Please follow the grading rubric. The paper should be 900 words APA format, based on the attached outline, and about the subject mentioned in the PICO question. The outline and annotated bibliography documents from down below will help you write this paper with ease. You have to be very specific to the PICO question!P: Adult critical care patients. I: Implement policies and interventions to reduce and eliminate ICU delirium. C: Patients who are not on sedation drugs in the ICU. O: Decrease the incidence or even eliminate delirium in ICU patients and decrease the length of stay of patients in the ICU. PICO Question Does limited use of sedation drugs with limited length of stay in critical care reduce delirium in critically ill patients compared to patient who are not on sedation drugs in the ICU?
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Unformatted Attachment Preview
Beni Costa
Literature Review Matrix
NURS 6990-D02
Middle Tennessee State University
February 10, 2019
P: Adult critical care patients.
I: Implement policies and interventions to reduce and eliminate ICU delirium.
C: Patients who are not on sedation drugs in the ICU.
O: Decrease the incidence or even eliminate delirium in ICU patients and decrease the length of stay of patients in the ICU.
PICO Question
Does limited use of sedation drugs with limited length of stay in critical care reduce delirium in critically ill patients
compared to patient who are not on sedation drugs in the ICU?
Author /
Article
title
Year
of
Publ
icati
on
Qualitative:
Concepts or
phenomena
Quantitative:
Citation
Key Variables
Hypothesis
Research
Question
Awissi, D. 2018 Assessing
impact of
K., Bégin,
sedation,
C., Moisan,
analgesia, and
delirium
J.,
protocols
Lachaine,
evaluated in
the intensive
J., &
care unit
Skrobik,
Theoret
ical
Framew
ork
Purpose
Design
Sa
mpl
e
(N)
Instru
ments
Findings/Res
ults
Controve
rsies,
disagree
ments
with
other
authors
Limitatio
ns
Implications
Orem,
Dorothy
—Self
Care
Deficit
Theory
Evaluate the
Experim
413
tests
The number
of patients
manifesting
subsyndromal
delirium was
significantly
less in the
POST group.
The rate of
delirium was
similar.
More patients
remained
cognitively
intact, i.e.,
had an ICDSC
score of 0
No
short-term
outcomes
like
delirium
and longterm
outcomes
such as
PTSD and
1-year
mortality
were not
sufficientl
y
investigate
d as endpoints in
most of
the studies
Recommends use
of
dexmedetomidine
rather than
benzodiazepines
management of ental
specific,
distinct, and
measurable
clinical
entities: pain,
Y.I-SAVE
agitation, and
study:
delirium.
impact of
sedation,
analgesia,
and
delirium
protocols
evaluated
in the
intensive
care unit:
an
Designs
controvers
ies with
other
authors
economic
evaluation.
Annals of
Pharmacot
herapy, 46(
1), 21-28.
Girard, T.
There are no
Roper,
outcomes are
Logan
associated with
and
Fuchs, B.
delirium in
Tierney
D.,
adult ICU
model
D., Kress,
J. P.,
Thomason,
J. W.,
Schweicker
t, W. D.,
Pun, B. T.,
… &
Jackson, J.
C. Efficacy
and safety
of a paired
sedation
2017
patients
To revise the
“Clinical
Practice
Guidelines for
the Sustained
Use of
Sedatives and
Analgesics in
the Critically
Ill Adult”
published in
Critical Care
Medicine in
2002.
QuasiExperim
ental
Design
220
Survey
and
intervie
ws
The use of
sedation
scales,
sedation
protocols
designed to
minimize
sedative use,
and the use of
nonbenzodiaz
epine
medications
are associated
with
improved ICU
patient
outcomes,
including a
shortened
duration of
mechanical
ventilation,
ICU and
hospital LOS,
This
research
had not
controvers
y or
conflict
with
existing
literatures.
moderatequality
study
(439)
required a
1:1 nurseto-patient
ratio and
the
availabilit
y of
patient
“sitters,”
and no
rigorous
pubSpecial
Article
Critical
Care
Medicine
www.ccm
journal.or
g 291
Further research
on effect of High
doses of sedative
agents and
mechanical
ventilation in
disrupting sleep
patterns in
critically ill
patients
and
and decreased
incidences of
delirium and
long-term
cognitive
dysfunction
ventilator
weaning
protocol
lished
studies
have
specificall
y
compared
analgesiafirst
sedation
with
conventio
nal
GABAbased
sedation
strategies
for
mechanical
ly
ventilated
patients in
intensive
care
(Awakenin
g and
Breathing
Controlled
trial): a
randomised
controlled
trial.
