverse events in older patients (95%CI: 1.013-1.091; P=.0087) and in men (95%CI: 1.129-7.668; P=.0272). These events were observed at the hepatic flexure. No significant differences between propofol or remifentanil dosage, use of rescue medication, and patient satisfaction were observed between groups. ConclusionsOur data suggest that BIS monitoring during sedation in scheduled colonoscopies reduces adverse respiratory events. Although its routine use in sedation does not appear to be warranted, clinicians should take steps to identify patients with a higher risk of complications who might benefit from this type of monitoring.

Substance use and its association with mental health among Swiss medical students: A cross-sectional study.

Studies on mental health and substance use among medical students indicated worrying prevalence but have been mainly descriptive. To evaluate the prevalence of substance use in a sample of medical students and investigate whether mental health variables have an influence on substance use. The data were collected as part of the first wave of the ETMED-L, an ongoing longitudinal open cohort study surveying medical students at the University of Lausanne (Switzerland). N = 886 students were included and completed an online survey including measures of mental health (depression, suicidal ideation, anxiety, stress, and burnout) and use of and risk related with several substances (tobacco, alcohol, cannabis, cocaine, stimulants, sedatives, hallucinogens, opioids, nonmedical prescription drugs, and neuroenhancement drugs). We evaluated the prevalence of use of each substance and then tested the association between mental health and substance use in an Exploratory Structural Equation Modeling framework. Statistical indices indicated a four-factor solution for mental health and a three-factor solution for substance use. A factor comprising risk level for alcohol, tobacco, and cannabis use - which were the most prevalent substances - was significantly associated with a burnout factor and a factor related to financial situation and side job stress. There was a significant association between a factor comprising depression, anxiety, and suicidal ideation and a factor related to the use of sedatives, nonmedical prescription drugs and neuroenhancement drugs. Although their use was less prevalent, a factor comprising the risk level of stimulants and cocaine use was significantly but more mildly related to the burnout factor. A factor comprising stress related to studies and work/life balance as well as emotional exhaustion was not related to substance use factors. In this sample of medical students, the prevalence of substance use was substantial and poorer mental health status was related with higher substance use risk levels.

The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience.

To describe the use and outcomes of the neurological wake-up test (NWT) in pediatric severe traumatic brain injury (pTBI). Retrospective single-center observational cohort study. Medical-surgical tertiary pediatric intensive care unit (PICU) in a university medical center and Level 1 Trauma Center. Children younger than 18 years with severe TBI [i.e., Glasgow Coma Scale (GCS) of ≤8] admitted between January 2010 and December 2020. Subjects with non-traumatic brain injury were excluded. Of 168 TBI patients admitted, 36 (21%) met the inclusion criteria. Median age was 8.5 years [2 months to 16 years], 5 patients were younger than 6 months. Median initial Glasgow Coma Scale (GCS) and Glasgow Motor Scale (GMS) was 6 [3-8] and 3 [1-5]. NWTs were initiated in 14 (39%) patients, with 7 (50%) labelled as successful. Fall from a height was the underlying injury mechanism in those seven. NWT-failure occurred in patients admitted after traffic accidents. Sedation use in both NWT-subgroups (successful vs. failure) was comparable. Cause of NWT-failure was non-arousal (71%) or severe agitation (29%). Subjects with NWT failure subsequently had radiological examination (29%), repeat NWT (43%), continuous interruption of sedation (14%) or intracranial pressure (ICP) monitoring (14%). The primary reason for not doing NWTs was intracranial hypertension in 59%. Compared to the NWT-group, the non-NWT group had a higher PRISM III score (18.9 vs. 10.6), lower GCS/GMS at discharge, more associated trauma, and circulatory support. Nine patients (25%) died during their PICU admission, none of them had an NWT. We observed limited use of NWTs in pediatric severe TBI. Patients who failed the NWT were indistinguishable from those without NWT. Both groups were more severely affected compared to the NWT successes. Therefore, our results may indicate that only a select group of severe pTBI patients qualify for the NWT.

GJ Express: an improvement initiative to decrease sedation and anesthesia for gastrojejunostomy tube exchanges.

