human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVES To determine whether sedation with propofol would lead to shorter times to tracheal extubation and ICU length of stay than sedation with midazolam . DESIGN Multicenter , r and omized , open label . SETTING Four academic tertiary-care ICUs in Canada . PATIENTS Critically ill patients requiring continuous sedation while receiving mechanical ventilation . INTERVENTIONS R and om allocation by predicted requirement for mechanical ventilation ( short sedation stratum , < 24 h ; medium sedation stratum , > or = 24 and < 72 h ; and long sedation stratum , > or = 72 h ) to sedation regimens utilizing propofol or midazolam . MEASUREMENTS AND RESULTS Using an intention-to-treat analysis , patients r and omized to receive propofol  in the short sedation  stratum  ( propofol , 21 patients ; midazolam , 26 patients ) and the long sedation stratum ( propofol , 4 patients ; midazolam , 10 patients ) were extubated earlier ( short sedation stratum : propofol , 5.6 h ; midazolam , 11.9 h ; long sedation stratum : propofol , 8.4 h ; midazolam , 46.8 h ; p < 0.05 ) . Pooled results showed that patients treated with propofol ( n = 46 ) were extubated earlier than those treated with midazolam ( n = 53 ) ( 6.7 vs 24.7 h , respectively ; p < 0.05 ) following discontinuation of the sedation but were not discharged from ICU earlier ( 94.0 vs 63.7 h , respectively ; p = 0.26 ) . Propofol-treated patients spent a larger percentage of time at the target Ramsay sedation level than midazolam-treated patients ( 60.2 % vs 44.0 % , respectively ; p < 0.05 ) . Using a treatment-received analysis , propofol sedation either did not differ from midazolam sedation in time to tracheal extubation or ICU discharge ( sedation duration , < 24 h ) or was associated with earlier tracheal extubation but longer time to ICU discharge ( sedation duration , > or = 24 h , < 72 h , or > or = 72 h ) . CONCLUSIONS The use of propofol sedation allowed for more rapid tracheal extubation than when midazolam sedation was employed . This did not result in earlier ICU discharge The aim of this study was to observe the impact of dexmedetomidine on postoperative myocardial injury in patients undergoing off-pump coronary artery bypass ( OPCAB ) grafting . One hundred and sixty-two patients who were undergoing OPCAB surgery were r and omly divided into control and dexmedetomidine groups ( groups C and Dex , respectively ) . Following the first vascular anastomosis grafting , the patients in group Dex received a continuous intravenous infusion of 0.2–0.5 μg/kg/h dexmedetomidine , until they were transferred to the Cardiac Surgery intensive care unit ( ICU ) for 12 h. Patients in group C received physiological saline intraoperatively and an intravenous infusion of 2–4 mg/kg/h isopropylphenol for postoperative sedation . Invasive arterial pressure and heart rate were continuously monitored for 5 min subsequent to entry into the operating theatre ( T0 ) , immediately following surgery ( T1 ) , 12 h post-surgery ( T2 ) , 24 h post-surgery(T3 ) , 48 h post-surgery(T4 ) and 72 h post-surgery ( T5 ) . Blood sample s were taken to determine the plasma levels of cardiac troponin I ( cTnI ) and creatine kinase-MB ( CK-MB ) at each time point . At 72 h post-surgery , a dynamic electrocardiogram was monitored . The blood pressure , heart rate , levels of cTnI , CK-MB , norepinephrine and cortisol , and postoperative arrhythmic events in the patients in group Dex all decreased compared with those in group C. The duration of mechanical ventilation and ICU residence time were also shorter than those in the control group ( P<0.05 ) . Dexmedetomidine reduced post-surgical myocardial injury in patients who had undergone OPCAB surgery Objective To compare the efficacy of dexmedetomidine versus morphine as a sedative/analgesic among post-operative cardiac surgery patients . Method A r and omized controlled open-label study was performed at the cardiothoracic intensive care unit of Penang Hospital , Malaysia . A total of 28 patients who underwent cardiac surgeries were r and omly assigned to receive either dexmedetomidine or morphine . Both groups were similar in terms of preoperative baseline characteristics . Efficacy