Susan Becker DNP, RN, CNS, CCRN, CCNS Marymount University, Arlington, VA
|
|
- Lindsay Johnston
- 5 years ago
- Views:
Transcription
1 Susan Becker DNP, RN, CNS, CCRN, CCNS Marymount University, Arlington, VA
2 Disclosures Study and presentation has no commercial bias or interests No financial relationship with a commercial interest, products, or services Objectives Discuss the negative outcomes when using traditional medications for MV patients Describe the implementation of an extubation protocol using dexmedetomidine. Analyze the statistical results of the implementation study
3 Acknowledgements Duke University Lisa Day RN, PhD Barbara Turner RN, PhD Julie Thompson PhD Phyllis Kennel Sentara Northern Virginia Medical Center Richard Robinson M.D. Mark Clinton M.D. Gary Spanik BSPharm, RPh
4 Problem While on the ventilator, patients are uncomfortable - require traditional sedation such as propofol, lorazepam, or midazolam. Traditional sedation is turned off to prevent respiratory depression so that the patient can participate in the weaning process. Without sedation, some patients become anxious, developing tachypnea and tachycardia, and fail the extubation trial. (Riker et al, 2009)
5 Background/Significance Delirium - 85% of ICU patients may experience, increases morbidity and mortality Benzodiazepines associated with 60-80% delirium rates (9-23% ventilator-associated pneumonia) Long hospitalizations on mechanical ventilation (MV) cause increase 20% additional days due to decrease strength and motor function for 3-6 months. Riker et al, 2009
6 Solution Dexmedetomidine Highly selective α2-adrenergic receptor agonist Induces anxiolysis Sedates Has analgesic affects Does not cause respiratory depression
7 Relevant Studies SEDCOM Trial (Riker et al, 2009) Dexmedetomide vs Midazolam for Sedation of Critically Ill Patients Randomized, double-blind, 68 centers, 5 countries (March 05-Aug. 07) Level I N=375 med/surg ICU pt. on mechanical ventilation (MV) for > 24 hrs. Objective: To compare the efficacy and safety of prolonged sedation with dexmedetomide vs midazolam on vented pts. Outcome: With dexmedetomide, less time on MV, less delirium, less tachycardia, more bradycardia
8 MENDS Trial (Pandharipande et al, 2010) Effect of Dexmedetomidine vs Lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized control trial Randomized, double-blind septic vs non-septic pts. (Aug. 04-May06) adjusted covariates Level I N=103 (63 w/sepsis, 40 without) Hypothesis: Sedation with dexmedetomidine compared to lorazepam would improve clinical outcomes among septic more than non-septic pts. Outcome: more days free of delirium, fewer vent days, decrease in mortality, and greater benefit seen for the septic pt.
9 (Venn, Hell, & Grounds, 2000) Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care Randomized, double-blind, placebo-controlled, retrospectively analyzed Level II N=33 Goal: to analyze the respiratory effects of dexmedetomidine on vent pts. Outcome: No adverse effects on respiration.
10 (Snapir et al, 2006) Effects of low and high plasma concentrations of dexmedetomidine on myocardial perfusion and cardiac function in healthy male subjects Convenience, healthy males level II N=12 Goal: to determine the effects of therapeutic and high concentrations of dexmedetomide on myocardial perfusion and cardiac function in healthy subjects. Outcome: high concentration of dexmedetomide did not seriously affect myocardial perfusion or induce myocardial ischemia.
11 Use of dexmedetomidine for primary sedation in a general intensive care unit Systematic review of correlational/observational studies Level III N=42 Goal: dexmedetomidine reduces duration of vent days Outcome: pts receiving dexmedetomidine were calm, stable, weaned quicker than pts on midazolam or propofol. (Short, 2010)
12 Clinical Question: Would patients who are difficult to extubate benefit from the use of dexmedetomidine either alone or in combination with traditional sedation by having fewer ventilator days within a 3 month trial period?
13 Aim To implement and evaluate the effect of an evidence-based protocol initiating intravenous dexmedetomidine to sedate MV patients who are having difficulty with extubation. The success of the protocol implementation was measured by MV LOS.
14 Study Design Pre/Post Outcomes measured quantitatively by the mean LOS ventilator days Compared ICU pre-initiation of the innovation ventilator days to the postintervention ventilator days
15 Data The patients receiving dexmedetomidine, dosage amounts, Richmond Agitation Sedation Scale (RASS), and the number of successful extubations were recorded and trended. Other sedation or analgesics were required, medications given and the frequency of administration were noted. Adverse reactions and any need to discontinue the use of dexmedetomidine prior to extubation were documented. Data obtained using EMR
16 Organizational Setting 183 Bed Hospital 15 Bed ICU with Medical, Surgical, and Cardiac patients 5 Pulmonologists CNS Deployed pharmacist on unit (M-F)
17 The Innovation Use of dexmedetomidine Alternative medication - sedative & analgesic without respiratory depression. To be initiated when considering a difficult extubation of a patient. Does not need to be discontinued when a patient is extubated, providing continuation of tranquility and fostering a successful transition off mechanical ventilation (Siobal, Kallet, Kivett, & Tang, 2006).