Overuse of sedation and anesthesia causes delays in gastrojejunostomy tube (GJ) exchanges, increased risk of complications, unnecessary use of resources, preventable hospital admissions, and an adverse impact on patient and family experience. Our hospital was over-utilizing sedation and anesthesia, and we aimed to decrease this use from 78% to 20% within two years. An interdisciplinary quality improvement team comprehensively evaluated current processes for GJ tube exchanges through a retrospective chart review for baseline data with prospective time series analysis after improvement implementation. The primary outcome measure was the percentage of pediatric patients that utilized sedation or anesthesia for routine GJ tube exchanges. A statistical process control p-chart was used to calculate and show changes over time for patients (n = 45 patients average). The median percent of pediatric GJ tube exchanges performed with sedation or anesthesia decreased from 77.8% to 11.3%. Most patients (76%) were covered by Medicaid programs; with low reimbursement rates, decreased anesthesiologist billing revenue does not have a negative financial impact. An interprofessional improvement initiative that engaged patients and families, incorporated pediatric-specific staff services, and developed systematic weaning was associated with a significant decrease in the overuse of sedation and anesthesia for GJ tube exchanges. We believe that this work is highly relevant and impactful for medical centers caring for children who require gastrojejunostomy tubes, an increasingly common approach to management of children with feeding issues. There is very little literature available on the use of sedation or anesthesia for changing these tubes. While large children's medical centers in the USA usually do not utilize sedation or anesthesia, there are likely many serious outliers, especially when children receive care outside of a pediatric specific institution. This paper brings awareness to this serious issue and provides information about how we changed care to achieve higher patient safety and lower medical costs.

Intelligent ultrafast total-body PET for sedation-free pediatric [18F]FDG imaging.

This study aims to develop deep learning techniques on total-body PET to bolster the feasibility of sedation-free pediatric PET imaging. A deformable 3D U-Net was developed based on 245 adult subjects with standard total-body PET imaging for the quality enhancement of simulated rapid imaging. The developed method was first tested on 16 children receiving total-body [18F]FDG PET scans with standard 300-s acquisition time with sedation. Sixteen rapid scans (acquisition time about 3 s, 6 s, 15 s, 30 s, and 75 s) were retrospectively simulated by selecting the reconstruction time window. In the end, the developed methodology was prospectively tested on five children without sedation to prove the routine feasibility. The approach significantly improved the subjective image quality and lesion conspicuity in abdominal and pelvic regions of the generated 6-s data. In the first test set, the proposed method enhanced the objective image quality metrics of 6-s data, such as PSNR (from 29.13 to 37.09, p < 0.01) and SSIM (from 0.906 to 0.921, p < 0.01). Furthermore, the errors of mean standardized uptake values (SUVmean) for lesions between 300-s data and 6-s data were reduced from 12.9 to 4.1% (p < 0.01), and the errors of max SUV (SUVmax) were reduced from 17.4 to 6.2% (p < 0.01). In the prospective test, radiologists reached a high degree of consistency on the clinical feasibility of the enhanced PET images. The proposed method can effectively enhance the image quality of total-body PET scanning with ultrafast acquisition time, leading to meeting clinical diagnostic requirements of lesion detectability and quantification in abdominal and pelvic regions. It has much potential to solve the dilemma of the use of sedation and long acquisition time that influence the health of pediatric patients.

Opioid Prescribing for Noncancer Patients—Issues of Drug Therapy Safety: Results from a German Study Based on Routine Data

Opioids are highly effective drugs but need close monitoring to avoid harm to patients. The aim of this study was to analyze how guideline recommendations are met for (i) the avoidance of the concomitant use of anxiolytics, hypnotics, or sedatives; (ii) the prescribing of laxatives in long-term opioid treatment; (iii) the co-prescribing of drugs to control the emetic effect of opioids; (iv) pretreatment with non-opioids; and (v) screening for depression when initiating opioids. The results are based on a routine data analysis of a large German health insurance fund. Different study populations of noncancer patients (18+ years old) treated with opioids were analyzed: 10.4% of the opioid recipients in 2021 received at least one concomitant prescription with anxiolytics, hypnotics, or sedatives; 69.3% of those with long-term opioid treatment received at least one laxative prescription. Of those with first-time opioid prescriptions, 4.8% received an antiemetic drug; 47.3% of those with a newly initiated opioid therapy received a non-opioid prescription within three months before the start of the opioid therapy; and 22.0% of patients with incident opioid prescription had at least one documentation of a depression diagnosis within three months of the first prescription. There is an urgent need to improve opioid prescribing to avoid risky combinations and adverse effects.