Girard, T.
D., Kress,
J. P.,
2018
No sedation of
critically ill
patients
receiving
mechanical
Orem,
Dorothy
—Self
Care
to establish
whether
duration of
casecontrol
study,
428
Tests
Agitated
and
delirium was
survey
more frequent
concernin
g aspect is
the choice
of
sedation
A
noteworth
y
limitation
that
A conservative
approach of less
sedation does not
appear to cause
harm in critically
Fuchs, B.
D.,
Thomason,
J. W.,
Schweicker
t, W. D.,
Pun, B. T.,
… &
Jackson, J.
C. Efficacy
and safety
of a paired
sedation
and
ventilator
weaning
protocol
for
mechanical
ly
ventilated
patients in
ventilation is
Deficit
associated with Theory
an increase in
days without
ventilation. A
multicentre
study is needed
to establish
whether this
effect can be
reproduced in
other facilities.
mechanical
in the
ventilation
intervention
could be
group than in
reduced with a
the control
protocol of no
group
sedation versus
daily
interruption of
sedation.
agent in
the control
arm.
Propofol
was
switched
to
midazola
m which,
has a
longer
clearance
time
especially
in the
setting of
liver or
renal
failure and
increase
duration
of
mechanica
l
ventilation
challenges
the
generaliza
bility of
this study
is the use
of 1:1
nurse to
patient
ratio and
patient
comforters
. This
suggests
that
successful
completio
n of this
protocol
requires
more staff
presence,
which is
often not
available
in most
ICUs.
ill mechanically
ventilated
patients. This is
an important
proof of concept
study. Larger,
multicenter trials
are necessary to
determine the
feasibility and
safety of this
approach.
intensive
care
(Awakenin
g and
Breathing
Controlled
trial): a
randomised
controlled
trial. The
Lancet,
Ely, E. W.,
Inouye, S.
K.,
Bernard,
2017
Roper,
Logan
and
Tierney
—A
model
for
nursing
based on
a model
of living
To develop and
validate an
instrument for
Prospec
tive
cohort
study.
30
Tests
ICU nurses
and
physicians
use in the
who use the
intensive care
CAM-ICU
unit to
can detect
accurately
delirium
diagnose deliri
reliably and
& Hart, R.
um in critically
with a high
P. Delirium
ill patients who
degree of
in
are often
G. R.,
Gordon, S.,
Francis, J.,
May, L., …
There are
no
controvers
ies or
conflict
between
this
research
and
existing
body of
knowledg
e
The
findings
of 100%
sensitivity
and
specificity
in this
group are
based on a
small
number of
patients
and
deserve
further
analysis
Future studies of
delirium in the
ICU setting
should use larger
populations of
patients both
during and after
mechanical
ventilation.
Another focus for
future
investigations
would include
more intensive
neuropsychologic
testing of patients
mechanical
nonverbal
sensitivity and
ly
because
specificity.
ventilated
of mechanical
patients:
ventilation
on a larger after their ICU
scale.
stay
validity
and
reliability
of the
confusion
assessment
method for
the
intensive
care unit
(CAMICU).
