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Patients' recollections of therapeutic paralysis in the intensive care unit.
Ballard N, Robley L, Barrett D, Fraser D, Mendoza I.
WellStar Health System, Marietta, Ga.
BACKGROUND: Neuromuscular blocking agents used for therapeutic purposes, such as facilitating mechanical ventilation and relieving life-threatening agitation, paralyze patients but leave them fully conscious. Aggressive sedation or analgesia is necessary to reduce awareness, relieve fear, produce comfort, decrease anxiety, induce unconsciousness, and minimize possible complications such as posttraumatic stress syndrome. Little information is available on the extent to which patients experience awareness during therapeutic paralysis. OBJECTIVES: To determine and describe the remembered experiences of critical care patients who were given neuromuscular blocking agents and sedatives and/or analgesics to facilitate mechanical ventilation, improve hemodynamic stability, and improve oxygenation. METHODS: A phenomenological approach with in-depth interviews with 11 patients was used. Data were analyzed by using the constant comparative approach. RESULTS: A total of 4 themes and 3 subthemes were identified. The first theme was back and forth between reality and the unreal, between life and death; the subtheme was having weird dreams. The second theme was loss of control; the 2 subthemes were (1) fighting or being tied down and (2) being scared. The third theme was almost dying, and the fourth theme was feeling cared for. CONCLUSIONS: Patients can remember having both negative and positive experiences during neuromuscular blockade. Steps to improve the experiences of patients receiving neuromuscular blockers include improving assessment parameters, developing and using sedation/analgesia guidelines, and investing in quality improvement programs to provide assessment of awareness during therapeutic paralysis and follow-up and referral as necessary. Ways to decrease the use of neuromuscular blockers would also be useful.
PMID: 16391318 [PubMed - in process]
The man with no heart.
Mosenkis A.
University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. mosenkis@hotmail.com
PMID: 16365474 [PubMed - indexed for MEDLINE]
Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003.
Klevens RM, Edwards JR, Tenover FC, McDonald LC, Horan T, Gaynes R; National Nosocomial Infections Surveillance System.
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. rmk2@cdc.gov
The proportion of Staphylococcus aureus isolates that were methicillin resistant (MRSA) increased from 35.9% in 1992 to 64.4% in 2003 for hospitals in the National Nosocomial Infections Surveillance system. During the same period, there was a decrease in resistance rates for several non- beta -lactam drugs among the MRSA isolates.
PMID: 16392087 [PubMed - in process]
Normalizing physiological variables in acute illness: five reasons for caution.
Kavanagh BP, Meyer LJ.
Department of Critical Care Medicine, Hospital for Sick Children, 555 University Avenue, Toronto , ONT, M5G 1X8, Canada. brian.kavanagh@sickkids.ca
Publication Types:
PMID: 16044251 [PubMed - indexed for MEDLINE]
Comment on:
Use of the physiochemical acid-base approach for mortality prediction in trauma intensive care unit patients.
Funk GC, Doberer D, Lindner G, Kneidinger N, Schneeweiss B.
Publication Types:
PMID: 16374304 [PubMed - indexed for MEDLINE]
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