Comparative Analysis of Palliative Sedation and Euthanasia - a literature review

Introduction and purpose: Palliative care is designed to ensure proper comfort in living and dying, primarily by alleviating suffering in patients for whom medical interventions have proved ineffective. In situations where suffering is unbearable, palliative care offers "last resort" treatment, namely palliative sedation. This involves the intentional administration of sedative drugs to the patient to reduce the level of consciousness, even inducing sleep, in order to control suffering caused by conditions that are resistant to other treatments. The aim of this article is to present various perspectives on palliative sedation.&#x0D; Description of the state knowledge: Topics discussed include: cessation of hydration and nutrition, loss of patient control over decision-making in treatment progression after the induction of pharmacological coma, the principle of double effect, complications arising from the use of indiscriminate polypharmacy, and views on life shortening through palliative sedation or its comparison to euthanasia. The distinction between palliative sedation and euthanasia is explored, with arguments on both sides contributing to ongoing debates. The paper concludes by advocating for comprehensive guidelines and interdisciplinary assessments to ensure ethical and patient-centered decision-making in the application of palliative sedation in terminally ill patients.&#x0D; Summary: A discussion is necessary on the creation of acceptable and appropriate procedures that would not arouse the controversies currently associated with the use of palliative sedation.&#x0D;

Trends and factors associated with illicit drug use in South Africa: Findings from multiple national population-based household surveys, 2002–2017

BackgroundIllicit drug use results in considerable global morbidity, but there is little data on its trends and factors associated with it in sub-Saharan Africa. We consider these questions using national data from South Africa for 2002–2017. MethodsWe analysed data among individuals aged 15 years or older from five national population-based household surveys in South Africa (2002–2017; n = 89,113). Recent drug use was defined as the last three-months use of illicit drugs, i.e., any use of cannabis, cocaine, amphetamine, inhalants, sedatives, hallucinogens, opioids, and/or other illicit drugs. Time trends in recent drug use were assessed using logistic regression. Multivariable logistic regression assessed the association between recent drug use and socio-demographic factors and between drug use and sexual risk behaviours, HIV-related and other well-being variables. ResultsThe prevalence of recent drug use increased from 1·5% to 10·0% from 2002 to 2017, driven by increases in cannabis use (1·5% to 7·8%) and use of opioids (0·01% to 1·6%), cocaine (0·02% to 1·8%), or amphetamines (0·1% to 1·5%). In adjusted analyses, male gender, younger age, living in urban areas, mixed-ancestry or white ethnicity (compared to black-African), and unemployment were positively associated with recent drug use. Recent drug use was associated with: multiple sexual partners (adjusted odds ratio [aOR] 2·13, 95% confidence interval [CI]: 1·80–2·51); sexual debut before 15 years old (aOR 1·70, 95%CI: 1·29–2·23); hazardous/harmful alcohol use (aOR 2·50, 95%CI: 2·14–2·93) or alcohol dependence (aOR 3·33, 95%CI 2·92–3·80); ever experiencing intimate partner violence (aOR 1·56, 95%CI 1·12–2·17); psychological distress (aOR 1·53, 95%CI: 1·28–1·82); and lower chance of ever testing for HIV (aOR 0·89, 95%CI 0·80–1·00). Recent drug use was not associated with HIV positivity, condom use or being on antiretroviral therapy. ConclusionIllicit drug use has increased substantially in South Africa and is associated with numerous socio-demographic characteristics, higher sexual risk behaviours and other well-being variables.

