Article
Medicine, Research & Experimental
Xiaoming Huang, Lei Lei, Shuai Zhang, Jinrong Yang, Lin Yang, Min Xu
Summary: The implementation of the ABCDE bundle in the pediatric intensive care unit (PICU) in southwestern China is insufficient. Existing problems need to be identified and a standardized sedation and analgesia management model needs to be established.
JOURNAL OF INTERNATIONAL MEDICAL RESEARCH
(2021)
Article
Critical Care Medicine
Brenda T. Pun, Jin Jun, Alai Tan, Diane Byrum, Lorraine Mion, Eduard E. Vasilevskis, E. Wesley Ely, Michele Balas
Summary: This study investigated the perceptions of ICU team members on teamwork and work environment, showing that most people rated teamwork and work environment positively but there is room for improvement, especially in care coordination and meaningful recognition.
AMERICAN JOURNAL OF CRITICAL CARE
(2022)
Review
Critical Care Medicine
Matthew F. Mart, Shawniqua Williams Roberson, Barbara Salas, Pratik P. Pandharipande, E. Wesley Ely
Summary: Delirium, a severe form of brain dysfunction commonly seen in ICU patients, is no longer recommended for routine treatment with antipsychotic medications. Nonpharmacologic interventions, such as the ABCDEF bundle, have shown to be effective in reducing the likelihood of delirium development and the necessity for mechanical ventilation. Further research is needed to better understand the pathobiology of ICU delirium and explore additional potential treatments beyond drugs and rehabilitation.
SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE
(2021)
Review
Critical Care Medicine
Kirstine N. la Cour, Nina C. Andersen-Ranberg, Sarah Weihe, Lone M. Poulsen, Camilla B. Mortensen, Cilia K. W. Kjer, Marie O. Collet, Stine Estrup, Ole Mathiesen
Summary: Hypoactive delirium is the most common motor subtype in critically ill patients. Mixed delirium has the worst outcomes and receives more pharmacological interventions compared to other subtypes. Standardization in delirium research is needed.
Article
Nursing
Gina Rohlik, A. Jeanne Pfeiffer, Christine E. Collins, Connie R. Parrett, Yu Kawai
Summary: Nursing education and feedback can increase delirium assessment rates and confidence in management, but the impact of BED on these outcomes is not clear. Improvement in pediatric delirium care may be obtained through a nurse-driven quality improvement project, but an interprofessional approach is needed for optimal management.
JOURNAL OF PEDIATRIC NURSING-NURSING CARE OF CHILDREN & FAMILIES
(2021)
Article
Critical Care Medicine
Eileen Kim, Charles Kast, Anika Afroz-Hossain, Michael Qiu, Karalyn Pappas, Liron Sinvani
Summary: The study identified common issues in early ICU aftercare such as delirium, debility, and dysphagia, while common practices included bed rest, dietary restrictions, and lack of advance directive documentation. Future studies are needed to further characterize and address early ICU aftercare.
AMERICAN JOURNAL OF CRITICAL CARE
(2021)
Article
Pediatrics
Matteo Di Nardo, Francesca Boldrini, Francesca Broccati, Federica Cancani, Tiziana Satta, Francesca Stoppa, Leonardo Genuini, Giorgio Zampini, Salvatore Perdichizzi, Gabriella Bottari, Maximilian Fischer, Orsola Gawronski, Annamaria Bonetti, Irene Piermarini, Veronica Recchiuti, Paola Leone, Angela Rossi, Paola Tabarini, Daniele Biasucci, Alberto Villani, Massimiliano Raponi, Corrado Cecchetti, Karen Choong
Summary: The study aimed to evaluate the feasibility and safety of implementing a PICU bundle prioritizing delirium screening, early mobilization, and benzodiazepine-limited sedation in a human resource-limited setting. Results showed that the implementation was feasible and safe, with improvements in delirium incidence, sedation practices, and mobilization efforts. Further studies are needed to assess the long-term impact on patients' outcomes and hospital finances.
