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Article ; Online: Pro: The Best Induction for the Physiologically Difficult Airway is Ketamine-Propofol Admixture ("Ketofol").

Brakke, Benjamin D / Smischney, Nathan J

Journal of cardiothoracic and vascular anesthesia

2023 Volume 37, Issue 8, Page(s) 1503–1505

MeSH term(s)	Humans ; Propofol ; Ketamine ; Anesthetics, Intravenous ; Anesthetics, Dissociative
Chemical Substances	Propofol (YI7VU623SF) ; Ketamine (690G0D6V8H) ; Anesthetics, Intravenous ; Anesthetics, Dissociative
Language	English
Publishing date	2023-01-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2022.12.036
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Zs.A 2203: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Association of Shock Indices with Peri-Intubation Hypotension and Other Outcomes: A Sub-Study of the KEEP PACE Trial.

Smischney, Nathan J / Seisa, Mohamed O / Schroeder, Darrell R

Journal of intensive care medicine

2024 , Page(s) 8850666241235591

Abstract: Background: Based on current evidence, there appears to be an association between peri-intubation hypotension and patient morbidity and mortality. Studies have identified shock indices as possible pre-intubation risk factors for peri-intubation ... ...

Abstract	Background: Based on current evidence, there appears to be an association between peri-intubation hypotension and patient morbidity and mortality. Studies have identified shock indices as possible pre-intubation risk factors for peri-intubation hypotension. Thus, we sought to evaluate the association between shock index (SI), modified shock index (MSI), and diastolic shock index (DSI) and peri-intubation hypotension along with other outcomes. Methods: The present study is a sub-study of a randomized controlled trial involving critically ill patients undergoing intubation. We defined peri-intubation hypotension as a decrease in mean arterial pressure <65 mm Hg and/or a reduction of 40% from baseline; or the initiation of, or increase in infusion dosage of, any vasopressor medication (bolus or infusion) during the 30-min period following intubation. SI, MSI, and DSI were analyzed as continuous variables and categorically using pre-established cut-offs. We also explored the effect of age on shock indices. Results: A total of 151 patients were included in the analysis. Mean pre-intubation SI was 1.0 ± 0.3, MSI 1.5 ± 0.5, and DSI 1.9 ± 0.7. Increasing SI, MSI, and DSI were significantly associated with peri-intubation hypotension (OR [95% CI] per 0.1 increase = 1.16 [1.04, 1.30], Conclusions: Increasing SI, MSI, and DSI were all significantly associated with peri-intubation hypotension and worse SOFA scores but not with other outcomes. Shock indices remain a useful bedside tool to assess the potential likelihood of peri-intubation hypotension. Trial registration: ClinicalTrials.gov identifier - NCT02105415.
Language	English
Publishing date	2024-02-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666241235591
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Article: Endotracheal intubation sedation in the intensive care unit.

Tarwade, Pritee / Smischney, Nathan J

World journal of critical care medicine

2022 Volume 11, Issue 1, Page(s) 33–39

Abstract: Endotracheal intubation is one of the most common, yet most dangerous procedure performed in the intensive care unit (ICU). Complications of ICU intubations include severe hypotension, hypoxemia, and cardiac arrest. Multiple observational studies have ... ...

