Head CT is of Limited Diagnostic Value in Critically Ill Patients Who Remain Unresponsive After Discontinuation of Sedation

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Head CT is of Limited Diagnostic Value in Critically Ill Patients Who Remain Unresponsive After Discontinuation of Sedation

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dc.contributor.author Jaleel, Mairaj
dc.contributor.author Jain, Manu
dc.contributor.author Mahajan, Niraj
dc.contributor.author Kalhan, Ravi
dc.contributor.author Balagani, Rajesh
dc.contributor.author Donnelly, Helen K
dc.contributor.author Greenstein, Eugene
dc.contributor.author Mutlu, Gökhan M
dc.contributor.author Balachandran, Jay Shankar
dc.date.accessioned 2011-03-08T17:39:01Z
dc.date.issued 2009
dc.identifier.citation Balachandran, Jay S., Mairaj Jaleel, Manu Jain, Niraj Mahajan, Ravi Kalhan, Rajesh Balagani, Helen K. Donnelly, Eugene Greenstein, and Gökhan M. Mutlu. 2009. Head CT is of limited diagnostic value in critically ill patients who remain unresponsive after discontinuation of sedation. BMC Anesthesiology 9: 3. en_US
dc.identifier.issn 1471-2253 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:4739146
dc.description.abstract Background: Prolonged sedation is common in mechanically ventilated patients and is associated with increased morbidity and mortality. We sought to determine the diagnostic value of head computed tomography (CT) in mechanically ventilated patients who remain unresponsive after discontinuation of sedation. Methods: A retrospective review of adult (age >18 years of age) patients consecutively admitted to the medical intensive care unit of a tertiary care medical center. Patients requiring mechanical ventilation for management of respiratory failure for longer than 72 hours were included in the study group. A group that did not have difficulty with awakening was included as a control. Results: The median time after sedation was discontinued until a head CT was performed was 2 days (interquartile range 1.375–2 days). Majority (80%) of patients underwent head CT evaluation within the first 48 hours after discontinuation of sedation. Head CT was non-diagnostic in all but one patient who had a small subarachnoid hemorrhage. Twenty-five patients (60%) had a normal head CT. Head CT findings did not alter the management of any of the patients. The control group was similar to the experimental group with respect to demographics, etiology of respiratory failure and type of sedation used. However, while 37% of subjects in the control group had daily interruption of sedation, only 19% in the patient group had daily interruption of sedation (p < 0.05). Conclusion: In patients on mechanical ventilation for at least 72 hours and who remain unresponsive after sedative discontinuation and with a non-focal neurologic examination, head CT is performed early and is of very limited diagnostic utility. Routine use of daily interruption of sedation is used in a minority of patients outside of a clinical trial setting though it may decrease the frequency of unresponsiveness from prolonged sedation and the need for head CT in patients mechanically ventilated for a prolonged period. en_US
dc.language.iso en_US en_US
dc.publisher BioMed Central en_US
dc.relation.isversionof doi://10.1186/1471-2253-9-3 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2685364/pdf/ en_US
dash.license LAA
dc.title Head CT is of Limited Diagnostic Value in Critically Ill Patients Who Remain Unresponsive After Discontinuation of Sedation en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal BMC Anesthesiology en_US
dash.depositing.author Balachandran, Jay Shankar
dc.date.available 2011-03-08T17:39:01Z
dash.affiliation.other HMS^Medicine-Massachusetts General Hospital en_US

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