The DOI matches its Crossref record; 44 of the 44 references it cites were found in a registry or an index.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“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]
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]
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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1985) · Critical Care Medicine · doi:10.1097/00003246-198510000-00009 · Cited by 15,518
APACHE II-A Severity of Disease Classification System
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1986) · Critical Care Medicine · doi:10.1097/00003246-198608000-00028 · Cited by 13,379
Modeling Survival Data: Extending the Cox Model
Therneau, T. M., & Grambsch, P. M. (2000) · Statistics for Biology and Health · doi:10.1007/978-1-4757-3294-8 · Cited by 8,674
Bernard, G. R., Artigas, A., Brigham, K. L., Carlet, J., Falke, K., Hudson, L., Lamy, M., Legall, J. R., Morris, A., & Spragg, R. (1994) · American journal of respiratory and critical care medicine · doi:10.1164/ajrccm.149.3.7509706 · Cited by 6,746
APACHE II: a severity of disease classification system.
Knaus, W. A., Draper, E. S., Wagner, D. P., & Zimmerman, J. E. (1985) · PubMed · Cited by 6,034
Ely, E. W., Inouye, S. K., Bernard, G. R., Gordon, S., Francis, J., May, L., Truman, B., Speroff, T., Gautam, S., Margolin, R., et al. (2001) · JAMA · doi:10.1001/jama.286.21.2703 · Cited by 3,210
Kress, J. P., Pohlman, A. S., O’Connor, M. F., & Hall, J. B. (2000) · New England Journal of Medicine · doi:10.1056/nejm200005183422002 · Cited by 2,971
Jacobi, J., Fraser, G. L., Coursin, D. B., Riker, R. R., Fontaine, D. K., Wittbrodt, E. T., Chalfin, D. B., Masica, M. F., Bjerke, H. S., Coplin, W. M., et al. (2002) · Critical Care Medicine · doi:10.1097/00003246-200201000-00020 · Cited by 1,876
Intensive Care Delirium Screening Checklist: evaluation of a new screening tool
Bergeron, N., Dubois, M.-J., Dumont, M., Dial, S., & Skrobik, Y. (2001) · Intensive Care Medicine · doi:10.1007/s001340100909 · Cited by 1,487
Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support
MacIntyre, N. R. (2001) · CHEST Journal · doi:10.1378/chest.120.6_suppl.375s · Cited by 1,245
The impact of delirium in the intensive care unit on hospital length of stay
Ely, E. W., Gautam, S., Margolin, R. A., Francis, J., May, L., Speroff, T., Truman, B., Dittus, R. S., Bernard, G. R., & Inouye, S. K. (2001) · Intensive Care Medicine · doi:10.1007/s00134-001-1132-2 · Cited by 1,032
Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation
Brook, A. D., Ahrens, T. S., Schaiff, R., Prentice, D., Sherman, G., Shannon, W. D., & Kollef, M. H. (1999) · Critical Care Medicine · doi:10.1097/00003246-199912000-00001 · Cited by 1,009
The Use of Continuous IV Sedation Is Associated With Prolongation of Mechanical Ventilation
Kollef, M. H., Levy, N. T., Ahrens, T. S., Schaiff, R., Prentice, D., & Sherman, G. (1998) · CHEST Journal · doi:10.1378/chest.114.2.541 · Cited by 916
A Prospective Study of Delirium in Hospitalized Elderly
Francis, J. (1990) · JAMA · doi:10.1001/jama.1990.03440080075027 · Cited by 900
Nurses' Recognition of Delirium and Its Symptoms
Inouye, S. K. (2001) · Archives of Internal Medicine · doi:10.1001/archinte.161.20.2467 · Cited by 774
Murray, M. J., DeBlock, H. F., Erstad, B. L., Gray, A. W., Jacobi, J., Jordan, C. J., McGee, W. T., McManus, C., Meade, M. O., Nix, S. A., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000002027 · Cited by 524