Abstract	Endotracheal intubation is one of the most common, yet most dangerous procedure performed in the intensive care unit (ICU). Complications of ICU intubations include severe hypotension, hypoxemia, and cardiac arrest. Multiple observational studies have evaluated risk factors associated with these complications. Among the risk factors identified, the choice of sedative agents administered, a modifiable risk factor, has been reported to affect these complications (hypotension). Propofol, etomidate, and ketamine or in combination with benzodiazepines and opioids are commonly used sedative agents administered for endotracheal intubation. Propofol demonstrates rapid onset and offset, however, has drawbacks of profound vasodilation and associated cardiac depression. Etomidate is commonly used in the critically ill population. However, it is known to cause reversible inhibition of 11 β-hydroxylase which suppresses the adrenal production of cortisol for at least 24 h. This added organ impairment with the use of etomidate has been a potential contributing factor for the associated increased morbidity and mortality observed with its use. Ketamine is known to provide analgesia with sedation and has minimal respiratory and cardiovascular effects. However, its use can lead to tachycardia and hypertension which may be deleterious in a patient with heart disease or cause unpleasant hallucinations. Moreover, unlike propofol or etomidate, ketamine requires organ dependent elimination by the liver and kidney which may be problematic in the critically ill. Lately, a combination of ketamine and propofol, "Ketofol", has been increasingly used as it provides a balancing effect on hemodynamics without any of the side effects known to be associated with the parent drugs. Furthermore, the doses of both drugs are reduced. In situations where a difficult airway is anticipated, awake intubation with the help of a fiberoptic scope or video laryngoscope is considered. Dexmedetomidine is a commonly used sedative agent for these procedures.
Language	English
Publishing date	2022-01-09
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2220-3141
ISSN	2220-3141
DOI	10.5492/wjccm.v11.i1.33
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Article: Inhaled volatile anesthetics in the intensive care unit.

Wieruszewski, Erin D / ElSaban, Mariam / Wieruszewski, Patrick M / Smischney, Nathan J

World journal of critical care medicine

2024 Volume 13, Issue 1, Page(s) 90746

Abstract: The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century. Recently, a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the ...

Abstract	The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century. Recently, a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres, finding diverse applications in intensive care settings. In the dynamic landscape of intensive care, volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements, managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus, conditions of high sedative requirements including burns, high opioid or alcohol use and neurological conditions such as status epilepticus. Volatile anesthetics can be administered through either inhaled route
Language	English
Publishing date	2024-03-09
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2220-3141
ISSN	2220-3141
DOI	10.5492/wjccm.v13.i1.90746
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Article ; Online: Predictors of hemodynamic derangement during intubation in the critically ill: A nested case-control study of hemodynamic management - Part II.

Smischney, Nathan J

Journal of critical care

2017 Volume 42, Page(s) 374

MeSH term(s)	Case-Control Studies ; Critical Illness ; Hemodynamics ; Humans ; Intensive Care Units ; Intubation
Language	English
Publishing date	2017-10-22
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2017.10.030
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Zs.A 2152: Show issues

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Noninvasive Cardiac Output Monitoring (NICOM) in the Critically Ill Patient Undergoing Endotracheal Intubation: A Prospective Observational Study.

Smischney, Nathan J / Stoltenberg, Anita D / Schroeder, Darrell R / DeAngelis, Jillian L / Kaufman, David A

Journal of intensive care medicine

2023 Volume 38, Issue 12, Page(s) 1108–1120

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Adult ; Humans ; Etomidate ; Anesthetics, Intravenous ; Propofol ; Ketamine ; Prospective Studies ; Critical Illness/therapy ; Intubation, Intratracheal/adverse effects ; Intubation, Intratracheal/methods ; Monitoring, Physiologic ; Cardiac Output
Chemical Substances	Etomidate (Z22628B598) ; Anesthetics, Intravenous ; Propofol (YI7VU623SF) ; Ketamine (690G0D6V8H)
Language	English
Publishing date	2023-06-15
Publishing country	United States
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666231183401
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article: Acute exacerbation of interstitial lung disease in the intensive care unit.

Charokopos, Antonios / Moua, Teng / Ryu, Jay H / Smischney, Nathan J

World journal of critical care medicine

2022 Volume 11, Issue 1, Page(s) 22–32

Abstract: Acute exacerbations of interstitial lung disease (AE-ILD) represent an acute, frequent and often highly morbid event in the disease course of ILD patients. Admission in the intensive care unit (ICU) is very common and the need for mechanical ventilation ... ...

Abstract	Acute exacerbations of interstitial lung disease (AE-ILD) represent an acute, frequent and often highly morbid event in the disease course of ILD patients. Admission in the intensive care unit (ICU) is very common and the need for mechanical ventilation arises early. While non-invasive ventilation has shown promise in staving off intubation in selected patients, it is unclear whether mechanical ventilation can alter the exacerbation course unless it is a bridge to lung transplantation. Risk stratification using clinical and radiographic findings, and early palliative care involvement, are important in ICU care. In this review, we discuss many of the pathophysiological aspects of AE-ILD and raise the hypothesis that ventilation strategies used in acute respiratory distress syndrome might be implemented in AE-ILD. We present possible decision-making and management algorithms that can be used by the intensivist when caring for these patients.
Language	English
Publishing date	2022-01-09
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2220-3141
ISSN	2220-3141
DOI	10.5492/wjccm.v11.i1.22
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Article: Clonidine use during dexmedetomidine weaning: A systematic review.