Exploring nurses' clinical judgment concerning the relative importance of fall risk factors: A mixed method approach using the Q Methodology

BackgroundNurses are pivotal in averting patient falls through their assessment of cues presented by patients and their environments, rendering clinical judgments regarding the risk of falling, and implementing tailored interventions. Despite the intricate cognitive processes entailed in nurses' judgment, no prior studies have explored their approach to assessing the risk of falling. ObjectiveThis study aimed to examine how nurses judge the risk of falling among patients with different conditions, whether there are differences in the importance of risk factors as judged by nurses, how they justify their judgments, and what attributes of the nurses influence their judgments. DesignA mixed method approach using the Q Methodology was employed. Setting(s)Three public and private hospitals in Japan. ParticipantsEighteen nurses participated in the study. MethodsParticipants were tasked with ranking 36 patient scenarios, each featuring a distinct set of fall risk factors. Subsequently, post-sorting interviews were conducted to gather insights into their typical approach to assessing fall risk and the rationale behind their ranking decisions. A by-person principal component factor extraction was employed to examine differences in the rankings of the scenarios. The interview data were analyzed descriptively to elucidate the reasons behind these discrepancies. ResultsNurses engage in complex cognitive manipulations when evaluating the risk of patient falls, drawing extensively from their wealth of experience while utilizing assessment tools to support their judgments. In essence, nurses identify patients' tendency to act alone without calling a nurse, impaired gait and cognition, sedative use, drains, and limited information sharing among healthcare professionals as key fall risks. In addition, nurses vary in the importance they attribute to certain risk factors, leading to the discrimination of three distinct judgment profiles. One group of nurses judges patients with cognitive impairment and acting alone as high risk. Another group of nurses considers patients with unstable gait and acting alone as high risk. The last group of nurses sees patients wearing slippers as high risk. The post-sorting interviews revealed that their judgments are closely related to the healthcare context and patient population. ConclusionsNurses operate within diverse contexts, wherein they interact with patients of varying characteristics, collaborate with professionals from diverse disciplines, and have access to varying levels of human and physical resources. This nuanced understanding empowers the formulation of judgments that are finely attuned to the specific context at hand. Study registrationNot registered.

Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools: impact of the sociodemographic index (SDI).

There is variability in the use of sedatives and analgesics in neonatal intensive care units (NICUs). We aimed to investigate the use of analgesics and sedatives and the management of neonatal pain and distress. This was a global, prospective, cross-sectional study. A survey was distributed May-November 2022. The primary outcome of this research was to compare results between countries depending on their socio-sanitary level using the sociodemographic index (SDI). We organized results based on geographical location. The survey collected 1304 responses, but we analyzed 924 responses after database cleaning. Responses from 98 different countries were analyzed. More than 60% of NICUs reported having an analgosedation guideline, and one-third of respondents used neonatal pain scales in more than 80% of neonates. We found differences in the management of sedation and analgesia between NICUs on different continents, but especially between countries with different SDIs. Countries with a higher SDI had greater availability of and adherence to analgosedation guidelines, as well as higher rates of analgosedation for painful or distressing procedures. Countries with different SDIs reported differences in analgosedation for neonatal intubation, invasive ventilation, and therapeutic hypothermia, among others. Socio-economic status of countries impacts on neonatal analgosedation management. There is significant variability in the pain management practices in neonates. There is a lack of knowledge related to how neonatal pain management practices differ between regions. Sociodemographic index is a key factor associated with differences in neonatal pain management practices across global regions.

Randomized, Single-Blind, Comparative Study of Remimazolam Besylate vs Propofol for Facial Plastic Surgery.

Use of local anesthesia and conscious sedation with a combination of a sedative and anesthetic drug during a surgical procedure is an approach designed to avoid intubation, which produces fewer adverse events compared to general anesthesia. In the present study, a comparison was made between the efficacy and safety of remimazolam besylate and propofol for facial plastic surgery. The objective was to evaluate the clinical efficacy, comfort, and incidence of adverse events of remimazolam compared with propofol combined with alfentanil in outpatient facial plastic surgery. In this randomized, single-blind, single-center, comparative study, facial plastic surgery patients were randomly divided into remimazolam-alfentanil (n = 50) and propofol-alfentanil (n = 50) groups for sedation and analgesia. The primary endpoint was the incidence of hypoxemia, while secondary endpoints included efficacy and safety evaluations. There were no significant differences regarding the surgical procedure, sedation and induction times, pain and comfort scores, muscle strength recovery, heart rate, respiratory rate, and blood pressure, but the dosage of alfentanil administered to the remimazolam group (387.5 μg) was lower than that for the propofol group (600 μg). The incidence of hypoxemia (P = .046) and towing of the mandibular (P = .028), as well as wake-up (P = .027) and injection pain (P = .008), were significantly higher in the propofol group than the remimazolam group. Remimazolam and propofol had similar efficacies for sedation and analgesia during facial plastic surgery, but especially the incidence of respiratory depression was significantly lower in patients given remimazolam.

