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  • JAMA September 19, 2017

    Figure 2: Change in Richmond Agitation-Sedation Scale (RASS) Over the First 8 Hours After Treatment

    A, Time 0 indicates immediately before treatment administration. Error bars indicate 95% CIs. Both treatments were associated with significant reduction in the mean RASS score within the first 30 minutes of treatment. RASS score remained relatively stable for both groups over the 8-hour observation period. Lorazepam + haloperidol was associated with a significantly greater reduction in RASS score than placebo + haloperidol at 8 hours (P < .001, 2-sided Wilcoxon rank sum test). B, A larger proportion of patients had hyperactivity (RASS score, 1 to 4) in the placebo + haloperidol group at both 30 minutes and 8 hours (P = .001 for both time points). In contrast, a larger proportion of patients had sedation in the lorazepam group (RASS score, −3 to −5). The 2-sided Fisher exact test was used to compare the 3 categories of RASS scores between groups.
  • Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial

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    JAMA. 2017; 318(11):1047-1056. doi: 10.1001/jama.2017.11468

    This randomized clinical trial compares the effect of lorazepam vs placebo added to haloperidol for persistent agitation in patients with advanced cancer and delirium.

  • JAMA September 19, 2017

    Figure 1: Flow of Patients Through the Study

    At the time of enrollment, patients were randomized to lorazepam or placebo. All enrolled patients immediately began a standardized regimen with haloperidol 2 mg every 4 hours intravenously and 2 mg every hour as needed for agitation. Because of the fluctuating nature of delirium, the Richmond Agitation-Sedation Scale score of each patient was monitored every 2 hours until the patient’s score was 1 or more and required rescue medication per the judgment of the bedside nurse. Once the dose of haloperidol was increased and standardized, 27 of 90 randomized patients (30%) did not develop further agitation until death or discharge and thus did not require the study medication.
  • Trends in Use of Sedation for Low-Risk Endoscopy: Looking Beyond Monitored Anesthesia Care

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    JAMA. 2017; 317(19):2006-2007. doi: 10.1001/jama.2017.4114

    This commentary discusses a study published in JAMA Internal Medicine that assessed trends in the use of monitored anesthesia care for outpatient gastrointestinal endoscopy in the Veterans Health Administration from 2000 to 2013.

  • JAMA April 4, 2017

    Figure 3: Percentage of Patients With Well-Controlled Sedation and Delirium- and Coma-Free Days During ICU Stay Among the Dexmedetomidine and Control Groups

    To examine the effect of dexmedetomidine on sedation control and the occurrence of delirium and coma, a generalized linear model was used accounting for repeated measurements in the same patient. Well-controlled sedation was defined as a Richmond Agitation-Sedation Scale (RASS) score between −3 and +1 throughout 1 day spent in the intensive care unit (ICU) and was defined as (rate of controlled sedation) = (patient’s number of days with well-controlled sedation)/(total number of patients in the ICU), calculated for each day. Coma was defined as an RASS score between −4 and −5 throughout 1 day in the ICU. Day 1 is defined as the first day of randomization into the trial.
  • Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial

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    JAMA. 2017; 317(13):1321-1328. doi: 10.1001/jama.2017.2088

    This randomized clinical trial compares the effects of sedation with vs without dexmedetomidine on mortality and ventilator-free days in patients with sepsis.

  • JAMA April 12, 2016

    Figure 3: Effect of the Multifaceted Quality Improvement Intervention on Processes of Care

    RASS indicates Richmond Agitation-Sedation Scale.aAll effect estimates were adjusted for baseline values of outcome variables.
  • Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure: A Randomized Clinical Trial

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    JAMA. 2015; 313(4):379-389. doi: 10.1001/jama.2014.18399

    This cluster randomized trial found that among children undergoing mechanical ventilation for acute respiratory failure, use of a nurse-implemented, goal-directed sedation protocol did not reduce the duration of mechanical ventilation compared with usual care.

  • Protocolized Sedation in Critically Ill Children

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    JAMA. 2015; 313(4):363-364. doi: 10.1001/jama.2015.1
  • JAMA June 12, 2013

    Figure 4: Sedation Frequency Scatterplots by Group

    The diagonal lines are the best fitted lines to demonstrate change over the study period.
  • Effects of Patient-Directed Music Intervention on Anxiety and Sedative Exposure in Critically Ill Patients Receiving Mechanical Ventilatory Support: A Randomized Clinical Trial

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    JAMA. 2013; 309(22):2335-2344. doi: 10.1001/jama.2013.5670
    Chlan and coauthors report on the effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support. In an accompanying Editorial, Azoulay and coauthors discuss the use of music therapy for reducing anxiety in critically ill patients.
  • Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol: A Randomized Controlled Trial

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    JAMA. 2012; 308(19):1985-1992. doi: 10.1001/jama.2012.13872
    To compare protocolized sedation with protocolized sedation plus daily sedation interruption in critically ill patients receiving mechanical ventilation, Mehta and coauthors conducted a randomized controlled trial in 16 North American intensive care units. See related Editorial by Hall.
  • The Changing Landscape of ICU Sedation

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    JAMA. 2012; 308(19):2030-2031. doi: 10.1001/jama.2012.48321
  • Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation: Two Randomized Controlled Trials

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    JAMA. 2012; 307(11):1151-1160. doi: 10.1001/jama.2012.304
  • Weighing the Costs and Benefits of a Sedative

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    JAMA. 2012; 307(11):1195-1197. doi: 10.1001/jama.2012.319
  • Reformulation of the Sedation Continuum

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    JAMA. 2010; 303(9):876-877. doi: 10.1001/jama.2010.217
  • A New Era for Sedation in ICU Patients

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    JAMA. 2009; 301(5):542-544. doi: 10.1001/jama.2009.24
  • Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients: A Randomized Trial

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    JAMA. 2009; 301(5):489-499. doi: 10.1001/jama.2009.56
  • JAMA February 4, 2009

    Figure 1: Patient Enrollment, Randomization, and Treatment Flow

    Data were analyzed using the primary analysis population (n = 366) as well as the long-term use population (n = 297), the group specifically requested by the US Food and Drug Administration as a means of obtaining long-term efficacy and safety data for dexmedetomidine. RASS indicates Richmond Agitation-Sedation Scale.aInvestigator felt that patient no longer met entry criteria (eg, extubated, no longer required sedation, required deeper sedation).bPatient had new information after consent that identified an exclusion criterion (eg, need for general anesthesia, unexpected liver or cardiac disease).
  • Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial

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    JAMA. 2007; 298(22):2644-2653. doi: 10.1001/jama.298.22.2644