Wiatrowski 2016
Analgosedatio
Myra
Levine
—
Conserv
ation
Model
examination of
Quasi-
, R.,
n can decrease
Norton, C.,
the risk of
& Giffen,
drug-related
D.
adverse events,
the ICU; trends
Analgosed
increase pain
in sedation
196
Intervie
the problem of
Experi
ws and
pain
mental
tests
management in
Design
Studies
demonstrate
the viability
of analgesiafirst regimens
and the
potential to
avoid or
reduce the use
The
research
has no
conflict
with other
authors
since it is
mainly
reviewing
None of
the
analgosed
ation
studies
looked
directly at
important
considerat
Further research
must examine
whether
analgosedation
improves or
worsens nurse
workload
ation:
control,
practices,
improving
decrease length
including light
patient
of mechanical
sedation and
outcomes
ventilation and
the daily
in ICU
its associated
interruption of
sedation
risks, and
sedation; and a
and pain
decrease the
literature
manageme
length of ICU
review of
nt. Pain
stay
analgosedation
of sedativehypnotic and
anesthetic
medications
in many
mechanically
ventilated
ICU patients.
existing
knowledg
e
Tests
results
The
ions like
nurse
workload,
whether or
not
analgosed
ation
allows for
earlier
implement
ation of
patient
mobility,
and the
total cost
of the
sedation
practice
compared
with
another
practice.
The
The sub-sedative
Manageme
nt
Su, X.,
2016
Meng, Z.
T., Wu, X.
H., Cui, F.,
Li, H. L.,
Wang, D.
X., & Ma,
D. (2016).
Dexmedeto
midine for
prevention
For patients
aged over 65
years who are
admitted to the
Orem,
Dorothy
—Self
Care
Deficit
Theory
investigated
randomi
700
whether
sed,
using
suggest that a
authors
authors
dose of
prophylactic
double-
comput
prophylactic
declared
had no
dexmedetomidine
low-dose
blind,
er-
low-dose
no
controver
can be safely used
intensive care
dexmedetomidi parallel-
generat
dexmedetomi
competing
sy or
for elderly ICU
unit after non-
ne, a highly
arm
ed
dine infusion
interests
conflict
patients after
cardiac
selective α2
placebo
random
significantly
with the
surgery, both with
of delirium
in elderly
patients
after noncardiac
surgery: a
randomised
, double
blind,
placebocontrolled
trial.
Kaplan, J.
2019
surgery,
adrenoceptor
controll
ization
decreases the
existing
and without
prophylactic
agonist, could
ed trial
sequenc incidence of
researche
endotracheal
low-dose
safely decrease
e
s.
intubation, to
dexmedetomidi
the incidence
the first 7
reduce the
ne significantly
of delirium in
days after
likelihood of
decreases the
elderly patients
surgery in
postoperative
occurrence of
after non-
elderly
delirium.
delirium
cardiac
patients
during the first
surgery.
admitted to
delirium in
7 days after
the ICU after
surgery. The
non-cardiac
therapy is safe
surgery
• Fewer
Meleis,
Afaf –
Transiti
ons
Theory.
The objective
A single
of this study
345
Intervie
The nursing-
There
center,
ws and
driven
are no
was to
retrospe
surveys
sedation
conflicts
determine the
ctive
protocol for
in this
study
mechanically
research.
B.,
patients
Eiferman,
received
D. S.,
continuous
Porter, K.,
infusion
impact of a
MacDermo
benzodiazepine
nursing-driven
ventilated
tt, J.,
s and opioids
ASP with
patients in the
Brumbaug
• Protocol
criteria for
SICU was
h, J., &
patients had
infusion
associated
Murphy, C.
more
with more
Limitation
s of using
the selfreported
numeric
rating
score pain
scale in
ICU
patients
and lack
of
objective
assessmen
t tool, we
Larger
randomized
controlled trials
utilizing a
nursing-driven
sedation and
analgesia protocol
should be
performed in a
SICU population
V. (2019).
documented
initiation in the
time free of
μImpact of
sedation scores
SICU.
mechanical
a nursing-
in target range
ventilation.
driven
Lower
sedation
benzodiazepin
protocol
e utilization
with
and fewer
criteria for
pain and
infusion
sedative
initiation in
continuous
the surgical
infusions may
intensive
allow for
care unit.
timelier
were
unable to
evaluate
the impact
of the
protocol
on pain
control.
to validate these
limited
literature
on pain
assessmen
t in the
PICU; the
available
studies
Guides
finding
extubation
and reduce
incidence of
ICU delirium.