FRONTIERS IN PEDIATRICS
(2021)
Article
Anesthesiology
Elzbieta Dulko, Michal Jedrusiak, Hari P. Osuru, Navya Atluri, Meghana Illendula, Eric M. Davis, Mark P. Beenhakker, Nadia Lunardi
Summary: In this study, an animal model was used to investigate the effects of Anesthesia, Surgery, and simulated ICU conditions (ASI) on sleep fragmentation, EEG slowing, and circadian disarray in aged mice. The results showed that ASI mice experienced frequent arousals, EEG slowing, and disrupted circadian gene expression, similar to delirious ICU patients. These findings suggest that the mouse model can be used to study the neurobiology of delirium.
ANESTHESIA AND ANALGESIA
(2023)
Article
Respiratory System
Griffin H. Olsen, Perry M. Gee, Doug Wolfe, Carrie Winberg, Lori Carpenter, Chris Jones, Jason R. Jacobs, Lindsay Leither, Ithan D. Peltan, Sara J. Singer, Steven M. Asch, Colin K. Grissom, Rajendu Srivastava, Andrew J. Knighton
Summary: This study examined the variation in routine daily use of coordinated spontaneous awakening and breathing trials (SAT/SBT) across 15 intensive care units (ICUs) within an integrated, community-based health system. The study identified implementation determinants, including knowledge deficits, challenges in workflow coordination, and the lack of performance measurement. Implementation strategies addressing these barriers should be tested in future trials to increase adherence to daily use of coordinated SAT/SBT and minimize harm related to prolonged mechanical ventilation and sedation.
ANNALS OF THE AMERICAN THORACIC SOCIETY
(2023)
Article
Pediatrics
Joerg Michel, Elena Schepan, Michael Hofbeck, Juliane Engel, Alexander Simma, Felix Neunhoeffer
Summary: The study found that a non-pharmacological delirium bundle may help reduce the incidence of pediatric delirium, particularly in young patients and those who have undergone surgery for congenital heart disease. Young age, length of stay in the pediatric intensive care unit, and iatrogenic withdrawal syndrome were identified as risk factors for delirium.
FRONTIERS IN PEDIATRICS
(2022)
Article
Cardiac & Cardiovascular Systems
Sung Eun Kim, Ryoung-Eun Ko, Soo Jin Na, Chi Ryang Chung, Ki Hong Choi, Darae Kim, Taek Kyu Park, Joo Myung Lee, Young Bin Song, Jin-Oh Choi, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Jeong Hoon Yang
Summary: This study externally validated the usefulness of two delirium prediction models, PRE-DELIRIC and E-PRE-DELIRIC, in the cardiac intensive care unit (CICU). The results showed that the PRE-DELIRIC model may have superior predictive performance compared to the E-PRE-DELIRIC model. Further studies are needed to design a specific delirium prediction model for CICU patients.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Clinical Neurology
Sophia Wang, Anthony J. Perkins, Rosalyn Chi, Brandon A. Yates, Sikandar H. Khan, Sujuan Gao, Malaz Boustani, Babar A. Khan
Summary: A secondary data analysis of ICU patients revealed that stroke and depression were identified as risk factors for post-ICU dementia, highlighting the need for interventions targeting these factors to reduce dementia incidence.
ALZHEIMERS & DEMENTIA
(2023)
Article
Nursing
Alessandra Negro, Stefano Bambi, Matteo De Vecchi, Pietro Isotti, Giulia Villa, Lucia Miconi, Mauro Dossi, Giuseppe Ponzetta, Luigi Rinaldi, Chiara Radaelli, Cristina Caballo, Carlo Leggieri, Sergio Colombo, Luca Cabrini, Duilio F. Manara, Alberto Zangrillo
Summary: The study revealed that healthcare teams in an intensive care unit in Italy had a good understanding of the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle, but the lack of coordination among healthcare professionals was identified as a barrier.
INTERNATIONAL JOURNAL OF NURSING PRACTICE
(2022)
Article
Anesthesiology
Marianna Desantis, Christoph Lichtenstern, Jan-Paul Hagenlocher, Thomas Bruckner, Markus A. Weigand, Armin Kalenka, Mascha O. Fiedler
Summary: This study investigates the impact of implementing a SAT/SBT protocol on the weaning process in surgical ICU patients. The results show that after implementing the protocol, the rate of successful extubation increased. Therefore, adopting a SAT/SBT protocol may improve the success rate of extubation for surgical patients.
