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Introduction: The use of sedation in intensive care units (ICUs) is necessary and ubiquitous. The impact of sedation strategy on outcome, particularly when delivered early after initiation of mechanical ventilation, is unknown. Evidence is increasing that volatile anaesthetic agents could be associated with better outcome. Their use in delirium prevention is unknown.
Methods And Analysis: This study is an investigator-initiated, prospective, multicentre, two-arm, randomised, control, open-trial comparing inhaled sedation strategy versus intravenous sedation strategy in mechanically ventilated patients in ICU. Two hundred and fifty patients will be randomly assigned to the intravenous sedation group or inhaled sedation group, with a 1:1 ratio in two groups according to the sedation strategy. The primary outcome is the occurrence of delirium assessed using two times a day confusion assessment method for the ICU (CAM-ICU). Secondary outcomes include cognitive and functional outcomes at 3 and 12 months.
Ethics And Dissemination: The study has been approved by the Regional Ethics Committee (CPP Ouest) and national authorities (ANSM). The results will be submitted for publication in peer-reviewed journals.
Trial Registration Number: NCT04341350.
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http://dx.doi.org/10.1136/bmjopen-2020-042284 | DOI Listing |
Respir Care
September 2025
Dr. Thomasian and Prof. Wunsch are affiliated with Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA.
Negative-pressure ventilation (NPV) is a form of noninvasive respiratory support in which an external subatmospheric pressure is applied to the thorax to facilitate lung expansion. Although largely supplanted by positive-pressure ventilation (PPV) in modern-day practice, NPV has garnered renewed interest as a potential noninvasive adjunct or alternative to PPV. Appropriate patient selection would be key, particularly in the ICU setting, where NPV is generally contraindicated in patients with severe upper airway obstruction, high oxygenation requirements, or absent airway reflexes.
View Article and Find Full Text PDFMalignant hyperthermia is a rare, life-threatening hypermetabolic reaction that can strike unexpectedly in the emergency department, demanding swift recognition and intervention to save lives. This syndrome can be fatal if not treated and occurrs in 1 in 100,000 adults and 1 in 30,000 children, with a 3% to 5% mortality rate. Although often associated with perioperative environments, malignant hyperthermia should remain on the radar for emergency nurses, especially when patients exhibit sudden hyperthermia, muscle rigidity, and tachycardia after intubation or procedural sedation.
View Article and Find Full Text PDFNed Tijdschr Geneeskd
September 2025
LUMC, Leiden, afd. Psychiatrie.
Agitated patients present a challenge in clinical practice. Management strategies vary depending on severity, ranging from (non-)verbal de-escalation to pharmacological sedation. This article outlines a stepwise approach to treating agitation, distinguishing between mild, moderate, and extreme agitation.
View Article and Find Full Text PDFAm J Psychiatry
September 2025
School of Psychology, Faculty of Science, University of Sydney, and Australia Brain and Mind Centre, University of Sydney, Sydney, Australia.
Objective: The objective of this study was to comprehensively examine the real-world safety of esketamine using 58 months of postapproval data in the United States.
Methods: U.S.
Ann Afr Med
September 2025
Department of Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Introduction: Delirium, a common acute brain dysfunction in older adults, features rapid changes in attention, awareness, and thinking that fluctuate. It presents diversely with altered activity levels and sleep. Postoperative delirium (POD), often seen in the postanesthesia care unit, is a temporary mental status change, with hypoactivity being common.
View Article and Find Full Text PDF