18 Inclusion Adults Patients in the ICU appropriate to wean off MV Exclusion Pediatric Symptomatic bradycardia
19 Linkage Respiratory Therapists Administrators ICU RNs Innovator Pulmonologists Pharmacists
20 Implementation Education Physicians Special Care Committee meetings, 1:1 ICU Nurses Team meetings, huddles, s Respiratory Therapists Team meetings Pharmacists Assessment Daily Multidisciplinary Rounds (MDRs) Conferred with Pulmonologists
21 Protocol No Bolus! Start infusion at 0.2 mcg/kg/hr. Do not titrate for first 30 minutes Then titrate at 0.1 mcg/kg/hr. (max 1mcg/kg/hr.) to keep RASS +1 to -2 May use additional sedatives/narcotics
22 Fact Sheet
23 Adverse Reactions Fever/chills, Nausea/vomiting Dry mouth Dysrhythmias Hyperglycemia Atelectasis Agitation Brought to the immediate attention of the pulmonologist.
24 Discontinuation Continued symptomatic bradycardia despite treatment Hypovolemia Hypoxia Physicians discretion
25 Results 15 patients Mean age Males/ 6 Female 2.13 Mean days on dexmedetomidine 3 patients were also on propofol and lorazepam 2 patients given analgesics (morphine) Decrease in mean MV LOS by 0.36 days per patient (ρ = 0.620) Adverse reactions - none
26 Results Pre Implementation Post Implementation Dexmedetomidine protocol N MV LOS Mean MV LOS 4.99 (SD = 0.726) 4.63 (SD = 0.498) 8.06 (SD = 5.56 )
27 Analysis Non-parametric test Mann-Whitney U-Test Effect size Mann-Whitney U Wilcoxon W Z
28 Limitations Small sample size One site Three months Hesitation to use a new protocol deviating from routine practice
29 Discussion Mean LOS for MV was 8.06 for the dexmedetomidine patients - longer than the average either pre (µ= 4.99) or post (µ=4.63). This result requires further investigation because there was no corresponding control group
30 Discussion (con t) Of the 15 patients, 13 (87%) were successfully weaned off MV while on dexmedetomidine 5 patients eventually died (one was terminally weaned)
31 Final analysis - trend of LOS days on MV declining after implementation of the dexmedetomidine protocol
32 Sustainability EMR order sets updated to reflect safer practice evidence-based standards Daily MDRs continue to assess suitability for dexmedetomidine use.
33 Future Studies Larger sample size Multi-institutional Longer interval to acquire data Other indications Maintenance on MV patients Alcohol withdrawal protocol Limiting PTSD during MV
34 Conclusion The use of dexmedetomidine was successfully implemented at the study site The trend, though not statistically significant, was noted to be decreasing in MV LOS for ICU patients on MV. Dexmedetomidine was found to be a safe, effective alternative to traditional sedation for difficult to extubate patients in ICU.
35 Questions
Propofol vs Dexmedetomidine
Propofol vs Dexmedetomidine A highlight of similarities & differences Lama Nazer, PharmD, BCPS Critical Care Clinical Pharmacy Specialist King Hussein Cancer Center Outline Highlight similarities and differences
More informationComparison of dexmedetomidine and propofol in mechanically ventilated patients with sepsis: A pilot study
Original article Comparison of dexmedetomidine and propofol in mechanically ventilated patients with sepsis: A pilot study Mark B. Sigler MD, Ebtesam A. Islam MD PhD, Kenneth M. Nugent MD Abstract Objective:
More informationASMIC 2016 DEXMEDETOMIDINE IN THE INTENSIVE CARE UNIT DR KHOO TIEN MENG
ASMIC 2016 DEXMEDETOMIDINE IN THE INTENSIVE CARE UNIT DR KHOO TIEN MENG PREAMBLE : EVOLUTION OF SEDATION IN THE ICU 1980s : ICU sedation largely extension of GA No standard approach, highly variable Deep
More informationDisclosures. Dexmedetomidine: The Good, The Bad and The Delirious. The Delirious. Objectives. Characteristics of Delirium. Definition of Delirium
Dexmedetomidine: The Good, The Bad and The Delirious Disclosures! I have no actual or potential conflict of interest in relation to this presentation. By John J. Bon, Pharm.D., BCPS Lead Clinical Pharmacist,
More informationTherapeutics and clinical risk management (2011) Vol.7:291~299. Dexmedetomidine hydrochloride as a long-term sedative.
