Discussion: Sedation drugs

Search Methods Draft Beni Costa Middle Tennessee State University Scholarly Synthesis NURS 6990-D02 Spring 2019 NURS 6990 Scholarly Synthesis Search activity My research question: In critically ill patients in the ICU (P), with limited use of sedation drugs (I), compared to not using sedation drugs (C), reduce delirium (P)? Places to search for information: School online library, and google scholar List of sources searched: Date of search 1. Lee, J., Choi, S., Park, Y., 13 February 2019 Search strategy used, Total number of results including any limits found Boolean operators 15,700 Comments Using the AND operator Lee, C. H., Lee, S. M., was very useful in Yim, J. J., … & Kim, Y. narrowing the research to (2017). C53 CRITICAL only include sedation use CARE: DELIRIUM AND and delirium. Discussion: Sedation drugs

THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. American Journal of Respiratory and Critical Care Medicine, 195. 2. Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients On The Wards. American Journal of Respiratory and Critical Care Medicine, 193, 1. 3. Djaiani, G., Silverton, N., Fedorko, L., Carroll, J., Styra, R., Rao, V., & Katznelson, R. (2016). Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery, a randomized controlled trial. Anesthesiology: The Journal of the American Society of Anesthesiologists, 124(2), 362-368. 1. Salluh, J. I., Wang, H., 13 Feb 2019 Truncation 15, 000 This strategy was useful Schneider, E. B., Nagaraja, in restricting the search to N., Yenokyan, G., a word stem. Damluji, A., … & Stevens, R. D. (2015). Outcome of delirium in critically ill patients: systematic review and metaanalysis. bmj, 350, h2538. 2. Vallabhajosyula, S., Kanmanthareddy, A., Morrow, L. E., & Esterbrooks, D. J. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: Role of Statins in Delirium Prevention in Critically Ill and Cardiovascular Surgery Patients: A MetaAnalysis. American Journal of Respiratory and Critical Care Medicine, 193, 1. 1. Lyons, P. G., Snyder, A. Parentheses 15,600 This strategical was M., Edelson, D. P., helpful in making the Mokhlesi, B., & Churpek, search logical by pacing M. M. (2016). C50 sedation use and delirium CRITICAL CARE: appear on the same search. DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid And 2. 14 Feb. 2019 Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients on The Wards. American Journal of Respiratory and Critical Care Medicine, 193, 1. 3. Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53 CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. American Journal of Respiratory and Critical Care Medicine, 195. 1. Jackson, P., & Khan, A. 14 Feb 2019 Phrase searching 15, 000 This method was pivotal (2015). Delirium in in searching all the critically ill documents with sedation patients. Critical care and delirium phrases clinics, 31(3), 589-603. 2. Traube, C., Silver, G., Reeder, R. W., Doyle, H., Hegel, E., Wolfe, H. A., … & Buttram, S. D. (2017). Pediatric delirium in critically-ill children: An international point prevalence study. Critical care medicine, 45(4), 584. Running head: OUTLINE Outline for my Intro-Methods Results Beni Costa NURS 6990- D02 Middle Tennessee State University February 19, 2019 2 OUTLINE Effect of Limited Sedation on Delirium Introduction ✓ Delirium is a primary adverse event in ventilated patients who receive long-term treatment. ✓ Too much sedation is associated with a longer duration of mechanical ventilation and a longer intensive care unit (ICU) stay. ✓ Limited sedation may reduce these adverse effects. ✓ Previous studies demonstrated that patients under mechanical ventilation exhibit a higher risk of experiencing delirium than non-mechanically ventilated patients. ✓ This study will evaluate risk factors for delirium in limited sedation patients Methods a. Patients ✓ In this planned study patients will be selected from a previous study ✓ Patients who underwent sequential sedation will be enrolled. b. Clinical Data. Patient demographic characteristics included age, gender, body mass index (BMI), allergic history, drinking and smoking stat us, and medical history, including the presence or absence of hypertension. c. Delirium Assessment. Discussion: Sedation drugs

