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Eduard E. Vasilevskis - One of the best experts on this subject based on the ideXlab platform.
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Validity of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-Sedation Scale.
Critical care medicine, 2016Co-Authors: Eduard E. Vasilevskis, E. Wesley Ely, Ayumi Shintani, Pratik P. Pandharipande, Amy J. Graves, Ryosuke Tsuruta, Timothy D. GirardAbstract:Objectives:The Sequential Organ Failure Assessment and other severity of illness Scales rely on the Glasgow Coma Scale to measure acute neurologic dysfunction, but the Glasgow Coma Scale is unavailable or inconsistently applied in some institutions. The objective of this study was to assess the vali
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The Diagnostic Performance of the Richmond Agitation Sedation Scale for Detecting Delirium in Older Emergency Department Patients
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2015Co-Authors: Jin H. Han, Ayumi Shintani, Eduard E. Vasilevskis, John F. Schnelle, Robert S. Dittus, Amanda Wilson, E. Wesley ElyAbstract:Objectives Delirium is frequently missed in older emergency department (ED) patients. Brief ( 0 or +1 or +1 or < –1 strongly increased the likelihood of delirium. The weighted kappa was 0.63, indicating moderate interobserver reliability. Conclusions In older ED patients, a RASS other than 0 has very good sensitivity and specificity for delirium as diagnosed by a psychiatrist. A RASS > +1 or < –1 is nearly diagnostic for delirium, given the very high positive likelihood ratio.
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Abstract 323: High Incidence of Delirium in Survivors of Cardiac Arrest Treated with Mild Therapeutic Hypothermia
Circulation, 2014Co-Authors: Jeremy S Pollock, Li Wang, Ryan D. Hollenbeck, Benjamin Holmes, Michael N Young, Eugene W. Ely, John A. Mcpherson, Eduard E. VasilevskisAbstract:Background: Mild therapeutic hypothermia (TH) is a recommended treatment for comatose patients resuscitated from cardiac arrest. To our knowledge, the incidence of delirium and its associated risk factors has not been assessed in survivors of cardiac arrest treated with TH. Methods: Retrospective analysis was performed on 251 consecutive comatose survivors of cardiac arrest treated with TH from 2007 to 2013 at Vanderbilt University Medical Center following sudden cardiac arrest. The incidence and duration of delirium were measured in patients who awoke from coma after cardiac arrest and survived to ICU discharge. Delirium evaluations began after TH (temp >36 degrees Celsius), and were performed at least daily using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU. A multivariable logistic regression analysis was performed to examine the effect of cardiac arrest and post-arrest management characteristics (prior to warming) on delirium duration. This model adjusted for a...
E. Wesley Ely - One of the best experts on this subject based on the ideXlab platform.
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Association of Hypoactive and Hyperactive Delirium With Cognitive Function After Critical Illness.
Critical care medicine, 2020Co-Authors: Christina J. Hayhurst, E. Wesley Ely, Annachiara Marra, Jin H. Han, Mayur B. Patel, Nathan E. Brummel, Jennifer L. Thompson, James C. Jackson, Rameela Chandrasekhar, Pratik P. PandharipandeAbstract:Objectives Delirium, a heterogenous syndrome, is associated with worse long-term cognition after critical illness. We sought to determine if duration of motoric subtypes of delirium are associated with worse cognition. Design Secondary analysis of prospective multicenter cohort study. Setting Academic, community, and Veteran Affairs hospitals. Patients Five-hundred eighty-two survivors of respiratory failure or shock. Interventions We assessed delirium and level of consciousness using the Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale daily during hospitalization. We defined a day with hypoactive delirium as a day with positive Confusion Assessment Method-ICU and corresponding Richmond Agitation Sedation Scale score less than or equal to 0 and a day with hyperactive delirium as a day with positive Confusion Assessment Method-ICU and corresponding Richmond Agitation Sedation Scale score greater than 0. At 3 and 12 months, we assessed global cognition with the Repeatable Battery for the Assessment of Neurologic Status and executive function with the Trail Making Test Part B. We used multivariable regression to examine the associations between days of hypoactive and hyperactive delirium with cognition outcomes. We allowed for interaction between days of hypoactive and hyperactive delirium and adjusted for baseline and in-hospital covariates. Measurements and results Hypoactive delirium was more common and persistent than hyperactive delirium (71% vs 17%; median 3 vs 1 d). Longer duration of hypoactive delirium was associated with worse global cognition at 3 (-5.13 [-8.75 to -1.51]; p = 0.03) but not 12 (-5.76 [-9.99 to -1.53]; p = 0.08) months and with worse executive functioning at 3 (-3.61 [-7.48 to 0.26]; p = 0.03) and 12 (-6.22 [-10.12 to -2.33]; p = 0.004) months; these associations were not modified by hyperactive delirium. Hyperactive delirium was not associated with global cognition or executive function in this cohort. Conclusions Longer duration of hypoactive delirium was independently associated with worse long-term cognition. Assessing motoric subtypes of delirium in the ICU might aid in prognosis and intervention allocation. Future studies should consider delineating motoric subtypes of delirium.