Therapeutics and clinical risk management (2011) Vol.7:291~299. Dexmedetomidine hydrochloride as a long-term sedative Kunisawa Takayuki Therapeutics and Clinical Risk Management open access to scientific
More informationDexmedetomidine for Sedation in the Critical Care Setting: An Economic Assessment
CADTH TECHNOLOGY REVIEW Dexmedetomidine for Sedation in the Critical Care Setting: An Economic Assessment Service Line: Technology Review Issue Number: 6 Version: 1.0 Publication Date: March 2017 Report
More informationAppendix: Outcomes when Using Adjunct Dexmedetomidine with Propofol Sedation in
SUPPLEMENTAL CONTENT Appendix: Outcomes when Using Adjunct Dexmedetomidine with Propofol Sedation in Mechanically Ventilated Surgical Intensive Care Patients Table of Contents Methods Summary of Definitions
More informationUse of Dexmedetomidine for Sedation of Children Hospitalized in the Intensive Care Unit
ORIGINAL RESEARCH Use of Dexmedetomidine for Sedation of Children Hospitalized in the Intensive Care Unit Christopher L. Carroll, MD 1 Diane Krieger, MSN, CPNP 1 Margaret Campbell, PharmD 2 Daniel G. Fisher,
More informationDexmedetomidine. Dr.G.K.Kumar,M.D.,D.A., Assistant Professor, Madras medical college,chennai. History
Dexmedetomidine Dr.G.K.Kumar,M.D.,D.A., Assistant Professor, Madras medical college,chennai Dexmedetomidine is the most recently released IV anesthetic. It is a highly selective α 2 -adrenergic agonist
More informationA COMPARATIVE STUDY OF MIDAZOLAM, PROPOFOL AND DEXMEDETOMIDINE INFUSIONS FOR SEDATION IN ME- CHANICALLY VENTILATED PATIENTS IN ICU
ORIGINAL ARTICLE A COMPARATIVE STUDY OF MIDAZOLAM, PROPOFOL AND DEXMEDETOMIDINE INFUSIONS FOR SEDATION IN ME- CHANICALLY VENTILATED PATIENTS IN ICU Suresh Chandra Dulara 1, Pooja Jangid 2, Ashish Kumar
More informationThe Addition of Dexmedetomidine as an Adjunctive Therapy to Benzodiazepine Use in Alcohol Withdrawal Syndrome
Original Article Journal of Addictions Nursing & Volume 28 & Number 4, 188Y195 & Copyright B 2017 International Nurses Society on Addictions The Addition of Dexmedetomidine as an Adjunctive Therapy to
More informationOriginal Contributions
Original Contributions Use of Dexmedetomidine to Facilitate Extubation in Surgical Intensive-Care-Unit Patients Who Failed Previous Weaning Attempts Following Prolonged Mechanical Ventilation: A Pilot
More informationTITLE: Dexmedetomidine for Sedation of Patients in the ICU or PICU: Review of Clinical Effectiveness and Safety
TITLE: Dexmedetomidine for Sedation of Patients in the ICU or PICU: Review of Clinical Effectiveness and Safety DATE: 16 January 2014 CONTEXT AND POLICY ISSUES Sedation of ICU patients is often essential
More informationComparison of Intensive Care Unit Sedation Using Dexmedetomidine, Propofol, and Midazolam
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/24 Comparison of Intensive Care Unit Sedation Using Dexmedetomidine, Propofol, and Midazolam Gajendra Singh, Kakhandki
More informationNIH Public Access Author Manuscript J Crit Care. Author manuscript; available in PMC 2013 July 28.
NIH Public Access Author Manuscript Published in final edited form as: J Crit Care. 2009 December ; 24(4): 568 574. doi:10.1016/j.jcrc.2009.05.015. A new dosing protocol reduces dexmedetomidine-associated
More informationProtocol DESIRE trial
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Protocol DESIRE trial (DExmedetomidine for Sepsis in ICU Randomized Eavaluation trial) Effect of dexmedetomidine on survival,
More informationClinical effectiveness of a sedation protocol minimizing benzodiazepine infusions and favoring early dexmedetomidine: A before-after study
Washington University School of Medicine Digital Commons@Becker Open Access Publications 2015 Clinical effectiveness of a sedation protocol minimizing benzodiazepine infusions and favoring early dexmedetomidine:
More informationOver the past 10 years, there has been an increase in
Dexmedetomidine for Sedation During Noninvasive Ventilation in Pediatric Patients Rasika Venkatraman, MD 1 ; James L. Hungerford, MD 2,3 ; Mark W. Hall, MD 1 ; Melissa Moore-Clingenpeel, MS 1,4 ; Joseph
More informationThe evolving approach to sedation in ventilated patients: a real world perspective
Editorial Page 1 of 5 The evolving approach to sedation in ventilated patients: a real world perspective Annachiara Marra 1,2, Pratik P. Pandharipande 3 1 Department of Medicine, Division of Allergy and
More informationDOI /yydb medetomidine a review of clinical applications J. Curr Opin Anaesthesiol
1573 medetomidine a review of clinical applications J. Curr Opin Anaesthesiol 2008 21 4 457-461. 6 DAHMANI S PARIS A JANNIER V et al. Dexmedetom- 2. α 2 idine increases hippocampal phosphorylated extracellular
More informationPDF of Trial CTRI Website URL -
Clinical Trial Details (PDF Generation Date :- Sun, 10 Mar 2019 06:52:14 GMT) CTRI Number Last Modified On 29/07/2016 Post Graduate Thesis Type of Trial Type of Study Study Design Public Title of Study
More informationTITLE: Dexmedetomidine for Sedation in the ICU or PICU: A Review of Cost- Effectiveness and Guidelines
TITLE: Dexmedetomidine for Sedation in the ICU or PICU: A Review of Cost- Effectiveness and Guidelines DATE: 17 December 2014 CONTEXT AND POLICY ISSUES Sedation of ICU patients is often essential for ICU
More informationSuitability of Antibiotic Treatment for CAP (CAPTIME) The duration of antibiotic treatment in community acquired pneumonia (CAP)
STUDY PROTOCOL Suitability of Antibiotic Treatment for CAP (CAPTIME) Purpose The duration of antibiotic treatment in community acquired pneumonia (CAP) lasts about 9 10 days, and is determined empirically.