Harris, J.,
2016
This position
Ramelet,
statement
A. S., van
provides
Dijk, M.,
clinical
Pokorna,
recommendatio
Myra
Levine
—
Conserv
ation
Model
provides
Prospect 700
Questi
: An ESPNIC
clinical
ive
oners
position
recommendatio cohort
statement was
ns for the
drafted which
assessment of
study.
provides
The
authors
declared
no
competing
interests
professionals in
the assessment
and
reassess- ment of
P.,
ns for the
pain, level of
clinical
Wielenga,
assessment of
sedation,
recommendati
J., Tume,
pain, level of
iatrogenic
ons on
L., & Ista,
sedation,
withdrawal
assessment of
E. Clinical
iatrogenic
syndrome and
pain (n = 5),
recommen
withdrawal
delirium in
distress and/or
dations for
syndrome and
critically ill
level of
withdrawal
pain,
delirium in
infants and
sedation (n =
syndrome and
sedation,
critically ill
children
4), iatrogenic
delirium.
withdrawal
patients.
withdrawal
and
syndrome (n =
delirium
3) and
assessment
delirium (n =
in critically
3). These
ill infants
recommendati
and
ons were
children:
based on the
an ESPNIC
available
position
evidence and
statement
consensus
for
amongst the
healthcare
experts and
concern
the
validation
of
instrument
s such as
the
COMFOR
T scale
the effectiveness
of treatment
interventions for
pain, distress,
inadequate
sedation,
professiona
other
ls. Intensiv
members of
e care
ESPNIC
medicine,
GRADING RUBRIC FOR INTRODUCTION, METHODS, AND RESULTS
GRADED CONTENT
POINTS
AVAILABLE
Introduction
1. Background of your proposed topic
•
20
A brief summary of the review of the
literature (5 points)
•
Summary of what is missing or unknown in
the research literature (5 points)
•
An overview of the scientific theory, nursing
theory, or conceptual model(s) that framed
the topic (5 points)
2. Clear purpose statement
•
Statement or research question/problem (5
points)
Methods
Literature Searching
•
Explanation of databases used to retrieve
literature (5 points)
•
Explanation of any revisions made to search
strategies (5 points)
•
Inclusion/exclusion criteria for the articles
chosen (5 points)
•
Time frame for the publications used (5
20
POINTS EARNED
GRADING RUBRIC FOR INTRODUCTION, METHODS, AND RESULTS
points)
Results
Describe characteristics of the articles included (5
20
points)
Formulate themes in the literature that respond to the
PICO question (5 points)
Construct evidence in a logical manner (5 points)
Synthesize existing and new knowledge on the topic
under review (5 points)
Correct APA formatting, grammar, spelling, and
punctuation (up to 10 points will be deducted for
violations)
Late policy: All students are expected to turn in
work on time. Late assignments will be penalized
10% per day (or any portion of the day) unless
prior arrangements have been made with the
instructor.
TOTAL
60
Running head: OUTLINE
Outline for my Intro-Methods Results
Beni Costa
NURS 6990- D02
Middle Tennessee State University
February 19, 2019
2
OUTLINE
Effect of Limited Sedation on Delirium
Introduction
✓ Delirium is a primary adverse event in ventilated patients who receive long-term
treatment.
✓ Too much sedation is associated with a longer duration of mechanical ventilation and a
longer intensive care unit (ICU) stay.
✓ Limited sedation may reduce these adverse effects.
✓ Previous studies demonstrated that patients under mechanical ventilation exhibit a higher
risk of experiencing delirium than non-mechanically ventilated patients.
✓ This study will evaluate risk factors for delirium in limited sedation patients
Methods
a. Patients
✓ In this planned study patients will be selected from a previous study
✓ Patients who underwent sequential sedation will be enrolled.
b. Clinical Data. Patient demographic characteristics included age, gender, body mass
index (BMI), allergic history, drinking and smoking status, and medical history,
including the presence or absence of hypertension.
c. Delirium Assessment. The primary endpoint of this study will be the occurrence of
delirium.
d. Statistical Analysis. Statistical analyses were performed using SPSS
Results
3
OUTLINE
Table will be used to presents demographic data and baseline characteristics of patients with or
without delirium.
Data will be used to evaluate risk factors for delirium in sequential sedation patients
✓ Univariate and multivariate Cox proportional hazards regressions will be used to predict
risk factors.