Impact of palliative care at end-of-life Covid-19 patients – a small-scale pioneering experience

BackgroundIn March 2020, the outbreak caused by the SARS-CoV-2 virus was declared a pandemic, resulting in numerous fatalities worldwide. To effectively combat the virus, it would be beneficial to involve professionals who specialize in symptom control for advanced illnesses, working closely with other specialties throughout the illness process. This approach can help manage a range of symptoms, from mild to severe and potentially life-threatening. No studies have been conducted in Portugal to analyse the intervention of Palliative Medicine at the end of life of Covid-19 patients and how it differs from other specialties. This knowledge could help determine the importance of including it in the care of people with advanced Covid-19.ObjectivesThe objective of this study is to examine potential differences in the care provided to patients with Covid-19 during their Last Hours and Days of Life (LHDOL) between those who received care from Palliative Medicine doctors and those who did not.MethodsThis is a retrospective cohort study spanning three months (Dec 2020 to Feb 2021), the duration of the Support Unit especially created to deal with Covid-19 patients. The database included clinical files from 181 patients admitted to the Support Unit, 27 of which died from Covid-19.ResultsStatistically significant differences were identified in the care provided. Specifically, fewer drugs were administered at the time of death, including drugs for dyspnoea, pain and agitation, suspension of futile devices and use of palliative sedation to control refractory symptoms.ConclusionsEnd-of-life care and symptomatic control differ when there’s regular follow-up by Palliative Medicine, which may translate less symptomatic suffering and promote a dignified and humane end of life.

Survey of Neonatal Management After Amnioinfusion for Anhydramnios

This survey study reports on use of renal replacement therapy, hemodynamic support, sedation, neuroimaging, and extracorporeal membrane oxygenation at Renal Anhydramnios Fetal Therapy trial sites for neonates with either bilateral renal agenesis or fetal kidney failure.

Work Stress and Psychoactive Substance Use among Correctional Officers in the USA

Background: Correctional officers’ life expectancy in the U.S. is 59 years, compared to the population average of 75 years. Correctional officers have higher suicide rates than others and carry a higher risk for substance use. This study examined relationships between work stress, psychoactive substance use, and preferred venues for treatment. Methods: Secondary analysis was conducted on 2017–2018 data from interviews with correctional officers, randomly sampled from prisons within Massachusetts and Texas. Independent sample t-test, multinomial logistic regression, and mediation effect model were used for analysis. Results: Of the 1083 participants (mean age = 38.6), 71.4% were males, 62.9% were White, 17.0% were veterans, and 46.7% worked in maximum-security prisons, among which 70.8% used alcohol and 17.2% sedatives in the last month. While 52.3% did not prefer receiving stress management services from the department, 32.9% did not prefer receiving from outside. Alcohol and sedative use were associated positively with work stress and counterproductive workplace behaviors, and negatively with organizational citizenship and task performance. Preferred treatment varied based on work stress and substance use. Conclusions: Work stress and psychoactive substance use among correctional officers are multifactorial. Interventions should be tailored to officers’ needs and preferred treatment venues. Prison reform should address the needs of not only inmates, but also officers.

Prescriptions of psychotropic and somatic medications among patients with severe mental disorders and healthy controls in a naturalistic study

Purpose Psychotropic and somatic medications are both used in treating severe mental disorders (SMDs). Realistic estimates of the prevalence of use across medication categories are needed. We obtained this in a clinical cohort of patients with SMD and healthy controls (HCs). Materials and methods Prescriptions filled at Norwegian pharmacies the year before and after admittance to the Thematically Organized Psychosis (TOP) study were examined in 1406 patients with SMD (mean age 32.5 years, 48.2% women) and 920 HC (34.1 years, 46.2% women). Using data from the Norwegian Prescription Database (NorPD), the number of users in different anatomical therapeutic chemical (ATC) categories was compared using logistic regression. Population estimates were used as reference data. Results Use of antipsychotics (N05A), antiepileptics (N03A), antidepressants (N06A), anxiolytics (N05B), hypnotics and sedatives (N05C), anticholinergics (N04A), psychostimulants, attention deficit hyperactivity disorder and nootropic agents (N06B) and drugs for addiction disorders (N07B) was significantly more prevalent in patients with SMD than HC. Use of diabetes treatment (A10), antithrombotic drugs (B01), beta blockers (C07), lipid modifiers (C10), and thyroid and endocrine therapeutics (H03) was also more prevalent in patients with SMD, but with two exceptions somatic medication use was comparable to the general population. Among HC, there was low prevalence of use for most medication categories. Conclusion Patients were using psychiatric medications, but also several types of somatic medications, more often than HC. Still, somatic medication use was mostly not higher than in the general population. The results indicate that HC had low use of most medication types.

