Impact of restarting home neuropsychiatric medications on sedation outcomes in medical intensive care unit patients
This single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes. Subjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated befo...
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| Published in | Journal of critical care Vol. 43; pp. 102 - 107 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.02.2018
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0883-9441 1557-8615 1557-8615 |
| DOI | 10.1016/j.jcrc.2017.07.046 |
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| Abstract | This single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes.
Subjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated before or on arrival to the intensive care unit (ICU); and were on benzodiazepine-based sedation. The intervention assessed was the timing of the initiation of home NPMs: early (≤5days) vs. late (>5days) into the ICU stay.
There were 56 and 53 patients in the early and late restart groups, respectively. Early cohort patients maintained a median daily RASS of −1.5, while late cohort patients had a median daily RASS of −2.0 (p=0.02). The effect was driven by the subgroup of patients on home anti-depressant therapy who were restarted early on these agents. The early restart group had a higher percentage of days with RASS scores within goal (p=0.01) and less delirium (p=0.02). Early restarting of home NPMs was associated with a non-significant decrease in ventilator days compared with late restarting (p=0.11).
Restarting home NPMs was associated with lighter sedation levels and less delirium.
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| AbstractList | PurposeThis single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes.Materials and methodsSubjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated before or on arrival to the intensive care unit (ICU); and were on benzodiazepine-based sedation. The intervention assessed was the timing of the initiation of home NPMs: early (<=5days) vs. late (>5days) into the ICU stay.ResultsThere were 56 and 53 patients in the early and late restart groups, respectively. Early cohort patients maintained a median daily RASS of −1.5, while late cohort patients had a median daily RASS of −2.0 (p=0.02). The effect was driven by the subgroup of patients on home anti-depressant therapy who were restarted early on these agents. The early restart group had a higher percentage of days with RASS scores within goal (p=0.01) and less delirium (p=0.02). Early restarting of home NPMs was associated with a non-significant decrease in ventilator days compared with late restarting (p=0.11).ConclusionsRestarting home NPMs was associated with lighter sedation levels and less delirium. This single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes. Subjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated before or on arrival to the intensive care unit (ICU); and were on benzodiazepine-based sedation. The intervention assessed was the timing of the initiation of home NPMs: early (≤5days) vs. late (>5days) into the ICU stay. There were 56 and 53 patients in the early and late restart groups, respectively. Early cohort patients maintained a median daily RASS of −1.5, while late cohort patients had a median daily RASS of −2.0 (p=0.02). The effect was driven by the subgroup of patients on home anti-depressant therapy who were restarted early on these agents. The early restart group had a higher percentage of days with RASS scores within goal (p=0.01) and less delirium (p=0.02). Early restarting of home NPMs was associated with a non-significant decrease in ventilator days compared with late restarting (p=0.11). Restarting home NPMs was associated with lighter sedation levels and less delirium. [Display omitted] This single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes.PURPOSEThis single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes.Subjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated before or on arrival to the intensive care unit (ICU); and were on benzodiazepine-based sedation. The intervention assessed was the timing of the initiation of home NPMs: early (≤5days) vs. late (>5days) into the ICU stay.MATERIALS AND METHODSSubjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated before or on arrival to the intensive care unit (ICU); and were on benzodiazepine-based sedation. The intervention assessed was the timing of the initiation of home NPMs: early (≤5days) vs. late (>5days) into the ICU stay.There were 56 and 53 patients in the early and late restart groups, respectively. Early cohort patients maintained a median daily RASS of -1.5, while late cohort patients had a median daily RASS of -2.0 (p=0.02). The effect was driven by the subgroup of patients on home anti-depressant therapy who were restarted early on these agents. The early restart group had a higher percentage of days with RASS scores within goal (p=0.01) and less delirium (p=0.02). Early restarting of home NPMs was associated with a non-significant decrease in ventilator days compared with late restarting (p=0.11).RESULTSThere were 56 and 53 patients in the early and late restart groups, respectively. Early cohort patients maintained a median daily RASS of -1.5, while late cohort patients had a median daily RASS of -2.0 (p=0.02). The effect was driven by the subgroup of patients on home anti-depressant therapy who were restarted early on these agents. The early restart group had a higher percentage of days with RASS scores within goal (p=0.01) and less delirium (p=0.02). Early restarting of home NPMs was associated with a non-significant decrease in ventilator days compared with late restarting (p=0.11).Restarting home NPMs was associated with lighter sedation levels and less delirium.CONCLUSIONSRestarting home NPMs was associated with lighter sedation levels and less delirium. This single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes. Subjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated before or on arrival to the intensive care unit (ICU); and were on benzodiazepine-based sedation. The intervention assessed was the timing of the initiation of home NPMs: early (≤5days) vs. late (>5days) into the ICU stay. There were 56 and 53 patients in the early and late restart groups, respectively. Early cohort patients maintained a median daily RASS of -1.5, while late cohort patients had a median daily RASS of -2.0 (p=0.02). The effect was driven by the subgroup of patients on home anti-depressant therapy who were restarted early on these agents. The early restart group had a higher percentage of days with RASS scores within goal (p=0.01) and less delirium (p=0.02). Early restarting of home NPMs was associated with a non-significant decrease in ventilator days compared with late restarting (p=0.11). Restarting home NPMs was associated with lighter sedation levels and less delirium. |
| Author | La, Mary K. Thompson Bastin, Melissa L. Flannery, Alexander H. Gisewhite, Jenee T. Johnson, Carrie A. |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28865338$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Anesthesia Antidepressants Antipsychotics Benzodiazepines Discharge Gabapentinoids Intensive care Medication reconciliation Psychotropic drugs Sedation |
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| Title | Impact of restarting home neuropsychiatric medications on sedation outcomes in medical intensive care unit patients |
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