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Severe agitation among ventilated medical intensive care unit patients: frequency, characteristics and outcomes
Abstract
Objective To determine the frequency, characteristics and outcomes of severe agitation among ventilated medical intensive care unit (MICU) patients.Design Prospective cohort study.Setting Eighteen-bed MICU in 964-bed tertiary care center.Patients All ventilated patients, aged 18 years or older and admitted for more than 24 h between January 1, 2001 and May 8, 2001.Interventions None.Measurements Data were collected daily by concurrent chart abstractions. Variables included sociodemographic, clinical, laboratory, pharmacologic and non-pharmacologic interventions, ventilator settings and adverse events. Severe agitation, the main outcome variable, was defined as two or more Motor Activity Assessment Scale (MAAS) scores above 4 in a 24-h period and sedative and/or narcotic doses above the established sedation and analgesia protocol or a combination of two or more sedatives.Results Twenty-three (16.1%) of 143 enrolled patients exhibited severe agitation. Agitated patients were younger (hazard ratio [HR] 1.32), more likely to be admitted from an outside hospital ICU (HR 2.48), had lower pH (HR 1.55) and PaO(2)/FIO(2) less than 200 mmHg (HR 2.59). Agitated patients had longer MICU stays (median 12 versus 5 days, p<0.0001) and more ventilator days (median 14 versus 6, p<0.0001). Agitated patients were more likely to self-extubate (26% versus 6%, p=0.002). Benzodiazepines, narcotics and neuromuscular blocking agents were administered more frequently and at higher doses, but haloperidol was not.Conclusion Severe agitation occurs commonly in critically ill patients and is associated with adverse events including longer ICU stays, duration of mechanical ventilation and self-extubation.
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“Behavioral disorders such as delirium and agitation in the critically ill occur with a high frequency, ranging from 15% to 80% of patients, and have been associated with increased morbidity and risk of mortality [7-13].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [13]
In the citing paper
“Behavioral disorders such as delirium and agitation in the critically ill occur with a high frequency, ranging from 15% to 80% of patients, and have been associated with increased morbidity and risk of mortality [7-13].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [13]
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“the 42% incidence of agitation in this study is in agreement with those previously reported in critically ill patients [13,26-28].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [13]
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“Patients with agitation were, however, more likely to be given supplemental sedative and analgesic agents or physical restraints to prevent self-inflicted injuries and thus treatment interference [13,27,28].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [13]
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“In our study, smoking abstinence, even in patients with weak tobacco dependency, was associated with agitation and then self-removal of catheters and tubes, as already reported [13,26,28].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [13]
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“Among these publications that focused on agitation in the ICU setting, only one included smoking status as a variable of interest [13], which was, however, not identified as a risk factor for agitation.”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [13]
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Metadata
- Authors
- Woods, J. C., Mion, L. C., Connor, J. T., Viray, F., Jahan, L., Huber, C., McHugh, R., Gonzales, J. P., Stoller, J. K., & Arroliga, A. C.
- Affiliations
- Huron Hospital (US)
- MetroHealth Medical Center (US)
- Cleveland Clinic (US)
- Corresponding author
- Arroliga, Alejandro C.
- Venue
- Intensive Care Medicine
- Published
- 2004-02-14
- Volume
- 30
- Issue
- 6
- Pages
- 1066-1072
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- OpenAlex
- W2081972845
- Cited by
- 142
- References
- 44
- Citations by year
- 2025: 7 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 9 · 2015: 9 · 2014: 11 · 2013: 12 · 2012: 7
- FWCI
- 7.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Intensive Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- mechanical ventilation, medical intensive care unit, critically ill patients, sedation, benzodiazepines, haloperidol, neuromuscular blocking agents, self-extubation, ICU length of stay, mechanical ventilation duration, adverse events
- MeSH terms
- Adult, Aged, Central Nervous System Depressants, Female, Humans, Intensive Care Units, Male, Middle Aged, Ohio, Prospective Studies, Psychomotor Agitation, Respiration, Artificial, Risk Factors, Multivariate Analysis, Proportional Hazards Models, Treatment Outcome
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