A Study to Investigate Parents’ Satisfaction and Concerns Regarding the Different Sedation Options Available for Pediatric Oral Surgery

ABSTRACT Background: Pediatric oral surgery often necessitates the use of sedation to ensure patient comfort and cooperation. This study examines parents’ satisfaction and concerns regarding the various sedation options available for their children’s oral surgery, aiming to improve the overall patient experience Materials and Methods: A cross-sectional study design was employed, with a sample size of 500 parents or guardians of children who had undergone pediatric oral surgery with sedation. A structured questionnaire was used to collect data on demographic characteristics, satisfaction with sedation methods, and common concerns. Results: The study revealed a high level of satisfaction among parents, with 80% reporting satisfaction or very high satisfaction with the sedation process. However, specific concerns were identified, including fear of sedation complications, concerns about long-term effects, child anxiety or trauma, perceived lack of control, and communication with the healthcare team Conclusion: The findings highlight the importance of clear communication and education for parents and guardians in the context of pediatric oral surgery.

Abstract WP165: Meth Use and Intracerebral Hemorrhage: Really "Breaking Bad"

Background: Unlike other stimulants, methamphetamine (meth) is highly addictive and can be injected, snorted, smoked, or ingested orally. Due to increased access, its use has increased globally. Recent studies have shown that there was no significant difference in hospital outcomes between ICH positive patients who utilize meth versus those who do not. However, there has not been a comprehensive evaluation of methamphetamine related ICH in recent times. Our objective is to determine if meth use impacts ICU length of stay/need for sedating agents, and if meth use varies by ethnicity in the ICH population. Methods: This is an IRB approved retrospective review of all patients with acute ICH at a large academic stroke center from 2017 to 2023. Data collected and analyzed include demographics, ICH score/size, intraventricular hemorrhage, location of hematoma, surgical intervention, GCS/NIHSS scores, ICU length of stay (LOS), and discharge destiny. Statistics used include Pearson’s Chi-squared test and Wilcoxon rank sum test. Results: Of 70 ICH patients with all data elements, 32 (46%) were meth users, with an average age of meth positive patients at 59. In our Hispanic population, significant meth use was seen (41% v 13%, p = 0.009). ICH patients had significant NICU LOS (10.1 v 6.1 days, p &lt; 0.001), with longer hospital mean LOS (12.4 v 7.8 days, p = 0.007). They also required more sedatives (63% v 37%, p = 0.032). Meth use was not associated with larger ICH size (15.7 v 29.2, p = 0.406), but was associated with higher discharge mRS (4.7 v 4.3, p = 0.788). Conclusions: Our study demonstrates that in ICH positive patients, meth-use was associated with increased use of sedatives and increased length of stay, as well as higher discharge mRS. However, it was not associated with larger ICH size. Hispanic ethnicity and ICH also appear to have a relationship, although that relationship needs to be further elucidated. Discussion: Methamphetamine is easily and relatively inexpensive to make, with over-the-counter ingredients such as pseudoephedrine. With over 35 million people using meth worldwide, our data found that the average user was older than previously thought. As ICH is one of the major complications of meth use, ICH has a major impact on complexity of care and health economics.

141. Adolescents Presenting With Illicit Drug Toxicity from Opioid, Stimulant or Sedative Use: A National Cross-Sectional Survey of Canadian Pediatricians

141. Adolescents Presenting With Illicit Drug Toxicity from Opioid, Stimulant or Sedative Use: A National Cross-Sectional Survey of Canadian Pediatricians

Ketamine for Primary Analgosedation in Critically Ill Surgery and Trauma Patients Requiring Mechanical Ventilation.