More informationCurrent Strategies In ICU Sedation
This Special Report is supported through an unrestricted educational grant from BROUGHT TO YOU BY THE PUBLISHERS OF CME ACCREDITED MARCH 2001 Current Strategies In ICU Sedation OBJECTIVES After completing
More informationReview of local guidelines Contributes to CQC Regulation number: 9,11
Dexmedetomidine Infusions in Burns Intensive Care for Adults Clinical Guideline Register No: 15026 Status: Public Developed in response to: Best practice Review of local guidelines Contributes to CQC Regulation
More informationN.C. A and T List of Approved Analgesics 1 of 5
1 of 5 Note to user: This list of commonly used analgesics and sedatives is not all-inclusive. The absence of an agent does not necessarily mean it is unacceptable. For any questions, call the Clinical
More informationAlfaxan. (alfaxalone 10 mg/ml) Intravenous injectable anesthetic for use in cats and dogs. TECHNICAL NOTES DESCRIPTION INDICATIONS
Alfaxan (alfaxalone 10 mg/ml) Intravenous injectable anesthetic for use in cats and dogs. NADA 141-342, Approved by FDA ALFAXAN (Schedule: C-IV) (alfaxalone 10 mg/ml) Intravenous injectable anesthetic
More informationPain Management in Racing Greyhounds
Pain Management in Racing Greyhounds Pain Pain is a syndrome consisting of multiple organ system responses, and if left untreated will contribute to patient morbidity and mortality. Greyhounds incur a
More informationWhat dose of methadone should I use?
What dose of methadone should I use? Professor Derek Flaherty BVMS, DVA, DipECVAA, MRCA, MRCVS RCVS and European Specialist in Veterinary Anaesthesia SPC dose rates for Comfortan dogs: 0.5-1.0 mg/kg SC,
More informationSupplemental Material
Supplemental Material Jakob SM, Ruokonen E, Grounds RM, et al; for the Dexmedetomidine for Long-Term Sedation Investigators. Dexmedetomidine vs. midazolam or propofol for sedation during prolonged mechanical
More informationPAEDIATRIC DEXMEDETOMIDINE INFUSIONS IN BURNS INTENSIVE CARE
Document Title: PAEDIATRIC DEXMEDETOMIDINE INFUSIONS IN BURNS INTENSIVE CARE Document Reference/Register no: 15027 Version Number: 2.0 Document type: (Policy/ Guideline/ SOP) Guideline To be followed by:
More informationA cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit*
A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit* Joseph F. Dasta, MSc, FCCM, FCCP; Sandra L. Kane-Gill, PharmD, MSc, FCCM, FCCP;
More informationHEALTH TECHNOLOGY ASSESSMENT
HEALTH TECHNOLOGY ASSESSMENT VOLUME 20 ISSUE 25 MARCH 2016 ISSN 1366-5278 Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review Moira Cruickshank,
More informationStudy the Effect of Dexmedetomidine on Emergence Agitation after Nasal Surgeries
Original Research Article Study the Effect of Dexmedetomidine on Emergence Agitation after Nasal Surgeries G V Krishna Reddy 1*, S. Kuldeep 2, G. Obulesu 3 1 Assistant Professor, Department of Anaesthesiology,
More informationDefine evidence based practices for selection and duration of antibiotics to treat suspected or confirmed neonatal sepsis
GLOBAL AIM: Antibiotic Stewardship Perinatal Quality Improvement Teams (PQITs) will share strategies and lessons learned to develop potentially better practices and employ QI methodologies to establish
More informationSUMMARY OF PRODUCT CHARACTERISTICS
SUMMARY OF PRODUCT CHARACTERISTICS 1. Name of the Veterinary Medicinal Product Vetofol 10mg/ml Emulsion for Injection for cats and dogs (AT, CY, EE, FI, DE, EL, LV, PT, ES) Norofol 10mg/ml Emulsion for
More informationTranslational Perioperative and Pain Medicine ISSN: (Open Access) Review Article
Translational Perioperative and Pain Medicine ISSN: 2330-4871 (Open Access) Review Article Dexmedetomidine induced neuroprotection: is it translational? Yunzhen Wang 1,2, Ruquan Han 2, and Zhiyi Zuo 1
More informationA New Advancement in Anesthesia. Your clear choice for induction.