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Validity of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-Sedation Scale.
Critical care medicine, 2016Co-Authors: Eduard E. Vasilevskis, E. Wesley Ely, Ayumi Shintani, Pratik P. Pandharipande, Amy J. Graves, Ryosuke Tsuruta, Timothy D. GirardAbstract:Objectives:The Sequential Organ Failure Assessment and other severity of illness Scales rely on the Glasgow Coma Scale to measure acute neurologic dysfunction, but the Glasgow Coma Scale is unavailable or inconsistently applied in some institutions. The objective of this study was to assess the vali
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The Diagnostic Performance of the Richmond Agitation Sedation Scale for Detecting Delirium in Older Emergency Department Patients
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2015Co-Authors: Jin H. Han, Ayumi Shintani, Eduard E. Vasilevskis, John F. Schnelle, Robert S. Dittus, Amanda Wilson, E. Wesley ElyAbstract:Objectives Delirium is frequently missed in older emergency department (ED) patients. Brief ( 0 or +1 or +1 or < –1 strongly increased the likelihood of delirium. The weighted kappa was 0.63, indicating moderate interobserver reliability. Conclusions In older ED patients, a RASS other than 0 has very good sensitivity and specificity for delirium as diagnosed by a psychiatrist. A RASS > +1 or < –1 is nearly diagnostic for delirium, given the very high positive likelihood ratio.
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Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS).
JAMA, 2003Co-Authors: E. Wesley Ely, Brenda Truman, Ayumi Shintani, Jason W. W. Thomason, Arthur P. Wheeler, Sharon M. Gordon, Joseph Francis, Theodore Speroff, Shiva Gautam, Richard MargolinAbstract:ContextGoal-directed delivery of sedative and analgesic medications is recommended as standard care in intensive care units (ICUs) because of the impact these medications have on ventilator weaning and ICU length of stay, but few of the available sedation Scales have been appropriately tested for reliability and validity.ObjectiveTo test the reliability and validity of the Richmond Agitation-Sedation Scale (RASS).DesignProspective cohort study.SettingAdult medical and coronary ICUs of a university-based medical center.ParticipantsThirty-eight medical ICU patients enrolled for reliability testing (46% receiving mechanical ventilation) from July 21, 1999, to September 7, 1999, and an independent cohort of 275 patients receiving mechanical ventilation were enrolled for validity testing from February 1, 2000, to May 3, 2001.Main Outcome MeasuresInterrater reliability of the RASS, Glasgow Coma Scale (GCS), and Ramsay Scale (RS); validity of the RASS correlated with reference standard ratings, assessments of content of consciousness, GCS scores, doses of sedatives and analgesics, and bispectral electroencephalography.ResultsIn 290-paired observations by nurses, results of both the RASS and RS demonstrated excellent interrater reliability (weighted κ, 0.91 and 0.94, respectively), which were both superior to the GCS (weighted κ, 0.64; P
Timothy D. Girard - One of the best experts on this subject based on the ideXlab platform.
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Validity of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-Sedation Scale.
Critical care medicine, 2016Co-Authors: Eduard E. Vasilevskis, E. Wesley Ely, Ayumi Shintani, Pratik P. Pandharipande, Amy J. Graves, Ryosuke Tsuruta, Timothy D. GirardAbstract:Objectives:The Sequential Organ Failure Assessment and other severity of illness Scales rely on the Glasgow Coma Scale to measure acute neurologic dysfunction, but the Glasgow Coma Scale is unavailable or inconsistently applied in some institutions. The objective of this study was to assess the vali
Scott K. Epstein - One of the best experts on this subject based on the ideXlab platform.