Evaluate effectiveness and safety outcomes associated with the use of ketamine for primary analgosedation in the surgical/trauma ICU setting. Retrospective cohort study. Academic medical center in Minnesota. Patients admitted to the surgical ICU between 2015 and 2019 requiring mechanical ventilation and meeting one of three definitions for ketamine primary analgosedation were included: 1) no concomitant opioid infusion, 2) ketamine monotherapy for greater than or equal to 6 hours with subsequent opioid infusion, or 3) ketamine initiated concomitantly or within 4 hours of opioid and total opioid duration less than 4 hours. None. Use of ketamine, analgesics, and sedatives were evaluated. Pain, sedation, and delirium assessments immediately before and during ketamine infusion were collected and compared with reported goals. Concomitant analgesics, sedatives, and psychotropics were recorded. Reported failures due to ineffectiveness and toxicity were collected. Of 164 included patients, 88% never received a concomitant opioid infusion (primary analgosedation definition 1), 12% met alternative criteria for primary analgosedation (definitions 2 and 3). A majority, 68%, were surgical admissions and mean Acute Physiology and Chronic Health Evaluation III score was 90 (± 30). Median mechanical ventilation duration was 2.5 days (1.1-4.5) and ICU length of stay of 4.9 days (3-8). The median ketamine infusion dose and duration were 0.18 mg/kg/hr (0.1-0.3) and 30 hours (15.1-51.8). Concomitant infusions of propofol and dexmedetomidine were administered in 49% and 29% of patients, respectively. During ketamine infusion, the median percent of total pain scores at goal was 62% (33-96%), while 64% (37-91%) of Richmond Agitation Sedation Scale scores were at goal, and 47% of patients were Confusion Assessment Method-ICU positive during the ketamine infusion. Hallucinations were documented in 14% of patients and ketamine failure occurred in 11% of patients. Ketamine may be an effective primary analgosedation option in intubated surgical ICU patients, but prospective randomized studies are needed to evaluate this strategy.

Improving Outcomes in Mechanically Ventilated Adult ICU Patients Following Implementation of the ICU Liberation (ABCDEF) Bundle Across a Large Healthcare System.

To measure how the ICU Liberation Bundle (aka ABCDEF Bundle or the Bundle) affected clinical outcomes in mechanically ventilated (MV) adult ICU patients, as well as bundle sustainability and spread across a healthcare system. We conducted a multicenter, prospective, cohort observational study to measure bundle performance versus patient outcomes and sustainability in 11 adult ICUs at six community hospitals. We then prospectively measured bundle spread and performance across the other 28 hospitals of the healthcare system. A large community-based healthcare system. In 11 study ICUs, we enrolled 1,914 MV patients (baseline n = 925, bundle performance/outcomes n = 989), 3,019 non-MV patients (baseline n = 1,323, bundle performance/outcomes n = 1,696), and 2,332 MV patients (bundle sustainability). We enrolled 9,717 MV ICU patients in the other 28 hospitals to assess bundle spread. We used evidence-based strategies to implement the bundle in all 34 hospitals. We compared outcomes for the 12-month baseline and bundle performance periods. Bundle implementation reduced ICU length of stay (LOS) by 0.5 days (p = 0.02), MV duration by 0.6 days (p = 0.01), and ICU LOS greater than or equal to 7 days by 18.1% (p < 0.01). Performance period bundle compliance was compared with the preceding 3-month baseline compliance period. Compliance with pain management and spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) remained high, and reintubation rates remained low. Sedation assessments increased (p < 0.01) and benzodiazepine sedation use decreased (p < 0.01). Delirium assessments increased (p = 0.02) and delirium prevalence decreased (p = 0.02). Patient mobilization and ICU family engagement did not significantly improve. Bundle element sustainability varied. SAT/SBT compliance dropped by nearly half, benzodiazepine use remained low, sedation and delirium monitoring and management remained high, and patient mobility and family engagement remained low. Bundle compliance in ICUs across the healthcare system exceeded that of study ICUs. The ICU Liberation Bundle improves outcomes in MV adult ICU patients. Evidence-based implementation strategies improve bundle performance, spread, and sustainability across large healthcare systems.