A New Advancement in Anesthesia Your clear choice for induction. By Kirby Pasloske When using Alfaxan, patients should be continuously monitored, and facilities for maintenance of a patent airway, artificial
More information11/22/2016. Antimicrobial Stewardship Update Disclosures. Outline. No conflicts of interest to disclose
Antimicrobial Stewardship Update 2016 APIC-CI Conference November 17 th, 2016 Jay R. McDonald, MD Chief, ID Section VA St. Louis Health Care System Assistant Professor of medicine Washington University
More informationEvaluation of efficacy of sedative and analgesic effects of single IV dose of dexmedetomidine in post-operative patients
www.ijpcs.net ABSTRACT Evaluation of efficacy of sedative and analgesic effects of single IV dose of dexmedetomidine in post-operative patients Manasa CR 1 *, Padma L 2, Shivshankar 3, Ranjani Ramanujam
More informationA Clinical Study of Dexmedetomidine under Combined Spinal Epidural Anaesthesia at a Tertiary Care Hospital
Original Research A Clinical Study of Dexmedetomidine under Combined Spinal Epidural Anaesthesia at a Tertiary Care Hospital Kamala GR 1, Leela GR 2 1 Assistant Professor, Department of Anaesthesiology,
More informationDOES TIMING OF ANTIBIOTICS IMPACT OUTCOME IN SEPSIS? Saravana Kumar MD HEAD,DEPT OF EM,DR MEHTA S HOSPITALS CHENNAI,INDIA
DOES TIMING OF ANTIBIOTICS IMPACT OUTCOME IN SEPSIS? Saravana Kumar MD HEAD,DEPT OF EM,DR MEHTA S HOSPITALS CHENNAI,INDIA drsaravanakumar.ep@gmail.com JOINT SECRETARY RECOMMENDATIONS: INITIAL RESUSCITATION
More informationPreliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit
Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit R. M. Venn, 1 C. J. Bradshaw, 1 R. Spencer, 2 D. Brealey, 3 E. Caudwell, 3 C. Naughton,
More informationAntimicrobial Stewardship in the Hospital Setting
GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 12 Antimicrobial Stewardship in the Hospital Setting Authors Dan Markley, DO, MPH, Amy L. Pakyz, PharmD, PhD, Michael Stevens, MD, MPH Chapter Editor
More informationThe Aquila Digital Community. The University of Southern Mississippi. Benjamin Heinrich Riebesel University of Southern Mississippi
The University of Southern Mississippi The Aquila Digital Community Doctoral Nursing Capstone Projects Fall 12-2016 In the Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, is
More informationMHA/OHA HIIN Antibiotic Stewardship/MDRO Collaborative
MHA/OHA HIIN Antibiotic Stewardship/MDRO Collaborative Place picture here Nov. 14, 2017 Reminders For best sound quality, dial in at 1-800-791-2345 and enter code 11076 Please use the chat box to ask questions!
More informationAlfaxan FAQs. Repeatable. Reliable. Relax.
Alfaxan FAQs INDICATIONS: Alfaxan is indicated for the induction and maintenance of anesthesia and for induction of anesthesia followed by maintenance with an inhalant anesthetic, in cats and dogs. Important
More informationProcedure # IBT IACUC Approval: December 11, 2017
IACUC Procedure: Anesthetics and Analgesics Procedure # IBT-222.04 IACUC Approval: December 11, 2017 Purpose: The purpose is to define the anesthetics and analgesics that may be used in mice and rats.
More informationA Randomized, Double-Blinded Study for the Prevention of Exit Site Infections in Pediatric Peritoneal Dialysis Patients
A Randomized, Double-Blinded Study for the Prevention of Exit Site Infections in Pediatric Peritoneal Dialysis Patients Joshua Zaritsky, MD PhD, Barbara Gales, RN, Georgina Ramos, and Isidro B. Salusky,
More informationDexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial
Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial Xian Su, Zhao-Ting Meng, Xin-Hai Wu, Fan Cui, Hong-Liang Li,
More informationActive Bacterial Core Surveillance Site and Epidemiologic Classification, United States, 2005a. Copyright restrictions may apply.