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Observational study of patient-ventilator asynchrony and relationship to sedation level.
Journal of critical care, 2009Co-Authors: Marjolein De Wit, Sammy Pedram, Al M. Best, Scott K. EpsteinAbstract:Abstract Purpose Clinicians frequently administer sedation to facilitate mechanical ventilation. The purpose of this study was to examine the relationship between sedation level and patient-ventilator asynchrony. Materials and Methods Airway pressure and airflow were recorded for 15 minutes. Patient-ventilator asynchrony was assessed by determining the number of breaths demonstrating ineffective triggering, double triggering, short cycling, and prolonged cycling. Ineffective triggering index (ITI) was calculated by dividing the number of ineffectively triggered breaths by the total number of breaths (triggered and ineffectively triggered). Sedation level was assessed by the following 3 methods: Richmond Agitation-Sedation Scale (RASS), awake (yes or no), and delirium (Confusion Assessment Method for the intensive care unit [CAM-ICU]). Results Twenty medical ICU patients underwent 35 observations. Ineffective triggering was seen in 17 of 20 patients and was the most frequent asynchrony (88% of all asynchronous breaths), being observed in 9% ± 12% of breaths. Deeper levels of sedation were associated with increasing ITI (awake, yes 2% vs no 11%; P P P Conclusions Asynchrony is common, and deeper sedation level is a predictor of ineffective triggering.
Pratik P. Pandharipande - One of the best experts on this subject based on the ideXlab platform.
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Association of Hypoactive and Hyperactive Delirium With Cognitive Function After Critical Illness.
Critical care medicine, 2020Co-Authors: Christina J. Hayhurst, E. Wesley Ely, Annachiara Marra, Jin H. Han, Mayur B. Patel, Nathan E. Brummel, Jennifer L. Thompson, James C. Jackson, Rameela Chandrasekhar, Pratik P. PandharipandeAbstract:Objectives Delirium, a heterogenous syndrome, is associated with worse long-term cognition after critical illness. We sought to determine if duration of motoric subtypes of delirium are associated with worse cognition. Design Secondary analysis of prospective multicenter cohort study. Setting Academic, community, and Veteran Affairs hospitals. Patients Five-hundred eighty-two survivors of respiratory failure or shock. Interventions We assessed delirium and level of consciousness using the Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale daily during hospitalization. We defined a day with hypoactive delirium as a day with positive Confusion Assessment Method-ICU and corresponding Richmond Agitation Sedation Scale score less than or equal to 0 and a day with hyperactive delirium as a day with positive Confusion Assessment Method-ICU and corresponding Richmond Agitation Sedation Scale score greater than 0. At 3 and 12 months, we assessed global cognition with the Repeatable Battery for the Assessment of Neurologic Status and executive function with the Trail Making Test Part B. We used multivariable regression to examine the associations between days of hypoactive and hyperactive delirium with cognition outcomes. We allowed for interaction between days of hypoactive and hyperactive delirium and adjusted for baseline and in-hospital covariates. Measurements and results Hypoactive delirium was more common and persistent than hyperactive delirium (71% vs 17%; median 3 vs 1 d). Longer duration of hypoactive delirium was associated with worse global cognition at 3 (-5.13 [-8.75 to -1.51]; p = 0.03) but not 12 (-5.76 [-9.99 to -1.53]; p = 0.08) months and with worse executive functioning at 3 (-3.61 [-7.48 to 0.26]; p = 0.03) and 12 (-6.22 [-10.12 to -2.33]; p = 0.004) months; these associations were not modified by hyperactive delirium. Hyperactive delirium was not associated with global cognition or executive function in this cohort. Conclusions Longer duration of hypoactive delirium was independently associated with worse long-term cognition. Assessing motoric subtypes of delirium in the ICU might aid in prognosis and intervention allocation. Future studies should consider delineating motoric subtypes of delirium.
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Validity of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-Sedation Scale.
Critical care medicine, 2016Co-Authors: Eduard E. Vasilevskis, E. Wesley Ely, Ayumi Shintani, Pratik P. Pandharipande, Amy J. Graves, Ryosuke Tsuruta, Timothy D. GirardAbstract:Objectives:The Sequential Organ Failure Assessment and other severity of illness Scales rely on the Glasgow Coma Scale to measure acute neurologic dysfunction, but the Glasgow Coma Scale is unavailable or inconsistently applied in some institutions. The objective of this study was to assess the vali