Shapiro, B. A., Warren, J., Egol, A. B., Greenbaum, D. M., Jacobi, J., Nasraway, S. A., Schein, R. M. H., Spevetz, A., & Stone, J. R. (1995) · Critical Care Medicine · doi:10.1097/00003246-199509000-00021 · Cited by 393
Sedation in the Intensive Care Unit
Ostermann, M., Keenan, S., Seiferling, R. A., & Sibbald, W. J. (2000) · JAMA · doi:10.1001/jama.283.11.1451 · Cited by 389
Devlin, J. W., Boleski, G., Mlynarek, M., Nerenz, D. R., Peterson, E., Jankowski, M., Horst, H. M., & Zarowitz, B. J. (1999) · Critical Care Medicine · doi:10.1097/00003246-199907000-00008 · Cited by 328
Delirium Severity and Psychomotor Types: Their Relationship with Outcomes after Hip Fracture Repair
Marcantonio, E. R., Ta, T., Duthie, E. H., & Resnick, N. M. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50210.x · Cited by 320
Regular review: Delirium: optimising management
Meagher, D. J. (2001) · BMJ · doi:10.1136/bmj.322.7279.144 · Cited by 307
The Motor Activity Assessment Scale
Devlin, J. W., Boleski, G., Mlynarek, M. E., Nerenz, D. R., Peterson, E. L., Horst, H. M., & Zarowitz, B. J. M. (1998) · Critical Care Medicine · doi:10.1097/00003246-199801001-00011 · Cited by 285
Murray, M. J., Cowen, J., DeBlock, H., Erstad, B., Gray, A. W., Tescher, A. N., McGee, W. T., Prielipp, R. C., Susla, G., Jacobi, J., et al. (2002) · Critical Care Medicine · doi:10.1097/00003246-200201000-00021 · Cited by 283
Delirium in the Intensive Care Unit: An Under-Recognized Syndrome of Organ Dysfunction
Ely, E. W., Siegel, M. D., & Inouye, S. K. (2001) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-2001-13826 · Cited by 260
Clinical significance of delirium subtypes in older people
O’Keeffe, S. T. (1999) · Age and Ageing · doi:10.1093/ageing/28.2.115 · Cited by 244
Rosenberg, A. L., Hofer, T. P., Strachan, C. L., Watts, C. M., & Hayward, R. A. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-11-200306030-00009 · Cited by 216
Escarce, J. J. (1990) · JAMA · doi:10.1001/jama.1990.03450180053028 · Cited by 211
Early, routine paralysis for intracranial pressure control in severe head injury
Hsiang, J. K., Chesnut, R. M., Crisp, C. B., Klauber, M. R., Blunt, B. A., & Marshall, L. F. (1994) · Critical Care Medicine · doi:10.1097/00003246-199409000-00019 · Cited by 190
Increasing the Recognition of Delirium in Elderly Patients
Rockwood, K. J., Cosway, S., Stolee, P., Kydd, D., Carver, D., Jarrett, P. G., & O'Brien, B. (1994) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1994.tb01747.x · Cited by 175
Frequency, Severity, and Treatment of Agitation in Young versus Elderly Patients in the ICU
Fraser, G. L., Prato, B. S., Riker, R. R., Berthiaume, D., & Wilkins, M. L. (2000) · Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.20.1.75.34663 · Cited by 160
Accidental removal of endotracheal and nasogastric tubes and intravascular catheters
Carrión, M. I., Ayuso, D., Marcos, M. S. D. P., Robles, M. P., de la Cal, M. A., Alía, I., & Esteban, A. (2000) · Critical Care Medicine · doi:10.1097/00003246-200001000-00010 · Cited by 141
Characteristics and Outcomes of Patients Who Self-Extubate From Ventilatory Support
Atkins, P., Mion, L. C., Mendelson, W. B., Palmer, R. M., Slomka, J., & Franko, T. (1997) · CHEST Journal · doi:10.1378/chest.112.5.1317 · Cited by 132
Self-citationA prospective study of unplanned endotracheal extubation in intensive care unit patients
Betbese, A. J., Márquez, M. P., Bak, E., Rialp, G., & Mancebo, J. (1998) · Critical Care Medicine · doi:10.1097/00003246-199807000-00016 · Cited by 127