Rajendraprasad, Sanu / Wheeler, Molly / Wieruszewski, Erin / Gottwald, Joseph / Wallace, Lindsey A / Gerberi, Danielle / Wieruszewski, Patrick M / Smischney, Nathan J

World journal of critical care medicine

2023 Volume 12, Issue 1, Page(s) 18–28

Abstract: Background: Dexmedetomidine is a centrally acting alpha-2A adrenergic agonist that is commonly used as a sedative and anxiolytic in the intensive care unit (ICU), with prolonged use increasing risk of withdrawal symptoms upon sudden discontinuation. As ... ...

Abstract	Background: Dexmedetomidine is a centrally acting alpha-2A adrenergic agonist that is commonly used as a sedative and anxiolytic in the intensive care unit (ICU), with prolonged use increasing risk of withdrawal symptoms upon sudden discontinuation. As clonidine is an enterally available alpha-2A adrenergic agonist, it may be a suitable agent to taper off dexmedetomidine and reduce withdrawal syndromes. The appropriate dosing and conversion strategies for using enteral clonidine in this context are not known. The objective of this systematic review is to summarize the evidence of enteral clonidine application during dexmedetomidine weaning for prevention of withdrawal symptoms. Aim: To systematically review the practice, dosing schema, and outcomes of enteral clonidine use during dexmedetomidine weaning in critically ill adults. Methods: This was a systematic review of enteral clonidine used during dexmedetomidine weaning in critically ill adults (≥ 18 years). Randomized controlled trials, prospective cohorts, and retrospective cohorts evaluating the use of clonidine to wean patients from dexmedetomidine in the critically ill were included. The primary outcomes of interest were dosing and titration schema of enteral clonidine and dexmedetomidine and risk factors for dexmedetomidine withdrawal. Other secondary outcomes included prevalence of adverse events associated with enteral clonidine use, re-initiation of dexmedetomidine, duration of mechanical ventilation, and ICU length of stay. Results: A total of 3427 studies were screened for inclusion with three meeting inclusion criteria with a total of 88 patients. All three studies were observational, two being prospective and one retrospective. In all included studies, the choice to start enteral clonidine to wean off dexmedetomidine was made at the discretion of the physician. Weaning time ranged from 13 to 167 h on average. Enteral clonidine was started in the prospective studies in a similar protocolized method, with 0.3 mg every 6 h. After starting clonidine, patients remained on dexmedetomidine for a median of 1-28 h. Following the termination of dexmedetomidine, two trials tapered enteral clonidine by increasing the interval every 24 h from 6 h to 8h, 12h, and 24 h, followed by clonidine discontinuation. For indicators of enteral clonidine withdrawal, the previously tolerable dosage was reinstated for several days before resuming the taper on the same protocol. The adverse events associated with enteral clonidine use were higher than patients on dexmedetomidine taper alone with increased agitation. The re-initiation of dexmedetomidine was not documented in any study. Only 17 (37%) patients were mechanically ventilated with median duration of 3.5 d for 13 patients in one of the 2 studies. ICU lengths of stay were similar. Conclusion: Enteral clonidine is a strategy to wean critically ill patients from dexmedetomidine. There is an association of increased withdrawal symptoms and agitation with the use of a clonidine taper.
Language	English
Publishing date	2023-01-09
Publishing country	United States
Document type	Journal Article
ISSN	2220-3141
ISSN	2220-3141
DOI	10.5492/wjccm.v12.i1.18
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Article ; Online: Intensive Care Unit Sedation Practices at a Large, Tertiary Academic Center.