✓ Clinical data will include the use of sedative and analgesic medications, mechanical
ventilation status, and sequential sedation characteristics.
✓ It will involve Delirium Assessment among the patients.
✓ The results of this study should demonstrate that sequential sedation with
dexmedetomidine was a protective method to prevent delirium.
✓ Results should show that management strategies may sometimes require alteration to
reduce the incidence and severity of delirium in sequential sedation patients.
Conclusion:
✓ The results used demonstrated that limited sedation is a protective method to prevent
delirium.
✓ Results should suggest that management strategies may sometimes require alteration to
reduce the incidence and severity of delirium in sequential sedation patients.
4
OUTLINE
References
Djaiani, G., Silverton, N., Fedorko, L., Carroll, J., Styra, R., Rao, V., & Katznelson, R.
(2016). Dexmedetomidine versus propofol sedation reduces delirium after cardiac
surgery a randomized controlled trial. Anesthesiology: The Journal of the American
Society of Anesthesiologists, 124(2), 362-368.
Jackson, P., & Khan, A. (2015). Delirium in critically ill patients. Critical care clinics, 31(3),
589-603.
Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53
CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED
CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent
Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. American
Journal of Respiratory and Critical Care Medicine, 195.
Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53
CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED
CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent
Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. American
Journal of Respiratory and Critical Care Medicine, 195.
Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50
CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association
Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized
Patients on The Wards. American Journal of Respiratory and Critical Care
Medicine, 193, 1.
5
OUTLINE
Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50
CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association
Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized
Patients On The Wards. American Journal of Respiratory and Critical Care
Medicine, 193, 1.
Salluh, J. I., Wang, H., Schneider, E. B., Nagaraja, N., Yenokyan, G., Damluji, A., … &
Stevens, R. D. (2015). Outcome of delirium in critically ill patients: systematic
review and meta-analysis. bmj, 350, h2538.
Traube, C., Silver, G., Reeder, R. W., Doyle, H., Hegel, E., Wolfe, H. A., … & Buttram, S. D.
(2017). Pediatric delirium in critically-ill children: An international point prevalence
study. Critical care medicine, 45(4), 584.
Vallabhajosyula, S., Kanmanthareddy, A., Morrow, L. E., & Esterbrooks, D. J. (2016). C50
CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: Role Of Statins in
Delirium Prevention In Critically Ill And Cardiovascular Surgery Patients: A MetaAnalysis. American Journal of Respiratory and Critical Care Medicine, 193, 1.
Search Methods Draft
Beni Costa
Middle Tennessee State University
Scholarly Synthesis
NURS 6990-D02
Spring 2019
NURS 6990 Scholarly Synthesis
Search activity
My research question:
In critically ill patients in the ICU (P), with limited use of sedation drugs (I), compared to not using sedation drugs
(C), reduce delirium (P)?
Places to search for information:
School online library, and google scholar
List of sources searched:
Date of search
1. Lee, J., Choi, S., Park, Y.,
13 February 2019
Search strategy used,
Total number of results
including any limits
found
Boolean operators
15,700
Comments
Using the AND operator
Lee, C. H., Lee, S. M.,
was very useful in
Yim, J. J., … & Kim, Y.
narrowing the research to
(2017). C53 CRITICAL
only include sedation use
CARE: DELIRIUM AND
and delirium.
THE EXPECTED AND
UNEXPECTED
CONSEQUENCES OF
SEDATION/ANALGESIA
IN THE ICU: Effect of
Recent Alcohol, Smoking
and Psychotropic Drug
Use on Delirium In
ICU. American Journal of
Respiratory and Critical
Care Medicine, 195.
2. Lyons, P. G., Snyder, A.
M., Edelson, D. P.,
Mokhlesi, B., & Churpek,
M. M. (2016). C50
CRITICAL CARE:
DELIRIUM AND
SEDATION IN THE ICU:
The Association Between
Opioid and
Benzodiazepine Use on
Clinical Deterioration in
Hospitalized Patients On
The Wards. American
Journal of Respiratory and
Critical Care
Medicine, 193, 1.
3. Djaiani, G., Silverton, N. …
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