Management of the agitated intensive care unit patient
Cohen, I. L., Gallagher, T. J., Pohlman, A. S., Dasta, J. F., Abraham, E. H., & Papadokos, P. J. (2002) · Critical Care Medicine · doi:10.1097/00003246-200201002-00001 · Cited by 108
Prospective evaluation of self-extubations in a medical intensive care unit
Vassal, T., Anh, N. G. D., Gabillet, J. M., Guidet, B., Staikowsky, F., & Offenstadt, G. (1993) · Intensive Care Medicine · doi:10.1007/bf01694708 · Cited by 107
Bair, N. D., Bobek, M. B., Hoffman-Hōgg, L., Mion, L. C., Slomka, J., & Arroliga, A. C. (2000) · Critical Care Medicine · doi:10.1097/00003246-200003000-00018 · Cited by 89
Self-citationThe Frequency and Cost of Patient‐Initiated Device Removal in the ICU
Fraser, G. L., Riker, R. R., Prato, S., & Wilkins, M. L. (2001) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.21.1.1.34444 · Cited by 81
ANXIETY, DELIRIUM, AND PAIN IN THE INTENSIVE CARE UNIT
Szokol, J. W., & Vender, J. S. (2001) · Critical Care Clinics · doi:10.1016/s0749-0704(05)70182-2 · Cited by 75
Freire, A. X., Afessa, B., Cawley, P. A., Phelps, S. G., & Bridges, L. (2002) · Critical Care Medicine · doi:10.1097/00003246-200211000-00011 · Cited by 59
Nonpharmacologic Management of Patient Distress During Mechanical Ventilation
Fontaine, D. K. (1994) · Critical Care Clinics · doi:10.1016/s0749-0704(18)30101-5 · Cited by 44
Mortality of patients transferred to a tertiary care hospital
Clough, J. D., Kay, R., Gombeski, W. R., NICKELSON, D. E., & Loop, F. D. (1993) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.60.6.449 · Cited by 32
Tuohy, K. A., Nicholson, W. J., & Schiffman, F. J. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12326-4 · Cited by 30
Interrater reliability of 2 sedation scales in a medical intensive care unit: a preliminary report
Hogg, L., Bobek, M. B., Mion, L. C., Legere, B. M., Banjac, S., VanKerkhove, K., & Arroliga, A. C. (2001) · American Journal of Critical Care · doi:10.4037/ajcc2001.10.2.79 · Cited by 27
Self-citationUsing a Best Practice Approach to Prevent Treatment Interference in Critical Care
Happ, M. B. (2000) · Progress in Cardiovascular Nursing · doi:10.1111/j.0889-7204.2000.080394.x · Cited by 14
Cited by
Sorted by citations
Impact of systematic evaluation of pain and agitation in an intensive care unit*
Chanques, G., Jaber, S., Barbotte, E., Violet, S., Sebbane, M., Perrigault, P.-F., Mann, C., Lefrant, J.-Y., & Eledjam, J.-J. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000218416.62457.56 · Cited by 536
Understanding brain dysfunction in sepsis
Sonneville, R., Verdonk, F., Rauturier, C., Klein, I. F., Wolff, M., Annane, D., Chrétien, F., & Sharshar, T. (2013) · Annals of Intensive Care · doi:10.1186/2110-5820-3-15 · Cited by 362
Evaluating and monitoring analgesia and sedation in the intensive care unit
Sessler, C. N., Grap, M. J., & Ramsay, M. A. E. (2008) · Critical Care · doi:10.1186/cc6148 · Cited by 284
The attributable mortality of delirium in critically ill patients: prospective cohort study
Klouwenberg, P. M. C. K., Zaal, I. J., Spitoni, C., Ong, D. S. Y., van der Kooi, A. W., Bonten, M. J. M., Slooter, A. J. C., & Cremer, O. L. (2014) · BMJ · doi:10.1136/bmj.g6652 · Cited by 200
A Prospective Study of Agitation in a Medical-Surgical ICU
Jaber, S., Chanques, G., Altairac, C., Sebbane, M., Vergne, C., Perrigault, P.-F., & Eledjam, J.-J. (2005) · Chest · doi:10.1378/chest.128.4.2749 · Cited by 154
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