MINERVA ANESTESIOLOGICA
(2023)
Article
Infectious Diseases
Rafael Dias, Joao Paulo Caldas, Andre Silva-Pinto, Andreia Costa, Antonio Sarmento, Lurdes Santos
Summary: This study found that there is no association between COVID-19 and a higher prevalence or duration of delirium compared to patients without COVID-19. However, COVID-19 is associated with more severe forms of delirium.
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
(2022)
Article
Surgery
Shayan Rakhit, Li Wang, Christopher J. Lindsell, Morgan A. Hosay, James W. Stewart, Gary D. Owen, Fernando Frutos-Vivar, Oscar Penuelas, Andres Esteban, Antonio R. Anzueto, Konstantinos Raymondos, Fernando Rios, Arnaud W. Thille, Marco Gonzalez, Bin Du, Salvatore M. Maggiore, Dimitrios Matamis, Fekri Abroug, Pravin Amin, Amine A. Zeggwagh, E. Wesley Ely, Eduard E. Vasilevskis, Mayur B. Patel
Summary: The study validated the first modification of SOFA using RASS in an international cohort and demonstrated its effectiveness in predicting ICU mortality. Other predictors of mortality included age, sex, medical status, and region.
Article
Geriatrics & Gerontology
Avantika Saraf Shah, Emily Kay Hollingsworth, Matthew Stephen Shotwell, Amanda S. Mixon, Sandra Faye Simmons, Eduard Eric Vasilevskis
Summary: A multipronged approach was used to obtain the best possible medication history (BPMH) for hospitalized older adults, revealing high prevalence of medication discrepancies in the study cohort. Factors such as lower age, greater prehospital medication count, and admission from assisted living or skilled nursing facility were significantly associated with greater medication discrepancies. These findings highlight the importance of addressing medication discrepancies prior to hospital discharge in order to support safe prescribing practices for multimorbid older adults.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2022)
Article
Geriatrics & Gerontology
Laura M. Keohane, Matthew F. Mart, E. Wesley Ely, Pikki Lai, Audrey Cheng, Anil N. Makam, David G. Stevenson
Summary: As Tennessee implemented policies to promote ventilator liberation in nursing homes, ventilator-related service use moderately declined, with fewer patients discharged home and more discharged to nursing homes. Ventilator liberation rates initially increased but then declined, with a decrease in the median number of days from admission to weaning.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2022)
Article
Gerontology
Emily Kay Hollingsworth, Avantika Saraf Shah, Matthew Stephen Shotwell, Sandra Faye Simmons, Eduard Eric Vasilevskis
Summary: This study investigated the attitudes toward deprescribing among hospitalized older patients transitioning to post-acute care in the United States. The majority of participants were willing to deprescribe if their physician agreed. Only 61% believed that all of their medications were necessary. Patients and surrogates had differing perceptions of medication appropriateness.
JOURNAL OF APPLIED GERONTOLOGY
(2022)
Editorial Material
Medical Ethics
Eugene Wesley Ely
Summary: As a physician, the author shares his struggle with feeling distant from the Lord in his interactions with patients and families. He tends to focus on big events and overlook the impact of small encounters. Through a seemingly mundane patient interaction, the author learns that God's grace knows no limits and makes the impossible possible.
Letter
Surgery
E. Wesley Ely
AMERICAN JOURNAL OF TRANSPLANTATION
(2022)
Article
Health Care Sciences & Services
Eugene Wesley Ely
Summary: We built a strong friendship through our encounters in academic medicine. Friendship holds immense value in my life and is an unearned grace. I learned from Dr. Curtis that illness is a mere transformation of love.