Hofer, Mikaela M / Wieruszewski, Patrick M / Nei, Scott D / Mara, Kristin / Smischney, Nathan J

Journal of intensive care medicine

2021 Volume 37, Issue 10, Page(s) 1383–1396

Abstract: Background: Sedatives are frequently administered in an ICU and are often dependent on patient population and ICU type. These differences may affect patient-centered outcomes.: Objective: Our primary objective was to identify differences in sedation ... ...

Abstract	Background: Sedatives are frequently administered in an ICU and are often dependent on patient population and ICU type. These differences may affect patient-centered outcomes. Objective: Our primary objective was to identify differences in sedation practice among three different ICU types at an academic medical center. Methods: This was a retrospective cross-sectional study of adult patients (≥18 years) requiring a continuous sedative for ≥6 h and admitted to a medical ICU, surgical ICU, and medical/surgical ICU at a single academic medical center in Rochester Minnesota from June 1, 2018 to May 31, 2020. We extracted baseline characteristics; sedative type, dose, and duration; concomitant therapies; and patient outcomes. Summary statistics are presented. Results: A total of 2154 patients met our study criteria (1010 from medical ICU, 539 from surgical ICU, 605 from medical/surgical ICU). Propofol was the most frequently used sedative in all ICU settings (74.1% in medical ICU, 53.8% in surgical ICU, 68.9% in medical/surgical ICU, and 67.5% in all ICUs). The mortality rate was highest in the medical/surgical ICU (40.2% in medical ICU, 26.0% in surgical ICU, 40.7% in medical/surgical ICU, and 36.8% in all ICUs). 90.7% of all patients required mechanical ventilation (92.9% in medical ICU, 88.5% in surgical ICU, and 89.1% in medical/surgical ICU). Overall, patients spent more time in light sedation than deep sedation, 75% versus 10.3%, during their ICU admission. Patients in the medical ICU spent a greater proportion of time positive for delirium than the other ICU settings (35.7% in medical ICU, 9.8% in surgical ICU, and 20% in medical/surgical ICU). Similar amounts of opioids (morphine milligram equivalents) were used during the continuous sedative infusion between the three settings. Conclusions: We observed that patients in the medical ICU spent more time deeply sedated with multiple agents which was associated with a higher proportion of delirium.
MeSH term(s)	Adult ; Cross-Sectional Studies ; Delirium/epidemiology ; Humans ; Hypnotics and Sedatives ; Intensive Care Units ; Length of Stay ; Respiration, Artificial ; Retrospective Studies
Chemical Substances	Hypnotics and Sedatives
Language	English
Publishing date	2021-12-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666211067515
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Zs.A 2158: Show issues

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Article ; Online: Trajectory of PaO

Wieruszewski, Patrick M / Coleman, Patrick J / Levine, Andrea R / Davison, Danielle / Smischney, Nathan J / Kethireddy, Shravan / Guo, Yanglin / Hecht, Jason / Mazzeffi, Michael A / Chow, Jonathan H

Journal of intensive care medicine

2023 Volume 38, Issue 10, Page(s) 939–948

Abstract: Introduction: High-dose catecholamines can impair hypoxic pulmonary vasoconstriction and increase shunt fraction. We aimed to determine if Angiotensin II (Ang-2) is associated with improved PaO: Methods: Adult patients at four tertiary care centers ... ...

Abstract	Introduction: High-dose catecholamines can impair hypoxic pulmonary vasoconstriction and increase shunt fraction. We aimed to determine if Angiotensin II (Ang-2) is associated with improved PaO Methods: Adult patients at four tertiary care centers and one community hospital in the United States who received Ang-2 from July 2018-September 2020 were included in this retrospective, observational cohort study. PaO Results: The study included 254 patients. In the 48 h prior to Ang-2 initiation, oxygenation was significantly declining (hourly PaO Conclusions: Ang-2 is associated with improved PaO
MeSH term(s)	Adult ; Humans ; Oximetry ; Angiotensin II/therapeutic use ; Retrospective Studies ; Respiratory Distress Syndrome/therapy ; Lung ; Shock ; Oxygen
Chemical Substances	Angiotensin II (11128-99-7) ; Oxygen (S88TT14065)
Language	English
Publishing date	2023-05-09
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666231174870
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