Impact of routine surgical ward and intensive care unit admission surveillance cultures on hospital-wide nosocomial methicillin-resistant Staphylococcus aureus infections in a university hospital: an interrupted
More informationSafety and efficacy of dexmedetomidine for long-term sedation in critically ill patients
J Anesth (2014) 28:38 50 DOI 10.1007/s00540-013-1678-5 ORIGINAL ARTICLE Safety and efficacy of dexmedetomidine for long-term sedation in critically ill patients Makoto Ozaki Junzo Takeda Keiji Tanaka Yasuhiro
More informationA SYSTEMATIC REVIEW ON THE USE OF DEXMEDETOMIDINE AS A SOLE AGENT FOR INTRAVENOUS MODERATE SEDATION
A SYSTEMATIC REVIEW ON THE USE OF DEXMEDETOMIDINE AS A SOLE AGENT FOR INTRAVENOUS MODERATE SEDATION by Dr. Samuel Y. Toong A thesis submitted in conformity with the requirements for the degree of Master
More informationSAFETY AND ACCEPTABILITY
Pulmonary Critical Care SAFETY AND ACCEPTABILITY OF PATIENT-ADMINISTERED SEDATIVES DURING MECHANICAL VENTILATION By Linda L. Chlan, RN, PhD, Debra J. Skaar, PharmD, Mary F. Tracy, RN, PhD, CCNS, Sarah
More informationPeriod of study: 12 Nov 2002 to 08 Apr 2004 (first subject s first visit to last subject s last visit)
Study Synopsis This file is posted on the Bayer HealthCare Clinical Trials Registry and Results website and is provided for patients and healthcare professionals to increase the transparency of Bayer's
More informationBest Practices for Antimicrobial Stewardship Programs. October 25, :00 AM 5:00 PM New Orleans, LA Room:
Best Practices for Antimicrobial Stewardship Programs October 25, 2016 8:00 AM 5:00 PM New Orleans, LA Room: 288-290 Co-organized by The Society for Healthcare Epidemiology of America (SHEA) and Pediatric
More informationMDR Acinetobacter baumannii. Has the post antibiotic era arrived? Dr. Michael A. Borg Infection Control Dept Mater Dei Hospital Malta
MDR Acinetobacter baumannii Has the post antibiotic era arrived? Dr. Michael A. Borg Infection Control Dept Mater Dei Hospital Malta 1 The Armageddon recipe Transmissible organism with prolonged environmental
More informationDay 90 Labelling, PL LABELLING AND PACKAGE LEAFLET
LABELLING AND PACKAGE LEAFLET A. LABELLING PARTICULARS TO APPEAR ON THE OUTER PACKAGE : Carton 1. NAME OF THE VETERINARY MEDICINAL PRODUCT Alvegesic vet. 10 mg/ml Solution for injection for Horses, Dogs
More informationDepartment of Intensive Care Medicine, Austin Hospital and the University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
Available online http://ccforum.com/content/13/3/r75 Vol 13 No 3 Research Open Access Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial Michael C
More informationDISSOCIATIVE ANESTHESIA
DISSOCIATIVE ANESTHESIA Adarsh Kumar Dissociative anesthesia implies dissociation from the surrounding with only superficial sleep mediated by interruption of neuronal transmission from unconscious to
More informationAND MISCONCEPTIONS IN THE MANAGEMENT OF SEPSIS
MYTHS AND MISCONCEPTIONS IN THE MANAGEMENT OF SEPSIS SEPSISMADE EASY SURVIVINGSEPSIS COOKBOOK SEPSIS ISAPIE MERVYN SINGER BLOOMSBURY INSTITUTE OF INTENSIVE CARE MEDICINE UNIVERSITY COLLEGE LONDON, UK DISCUSSION
More informationDexmedetomidine and its Injectable Anesthetic-Pain Management Combinations
Back to Anesthesia/Pain Management Back to Table of Contents Front Page : Library : ACVC 2009 : Anesthesia/Pain Management : Dexmedetomidine Dexmedetomidine and its Injectable Anesthetic-Pain Management
More informationPredictors of the Diagnosis and Antibiotic Prescribing to Patients Presenting with Acute Respiratory Infections
Predictors of the Diagnosis and Antibiotic Prescribing to Patients Presenting with Acute Respiratory Infections BY RYAN JOERRES CAPSTONE COMMITTEE MEMBERS: DENNIS J. BAUMGARDNER, MD, AJAY K. SETHI, PH.D.,
More informationDepartment of clinical pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Comparative Study between Dexmedetomidine and Propofol as Sedatives after Cardiac Surgery Ahmed Mohamed Shawky 1, Ahmed Mohamed Abd-Alrahman Tahoun 2, Ahmed Said Abd-Alrahman 1, Usama Ibrahim Abd-Alkarim
More informationAntibiotic Stewardship and Critical Access Hospitals. Robert White, BA, PT, CPHQ Program Manager TMF Quality Innovation Network
Antibiotic Stewardship and Critical Access Hospitals Robert White, BA, PT, CPHQ Program Manager TMF Quality Innovation Network Antibiotic-Resistant Bacteria A serious threat to public health and the economy
More informationUPDATE ON ANTIMICROBIAL STEWARDSHIP REGULATIONS AND IMPLEMENTATION OF AN AMS PROGRAM
UPDATE ON ANTIMICROBIAL STEWARDSHIP REGULATIONS AND IMPLEMENTATION OF AN AMS PROGRAM Diane Rhee, Pharm.D. Associate Professor of Pharmacy Practice Roseman University of Health Sciences Chair, Valley Health
More informationDexmedetomidine for Sedation of Neonates with HIE Undergoing Therapeutic Hypothermia: A Single-Center Experience
e168 Case Report THIEME Dexmedetomidine for Sedation of Neonates with HIE Undergoing Therapeutic Hypothermia: A Single-Center Experience Keliana O Mara, PharmD 1 Michael D. Weiss, MD 2 1 Department of
More informationOptimizing Antimicrobial Stewardship Activities Based on Institutional Resources
Optimizing Antimicrobial Stewardship Activities Based on Institutional Resources Andrew Hunter, PharmD, BCPS Infectious Diseases Clinical Pharmacy Specialist Michael E. DeBakey VA Medical Center Andrew.hunter@va.gov
More informationJOINT CONFERENCE COMMITTEE CORE MEASURE UPDATE APRIL 13, 2010
JOINT CONFERENCE COMMITTEE CORE MEASURE UPDATE APRIL 13, 2010 See attached Core Measure Performance Graphs Data through Quarter 4 2009. Core Measure Performance is reported publicly at: WWW.HOSPITALCOMPARE.HHS.GOV
More informationDexmedetomidine Hydrochloride Injection for intravenous use
DISCLAIMER All labeling reflected on this website is for informational and promotional purposes only. It is not intended to be used by healthcare professionals or patients for the purpose of prescribing
More informationDexmedetomidine use in a pediatric cardiac intensive care unit: Can we use it in infants after cardiac surgery?