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
(2022)
Article
Geriatrics & Gerontology
Elizabeth A. Bayliss, Kathleen Albers, Kathy Gleason, Lisa E. Pieper, Cynthia M. Boyd, Noll L. Campbell, Kristine E. Ensrud, Shelly L. Gray, Amy M. Linsky, Derelie Mangin, Lillian Min, Michael W. Rich, Michael A. Steinman, Justin Turner, Eduard E. Vasilevskis, Sascha Dublin
Summary: Interpreting and generating actionable evidence from deprescribing interventions is challenging due to inconsistent and heterogeneous outcome definitions. A scoping review and expert panel discussions were conducted to characterize deprescribing intervention outcomes and recommend measurement approaches. The review identified common outcomes such as medication discontinuation, medication appropriateness, and a range of clinical outcomes. Recommendations included defining meaningful medication outcomes, ensuring adequate sample size and follow-up time, and selecting appropriate data sources. Further development is needed for implementation outcomes and measures of adverse drug withdrawal events.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2022)
Article
Medicine, General & Internal
Edward Tang Qian, Cheryl L. Gatto, Olga Amusina, Mary Lynn Dear, William Hiser, Reagan Buie, Sunil Kripalani, Frank E. Harrell, Robert E. Freundlich, Yue Gao, Wu Gong, Cassandra Hennessy, Jillann Grooms, Megan Mattingly, Shashi K. Bellam, Jessica Burke, Arwa Zakaria, Eduard E. Vasilevskis, Frederic T. Billings, Jill M. Pulley, Gordon R. Bernard, Christopher J. Lindsell, Todd W. Rice
Summary: Awake prone positioning does not provide clinical benefit for COVID-19 patients with hypoxemia who have not received mechanical ventilation. There is even evidence suggesting potential harm from the awake prone positioning intervention.
JAMA INTERNAL MEDICINE
(2022)
Article
Medicine, General & Internal
Kevin G. Buell, Muhammad H. Hayat, David W. Walsh, Kathleene T. Wooldridge, Eduard E. Vasilevskis, Lawrence T. Heller
Summary: This study describes the design, implementation, and ongoing oversight of a Medical Procedure Services (MPS) at a large tertiary academic hospital, and reports the procedural outcomes. The results show that procedures performed by supervised residents have high success rates and comparable safety to those performed by attending physicians.
JOURNAL OF HOSPITAL MEDICINE
(2022)
Article
Gerontology
Jennifer L. Kim, Kanah M. Lewallen, Emily K. Hollingsworth, Avantika S. Shah, Sandra F. Simmons, Eduard E. Vasilevskis
Summary: This study assessed barriers and enablers to patient decision making in deprescribing and found that appropriateness of a medication was the most common factor influencing deprescribing.
Editorial Material
Pharmacology & Pharmacy
Kristina M. Niehoff, Joseph Muscarella, Molly Knostman, Mark Sullivan, Amanda Gani, Henry Lim, Andrea R. Calhoun, Brett T. Young, Eduard E. Vasilevskis, Amanda S. Mixon, Neesha N. Choma, Kerry G. Gillihan, Anna L. Sachs, Catherine Ivory, Cathy A. Maxwell, Deonni P. Stolldorf, Tara B. Horr, Sunil Kripalani
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY
(2022)
Letter
Medical Ethics
Jason T. Eberl, E. Wesley Ely, Rev. John J. Raphael
Editorial Material
Critical Care Medicine
Antonio Paulo Nassar, Eugene Wesley Ely, Kirsten M. Fiest
INTENSIVE CARE MEDICINE
(2023)
Article
Geriatrics & Gerontology
Dae Hyun Kim, Hemin Lee, Ajinkya Pawar, Su Been Lee, Chan Mi Park, Raisa Levin, Eran Metzger, Brian T. Bateman, E. Wesley Ely, Pratik P. Pandharipande, Margaret A. Pisani, Samuel F. Hohmann, Edward R. Marcantonio, Sharon K. Inouye
Summary: Professional society guidelines recommend limiting the use of antipsychotics in older patients with postoperative delirium. This retrospective cohort study examined the use of antipsychotics and other psychoactive drugs in the postoperative period in older patients. The study found that the use of haloperidol and benzodiazepines declined, while the use of other psychoactive drugs increased.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2023)