measures included sedation scores and pain intensity and requirements for additional sedative/analgesic . Mean heart rate and arterial blood pressure were used as safety measures . Other measures were additional inotropes , extubation time and other concurrent medications . Results The mean dose of dexmedetomidine infused was 0.12 [ SD 0.03 ] μg kg−1 h−1 , while that of morphine was 13.2 [ SD 5.84 ] μg kg−1 h−1 . Dexmedetomidine group showed more benefits in sedation and pain levels , additional sedative/analgesic requirements , and extubation time . No significant differences between the two groups for the outcome measures , except heart rate , which was significantly lower in the dexmedetomidine group . Conclusion This preliminary study suggests that dexmedetomidine was at least comparable to morphine in terms of efficacy and safety among cardiac surgery patients . Further studies with larger sample s are recommended in order to determine the significant effects of the outcome measures BACKGROUND Patients and medical staff are exposed to high noise levels in ICUs , which may have a negative impact on their health . Due to the diversity of noise sources present , including the operating noise of medical devices , staff conversations and the unwrapping of disposables , noise profiles are varied . Psychoacoustics deals with the analysis of sound , focusing on its effects on physiological perception and stress . OBJECTIVES The aim of our study was to examine and to classify noise and its psychoacoustic properties in different locations in our ICU at different times . The impact of noise on subjective parameters and stress-related physiological data was also assessed with and without interventional methods . DESIGN A r and omised , controlled , single-blinded clinical trial . SETTING University Hospital , from November 2010 to May 2011 . PATIENTS One hundred and forty-four patients in the ICU . INTERVENTIONS In the first part , multidisciplinary psychoacoustic measurement was performed on the patients in our ICU . In the subsequent clinical trial , patients were equipped with effective earplugs , less effective earplugs and no earplugs . Thereafter , active noise cancellation headphones with or without sound masking were employed on a third patient population . MAIN OUTCOME MEASURES Cortisol and & agr;-amylase in saliva , skin conductance measures , vital signs , psychoacoustic analyses and two st and ardised question naires [ State-Trait Anxiety Inventory ( STAI ) and Hospital Anxiety and Depression Scale ( HADS ) ] were assessed . RESULTS In the first part , the mean ± st and ard deviation ( SD ) subjective loudness was 9.2 ± 4.0 sone . Although absolute sound pressure level and loudness were lower during the night , the number of loud events increased significantly . Skin conductance in the earplug groups was significantly reduced in comparison to that in the control population but not the active noise reduction groups . Nevertheless , noise reduction was found to be comfortable for most patients . CONCLUSION Noise in the ICU is of high clinical relevance . Diverse noise reduction methods , such as earplugs and active noise cancellation , are available . The avoidance of unnecessary noise , however , should be the primary focus . TRIAL REGISTRATION German Clinical Trials Register ( DRKS00000534 ) Background and Aims : Patients on ventilatory support in intensive care unit ( ICU ) require sedation and analgesia to facilitate mechanical ventilation and endotracheal tube tolerance . The selection of the agent should be such that it does not interfere with the early extubation of the patients . We compared the efficacy of dexmedetomidine with midazolam to facilitate extubation of patients from mechanical ventilation in terms of the sedative properties , cardiovascular responses , ventilation , and extubation characteristics and safety profile . Material s and Methods : A total of 40 adult , mechanically ventilated patients of either sex , aged 18 - 60 years , meeting the st and ard criteria for weaning , r and omized into 2 groups of 20 patients each , received intravenous infusion of dexmedetomidine ( 0.2 - 0.7 mcg/kg/h ) or midazolam ( 0.04 - 0.2 mg/kg/h ) as needed for Ramsay sedation scale 2 - 4 . Extubation following st and ard extubation protocol was done . Time for extubation and vital parameters were regularly recorded . Results : The time to extubation in the dexmedetomidine group was significantly lower than in the midazolam group . Heart rate and blood pressure was significantly lower in dexmedetomidine group than the midazolam group at most of the times . Conclusions : Dexmedetomidine has clinical ly relevant benefits compared with midazolam in facilitating extubation due to its shorter time to extubation , more hemodynamic stability , easy arousability , and lack of respiratory depression Introduction This study hypothesised that a reduction of sound during the night using earplugs could be beneficial in the prevention of intensive care delirium .  Two research questions were formulated . First , does the use of earplugs during the night reduce the onset of delirium or confusion in the ICU ? Second , does the use of earplugs during the night improve the quality of sleep in the ICU ? Methods A r and omized clinical trial included adult intensive care patients in an intervention group of 69 patients sleeping with earplugs during the night and a control group of 67 patients sleeping without earplugs during the night . The research ers were blinded during data collection . Assignment was performed by an independent nurse research er using a computer program . Eligible patients had an expected length of stay in the ICU of more than 24 hours , were Dutch- or English-speaking and scored a minimum Glasgow Coma Scale of 10 .  Delirium was assessed using the vali date d NEECHAM scale , sleep perception was reported by the patient in response to five questions . Results The use of earplugs during the night lowered the incidence of confusion in the studied intensive care patients . A vast improvement was shown by a Hazard Ratio of 0.47 ( 95 % confidence interval ( CI ) 0.27 to 0.82 ) . Also , patients sleeping with earplugs developed confusion later than the patients sleeping without earplugs . After the first night in the ICU , patients sleeping with earplugs reported a better sleep perception . Conclusions Earplugs may be a useful instrument in the prevention of confusion or delirium . The beneficial effects seem to be strongest within 48 hours after admission . The relation between sleep , sound and delirium , however , needs further research .Trial registration Current Controlled Trials IS RCT CONTEXT Lorazepam is currently recommended for sustained sedation of mechanically ventilated intensive care unit ( ICU ) patients , but this and other benzodiazepine drugs may contribute to acute brain dysfunction , ie , delirium and coma , associated with prolonged hospital stays , costs , and increased mortality . Dexmedetomidine induces sedation via different central nervous system receptors than the benzodiazepine drugs and may lower the risk of acute brain dysfunction . OBJECTIVE To determine whether dexmedetomidine reduces the duration of delirium and coma in mechanically ventilated ICU patients while providing adequate sedation as compared with lorazepam . DESIGN , SETTING , PATIENTS , AND INTERVENTION Double-blind , r and omized controlled trial of 106 adult mechanically ventilated medical and surgical ICU patients at 2 tertiary care centers between August 2004 and April 2006 . Patients were se date d with dexmedetomidine or lorazepam for as many as 120 hours . Study drugs were titrated to achieve the desired level of sedation , measured using the Richmond Agitation-Sedation Scale ( RASS ) . Patients were monitored twice daily for delirium using the Confusion Assessment Method for the ICU ( CAM-ICU ) . MAIN OUTCOME MEASURES Days alive without delirium or coma and percentage of days spent within 1 RASS point of the sedation goal . RESULTS Sedation with dexmedetomidine result ed in more days alive without delirium or coma ( median days , 7.0 vs 3.0 ; P = .01 ) and a lower prevalence of coma ( 63 % vs 92 % ; P < .001 ) than sedation with lorazepam . Patients se date d with dexmedetomidine spent more time within 1 RASS point of their sedation goal compared with patients se date d with lorazepam ( median percentage of days , 80 % vs 67 % ; P = .04 ) . The 28-day mortality in the dexmedetomidine