Cardiac Intensive Care Dexmedetomidine use in a pediatric cardiac intensive care unit: Can we use it in infants after cardiac surgery? Constantinos Chrysostomou, MD; Joan Sanchez De Toledo, MD; Tracy Avolio,
More informationDexmedetomidine: its use in intensive care medicine and anaesthesia
BJA Education, 16 (7): 242 246 (2016) doi: 10.1093/bjaed/mkv047 Advance Access Publication Date: 26 September 2015 Matrix reference 1A02, 2C05, 2A10, 3C00 Dexmedetomidine: its use in intensive care medicine
More informationHot Topics in Antimicrobial Stewardship. Meghan Brett, MD Medical Director, Antimicrobial Stewardship University of New Mexico Hospital
Hot Topics in Antimicrobial Stewardship Meghan Brett, MD Medical Director, Antimicrobial Stewardship University of New Mexico Hospital Antimicrobial Stewardship Goals Primary Goal Optimize clinical outcomes
More informationPremedication with alpha-2 agonists procedures for monitoring anaesthetic
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Premedication with alpha-2 agonists procedures for monitoring anaesthetic Author : Lisa Angell, Chris Seymour Categories :
More informationOptimize Durations of Antimicrobial Therapy
Optimize Durations of Antimicrobial Therapy Evidence & Application Jill Cowper, Pharm.D. Division Infectious Diseases Pharmacist Parallon Supply Chain Solutions Richmond, VA P: 607 221 5101 jill.butterfield@parallon.com
More informationHemodynamic effects of dexmedetomidine-- fentanyl vs. nalbuphine--propofol in plastic surgery
Hemodynamic effects of dexmedetomidine-- fentanyl vs. nalbuphine--propofol in plastic surgery Juan F. De la Mora-González *, José A. Robles-Cervantes 2,4, José M. Mora-Martínez 3, Francisco Barba-Alvarez
More informationSUMMARY OF PRODUCT CHARACTERISTICS
SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE VETERINARY MEDICINAL PRODUCT NOSEDORM 5 mg/ml Solution for injection for dogs and cats [DE, ES, FR, PT] 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each
More informationIdentifying Medicine Use Problems Using Indicator-Based Studies in Health Facilities
Identifying Medicine Use Problems Using Indicator-Based Studies in Health Facilities Review of the Cesarean-section Antibiotic Prophylaxis Program in Jordan and Workshop on Rational Medicine Use and Infection
More informationUsing Data to Track Antibiotic Use and Outcomes
Using Data to Track Antibiotic Use and Outcomes Michelle Nemec, PharmD Thrifty White Drug Pharmacy Objectives Describe the Antibiotic Stewardship Core Element of tracking and the specific interventions
More informationTop 5 Short Procedure Sedation Scenarios
Top 5 Short Procedure Scenarios Khursheed Mama, DVM, DACVAA Colorado State University can be used to facilitate management of aggressive animals, completion of minor procedures (eg, biopsy, laceration
More informationMAGNITUDE OF ANTIMICROBIAL USE. Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges
Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges John A. Jernigan, MD, MS Division of Healthcare Quality Promotion Centers for Disease Control
More informationThe International Collaborative Conference in Clinical Microbiology & Infectious Diseases
The International Collaborative Conference in Clinical Microbiology & Infectious Diseases PLUS: Antimicrobial stewardship in hospitals: Improving outcomes through better education and implementation of
More informationAnesthesia Check-off Form
Anesthesia Check-off Form 5231 SW 91st Drive Gainesville, FL 32608 (352) 377-6003 The doctors and staff at Haile Plantation Animal Clinic would like to offer the most advanced medical care and services
More informationSUMMARY OF PRODUCT CHARACTERISTICS
SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE VETERINARY MEDICINAL PRODUCT Medeson 1 mg/ml solution for injection for dogs and cats [AT, CY, CZ, DE, EL, ES, HR, IT, LT, LV, PL, PT, RO, SI, SK] Medeson,
More informationASCENSION TEXAS Antimicrobial Stewardship: Practical Implementation Strategies
ASCENSION TEXAS Antimicrobial Stewardship: Practical Implementation Strategies Theresa Jaso, PharmD, BCPS (AQ-ID) Network Clinical Pharmacy Specialist Infectious Diseases Seton Healthcare Family Ascension
More informationDuration of antibiotic therapy:
Duration of antibiotic therapy: How low can you go? Thomas Holland, MD Hilton Head, SC July 2017 Disclosures Consulting: The Medicines Company, Basilea Pharmaceutica Adjudication committee: Achaogen Grant
