Bold Voices - August 2017 - 14

AT THE BEDSIDE

Effects of Dexmedetomidine
More research is needed
to determine if the use
of dexmedetomidine
compared with no
dexmedetomidine could
result in statistically
significant improvement
in 28-day mortality or
ventilator-free days.

I
www.aacnboldvoicesonline.org

14

n a small randomized clinical trial,
patients with sepsis undergoing
ventilation and sedated with dexmedetomidine did not perform significantly
better than a control group in regard to
ventilator-free days or 28-day mortality.
In "Effect of Dexmedetomidine on
Mortality and Ventilator-Free Days
in Patients Requiring Mechanical
Ventilation With Sepsis," in JAMA:
The Journal of the American Medical

Seizure Risk
Much Higher for
Sepsis Survivors
Further study needs to
focus on interventions
and strategies to reduce
the risk of seizure.

S

urvivors of sepsis are almost
five times more likely than
other hospitalized patients to
have a seizure in the years after
discharge.
"Long-Term Risk of Seizures in
Survivors of Sepsis," in Neurology,
and presented at the American
Academy of Neurology's annual
meeting, notes that 6.67 percent
of hospitalized patients with sepsis
had a seizure within eight years,

Association, 201 adult patients
with sepsis - who needed
mechanical ventilation for at
least 24 hours - in eight ICUs
in Japan received dexmedetomidine plus analgesia (100
patients), or the control group
received either propofol or
midazolam plus analgesia (101
patients) from 2013 to 2016.
The mean age of all patients
was 69, and 63 percent were
male.
Compared to the control
group, the study group had
fewer deaths (19 to 28) and
more days ventilator-free (20
to 18); however, these results were
not considered statistically significant.
(The trial was prospectively powered to
detect a 20 percent difference in 28-day
survival based on the results of the
MENDs subgroup analysis. Physicians
may consider an 8 percent difference in
28-day mortality to be clinically significant, but this study was underpowered

compared to 1.27 percent of other
post-hospitalization patients. On
an annual basis, the incidence was
1.28 percent among sepsis survivors, compared to 0.16 percent
among the general population.
Although the retrospective,
population-based cohort study
provides no insight on the specific
risk factors that might cause
seizures, it builds on the knowledge that patients with sepsis have
an increased short-term risk of
seizure during hospitalization.
The study involved the case
histories of 842,723 patients with
sepsis in New York, Florida and
California from 2005 to 2013 and
then confirmed the findings after
reviewing a Medicare beneficiary
data sample. Patients 65 and older
in that sample were 2.8 times more
likely to have seizures, but patients
younger than 65 were 10.3 times

to detect this difference.) The
authors recommend additional
studies to evaluate the effect
of this protocol on mortality
and ventilator-free days.
Other potential limitations
include a lower dexmedetomidine dosage than other trials
because of limits imposed
by Japanese medical insurance, as well as attention to
short-term patient outcomes
only. The trial hypothesizes
that dexmedetomidine, as
a lighter sedative, would
benefit patients with sepsis
through an increased ability to
communicate and reduced agitation and
delirium. Dexmedetomidine in this study
was associated with better sedation, but
not lower delirium incidence in patients
with sepsis.
REFERENCE: Kawazoe Y, Miyamoto K, Morimoto T, et al.
Effect of dexmedetomidine on mortality and ventilator-free
days in patients requiring mechanical ventilation with sepsis:
a randomized clinical trial. JAMA. 2017;317(13):1321-1328.

more likely. The study used claims
records from the Healthcare
Cost and Utilization Project and
excluded patients with a history of
seizure and those who didn't live in
those three states.
In a related article in MedPage
Today, lead author Michael Reznik,
Columbia University Medical
Center, New York, points out study
limitations, including reliance on
administrative records, lack of
detail about patients' sepsis and
the potential for patients with
recent sepsis to receive closer monitoring and therefore be more likely
to have seizures noted. He adds
that further study needs to focus
on interventions and strategies to
reduce the risk of seizure.
REFERENCE: Reznik M, Merkler A, Mahta A, Murthy
S, Claassen J, Kamel H. Long-term risk of seizures in
survivors of sepsis. Neurology. 2017;(88):18 (suppl
S5.003).