The primary endpoint of this study will be the occurrence of delirium. d. Statistical Analysis. Statistical analyses were performed using SPSS Results 3 OUTLINE Table will be used to presents demographic data and baseline characteristics of patients with or without delirium. Data will be used to evaluate risk factors for delirium in sequential sedation patients ✓ Univariate and multivariate Cox proportional hazards regressions will be used to predict risk factors. ✓ Clinical data will include the use of sedative and analgesic medications, mechanical ventilation status, and sequential sedation characteristics. ✓ It will involve Delirium Assessment among the patients. ✓ The results of this study should demonstrate that sequential sedation with dexmedetomidine was a protective method to prevent delirium. ✓ Results should show that management strategies may sometimes require alteration to reduce the incidence and severity of delirium in sequential sedation patients. Conclusion: ✓ The results used demonstrated that limited sedation is a protective method to prevent delirium. ✓ Results should suggest that management strategies may sometimes require alteration to reduce the incidence and severity of delirium in sequential sedation patients. 4 OUTLINE References Djaiani, G., Silverton, N., Fedorko, L., Carroll, J., Styra, R., Rao, V., & Katznelson, R. (2016). Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery a randomized controlled trial. Anesthesiology: The Journal of the American Society of Anesthesiologists, 124(2), 362-368. Jackson, P., & Khan, A. (2015). Delirium in critically ill patients. Critical care clinics, 31(3), 589-603. Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53 CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. American Journal of Respiratory and Critical Care Medicine, 195. Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53 CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. American Journal of Respiratory and Critical Care Medicine, 195. Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). Discussion: Sedation drugs

C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients on The Wards. American Journal of Respiratory and Critical Care Medicine, 193, 1. 5 OUTLINE Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients On The Wards. American Journal of Respiratory and Critical Care Medicine, 193, 1. Salluh, J. I., Wang, H., Schneider, E. B., Nagaraja, N., Yenokyan, G., Damluji, A., … & Stevens, R. D. (2015). Outcome of delirium in critically ill patients: systematic review and meta-analysis. bmj, 350, h2538. Traube, C., Silver, G., Reeder, R. W., Doyle, H., Hegel, E., Wolfe, H. A., … & Buttram, S. D. (2017). Pediatric delirium in critically-ill children: An international point prevalence study. Critical care medicine, 45(4), 584. Vallabhajosyula, S., Kanmanthareddy, A., Morrow, L. E., & Esterbrooks, D. J. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: Role Of Statins in Delirium Prevention In Critically Ill And Cardiovascular Surgery Patients: A MetaAnalysis. American Journal of Respiratory and Critical Care Medicine, 193, 1. P I Population/Patient This is the “Who”. For this you need to think of age, sex, ethnic origins or other defining characteristics of the patient and the population Intervention This is also sometimes known as exposure and makes up the “What”. This is what is happening to the patient or population, so it could be a drug or a therapy, a screening questionnaire, or a health improvement program. C Comparison With what is the intervention being compared? This could be a control group. O Outcome What outcome do you expect to see?

For example, you may be interested in knowing whether an intervention has a health benefit, or whether an exposure results in mortality. When searching the literature, terms within a column should be combined with “OR” Columns should be combined with “AND” Potential Theoretical Framework for this PICO: Grading Rubric for Topic, PICO Question, and Theory GRADED ITEM POINTS POINTS AVAILABLE EARNED Topic • • • Relevance and justification (5 points) Related to nursing practice (5 points) Narrowness and specificity (5 points) 15 Underlying Theoretical Framework • • • Two possibilities have been identified (5 points) Related to nursing practice (5 points) Related to the research question (5 points) 15 PICO Question • • • All components present; follows PICO format (5 points) Addresses question you want to know about (5 points) Logical and makes sense (5 points) 15 Correct APA formatting, grammar, spelling, and punctuation (up to 10 points will be deducted for violations) Total 45 Late policy: All students are expected to turn in work on time. Late assignments will be penalized 10% per day (or any portion of the day) unless prior arrangements have been made with the instructor. … Discussion: Sedation drugs