More informationAntimicrobial Stewardship Programs The Same, but Different. Sara Nausheen, MD Kevin Kern, PharmD
Antimicrobial Stewardship Programs The Same, but Different Sara Nausheen, MD Kevin Kern, PharmD Antimicrobial Stewardship Programs The Same, but Different Objectives: Outline the overall function of an
More informationCefazolin vs. Antistaphyloccal Penicillins: The Great Debate
Cefazolin vs. Antistaphyloccal Penicillins: The Great Debate Annie Heble, PharmD PGY2 Pediatric Pharmacy Resident Children s Hospital Colorado Microbiology Rounds March 22, 2017 Image Source: Buck cartoons
More informationDexmedetomidine Versus Midazolam for the Sedation of Patients with Non-invasive Ventilation Failure
ORIGINAL ARTICLE Dexmedetomidine Versus Midazolam for the Sedation of Patients with Non-invasive Ventilation Failure Zhao Huang, Yu-sheng Chen, Zi-li Yang and Ji-yun Liu Abstract Objective To compare the
More informationHighly variable pharmacokinetics of dexmedetomidine during intensive care: a case report
JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Highly variable pharmacokinetics of dexmedetomidine during intensive care: a case report Timo Iirola 1*, Ruut Laitio 1, Erkki Kentala 1, Riku Aantaa
More informationCombating Antimicrobial Resistance with Extended Infusion Beta-lactams. Stephen Andrews, PharmD PGY-1 Pharmacy Practice Resident
Combating Antimicrobial Resistance with Extended Infusion Beta-lactams Stephen Andrews, PharmD PGY-1 Pharmacy Practice Resident Disclosure The presenter has no conflicts of interest to disclose with material
More informationDisclosure. Objectives. Combating Antimicrobial Resistance with Extended Infusion Beta-lactams
Combating Antimicrobial Resistance with Extended Infusion Beta-lactams Stephen Andrews, PharmD PGY-1 Pharmacy Practice Resident Disclosure The presenter has no conflicts of interest to disclose with material
More informationResponsible Antibiotic Use
Procalcitonin Levels to Promote Responsible Antibiotic Use Judy Neubrander, EdD, FNP-BC Western Carolina University School of Nursing Learning Objectives To understand the issues associated with the increase
More information1. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER AND OF THE MANUFACTURING AUTHORISATION HOLDER RESPONSIBLE FOR BATCH RELEASE, IF DIFFERENT
PACKAGE LEAFLET FOR: Dormilan solution for injection for dogs and cats [FR] Dormilan 1 mg/ml solution for injection for dogs and cats [DE, PT, UK] Reanest 1 mg/ml solution for injection for dogs and cats
More informationANNEX I SUMMARY OF PRODUCT CHARACTERISTICS
Butomidor 10 mg/ml - Solution for injection for horses, dogs and cats SPC_labelling_PIL 22 December 2011 [Version 7.2, 12/2008] ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE VETERINARY MEDICINAL
More informationFujita et al. Journal of Intensive Care 2013, 1:15
Fujita et al. Journal of Intensive Care 2013, 1:15 RESEARCH Open Access A comparison between dosages and plasma concentrations of dexmedetomidine in clinically ill patients: a prospective, observational,
More informationAntibiotic Stewardship in the Neonatal Intensive Care Unit. Objectives. Background 4/20/2017. Natasha Nakra, MD April 28, 2017
Antibiotic Stewardship in the Neonatal Intensive Care Unit Natasha Nakra, MD April 28, 2017 Objectives 1. Describe antibiotic use in the NICU 2. Explain the role of antibiotic stewardship in the NICU 3.
More informationPharmacokinetic & Pharmadynamic of Once Daily Aminoglycosides (ODA) and their Monitoring. Janis Chan Pharmacist, UCH 2008
Pharmacokinetic & Pharmadynamic of Once Daily Aminoglycosides (ODA) and their Monitoring Janis Chan Pharmacist, UCH 25-4-2008 2008 Aminoglycosides (AG) 1. Gentamicin 2. Amikacin 3. Streptomycin 4. Neomycin
More information4/3/2017 CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA DISCLOSURE LEARNING OBJECTIVES
CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA BILLIE BARTEL, PHARMD, BCCCP APRIL 7 TH, 2017 DISCLOSURE I have had no financial relationship over the past 12 months with any commercial
More informationSedation and analgesia in patients on mechanical ventilation in pediatric intensive care units in Argentina
Original article Arch Argent Pediatr 2018;116(2):e196-e203 / e196 Sedation and analgesia in patients on mechanical ventilation in pediatric intensive care units in Argentina Pedro Taffarel, M.D. a,b, German
More information