http://www.jamanetwork.com/journals/jama/article-abstract/2612911 http://www.jamanetwork.com/journals/jama/article-abstract/2612911 http://www.jamanetwork.com/journals/jama/article-abstract/2612911 http://www.jamanetwork.com/journals/jama/article-abstract/2612911 http://www.aacnboldvoicesonline.org http://www.medpagetoday.com/meetingcoverage/aan/64738 http://www.medpagetoday.com/meetingcoverage/aan/64738 http://www.neurology.org/content/88/16_Supplement/S5.003 http://www.neurology.org/content/88/16_Supplement/S5.003

Table of Contents for the Digital Edition of Bold Voices - August 2017

Another Angle
Pres Note Front Teaser
Masthead
New Online Toolkit Shows Crucial Roles of Nurses in Serious Illness Communication
Oct. 31 Deadline to Apply for AACN Research Grants
PCCN or CCRN: Which Certification Is Right for You?
Failed Resuscitations May Increase Stress for Nurses
Updated Cardiac Nursing Course and CMC Review Course Online
New Behavior-Based Pain Assessment Tool
Hospital Rooftop Is a Hive of Activity
Former ICU Nurse Collects 100K Objects for Medical Mosaic
Interventions Reduce Wrong-Patient Orders in NICUs
Increasing Acceptance of Pediatric Telemedicine
The Privilege of Nursing
Effects of Dexmedetomidine
Seizure Risk Much Higher for Sepsis Survivors
Studies Provide Insights Into Reducing Opioid Use
Short-Term Oral Corticosteroids Increase Risk of Adverse Effects
Hospital Staff Becoming Product Innovators
Addressing Barriers to APRN Practice
Survival Rates Higher During Joint Commission Surveys
Effect of Rudeness on Pediatric Team Performance
Glasgow Coma Scale Stands the Test of Time
ECRI Introduces Patient Identification Tools
Reducing Risk Factors in Pediatric Delirium
Bundle Compliance Increases Survival, Reduces Delirium
Fostering Resilience in Healthcare Professionals Who Are Also Moms
Members: Enhance Your Career With an AACN Scholarship
In Our Journals
Transitions
President’s Note
Bold Voices - August 2017 - Cover1
Bold Voices - August 2017 - Cover2
Bold Voices - August 2017 - Pres Note Front Teaser
Bold Voices - August 2017 - Masthead
Bold Voices - August 2017 - Oct. 31 Deadline to Apply for AACN Research Grants
Bold Voices - August 2017 - PCCN or CCRN: Which Certification Is Right for You?
Bold Voices - August 2017 - 7
Bold Voices - August 2017 - Updated Cardiac Nursing Course and CMC Review Course Online
Bold Voices - August 2017 - New Behavior-Based Pain Assessment Tool
Bold Voices - August 2017 - Former ICU Nurse Collects 100K Objects for Medical Mosaic
Bold Voices - August 2017 - Increasing Acceptance of Pediatric Telemedicine
Bold Voices - August 2017 - The Privilege of Nursing
Bold Voices - August 2017 - 13
Bold Voices - August 2017 - Seizure Risk Much Higher for Sepsis Survivors
Bold Voices - August 2017 - Short-Term Oral Corticosteroids Increase Risk of Adverse Effects
Bold Voices - August 2017 - Addressing Barriers to APRN Practice
Bold Voices - August 2017 - Effect of Rudeness on Pediatric Team Performance
Bold Voices - August 2017 - ECRI Introduces Patient Identification Tools
Bold Voices - August 2017 - Bundle Compliance Increases Survival, Reduces Delirium
Bold Voices - August 2017 - Members: Enhance Your Career With an AACN Scholarship
Bold Voices - August 2017 - Transitions
Bold Voices - August 2017 - President’s Note
Bold Voices - August 2017 - Cover3
Bold Voices - August 2017 - Cover4
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