group was 17 % vs 27 % in the lorazepam group ( P = .18 ) and cost of care was similar between groups . More patients in the dexmedetomidine group ( 42 % vs 31 % ; P = .61 ) were able to complete post-ICU neuropsychological testing , with similar 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVES To determine whether sedation with propofol would lead to shorter times to tracheal extubation and ICU length of stay than sedation with midazolam . DESIGN Multicenter , r and omized , open label . SETTING Four academic tertiary-care ICUs in Canada . PATIENTS Critically ill patients requiring continuous sedation while receiving mechanical ventilation . INTERVENTIONS R and om allocation by predicted requirement for mechanical ventilation ( short sedation stratum , < 24 h ; medium sedation stratum , > or = 24 and < 72 h ; and long sedation stratum , > or = 72 h ) to sedation regimens utilizing propofol or midazolam . MEASUREMENTS AND RESULTS Using an intention-to-treat analysis , patients r and omized to receive propofol  in the short sedation  stratum  ( propofol , 21 patients ; midazolam , 26 patients ) and the long sedation stratum ( propofol , 4 patients ; midazolam , 10 patients ) were extubated earlier ( short sedation stratum : propofol , 5.6 h ; midazolam , 11.9 h ; long sedation stratum : propofol , 8.4 h ; midazolam , 46.8 h ; p < 0.05 ) . Pooled results showed that patients treated with propofol ( n = 46 ) were extubated earlier than those treated with midazolam ( n = 53 ) ( 6.7 vs 24.7 h , respectively ; p < 0.05 ) following discontinuation of the sedation but were not discharged from ICU earlier ( 94.0 vs 63.7 h , respectively ; p = 0.26 ) . Propofol-treated patients spent a larger percentage of time at the target Ramsay sedation level than midazolam-treated patients ( 60.2 % vs 44.0 % , respectively ; p < 0.05 ) . Using a treatment-received analysis , propofol sedation either did not differ from midazolam sedation in time to tracheal extubation or ICU discharge ( sedation duration , < 24 h ) or was associated with earlier tracheal extubation but longer time to ICU discharge ( sedation duration , > or = 24 h , < 72 h , or > or = 72 h ) . CONCLUSIONS The use of propofol sedation allowed for more rapid tracheal extubation than when midazolam sedation was employed . This did not result in earlier ICU discharge The aim of this study was to observe the impact of dexmedetomidine on postoperative myocardial injury in patients undergoing off-pump coronary artery bypass ( OPCAB ) grafting . One hundred and sixty-two patients who were undergoing OPCAB surgery were r and omly divided into control and dexmedetomidine groups ( groups C and Dex , respectively ) . Following the first vascular anastomosis grafting , the patients in group Dex received a continuous intravenous infusion of 0.2–0.5 μg/kg/h dexmedetomidine , until they were transferred to the Cardiac Surgery intensive care unit ( ICU ) for 12 h. Patients in group C received physiological saline intraoperatively and an intravenous infusion of 2–4 mg/kg/h isopropylphenol for postoperative sedation . Invasive arterial pressure and heart rate were continuously monitored for 5 min subsequent to entry into the operating theatre ( T0 ) , immediately following surgery ( T1 ) , 12 h post-surgery ( T2 ) , 24 h post-surgery(T3 ) , 48 h post-surgery(T4 ) and 72 h post-surgery ( T5 ) . Blood sample s were taken to determine the plasma levels of cardiac troponin I ( cTnI ) and creatine kinase-MB ( CK-MB ) at each time point . At 72 h post-surgery , a dynamic electrocardiogram was monitored . The blood pressure , heart rate , levels of cTnI , CK-MB , norepinephrine and cortisol , and postoperative arrhythmic events in the patients in group Dex all decreased compared with those in group C. The duration of mechanical ventilation and ICU residence time were also shorter than those in the control group ( P<0.05 ) . Dexmedetomidine reduced post-surgical myocardial injury in patients who had undergone OPCAB surgery Objective To compare the efficacy of dexmedetomidine versus morphine as a sedative/analgesic among post-operative cardiac surgery patients . Method A r and omized controlled open-label study was performed at the cardiothoracic intensive care unit of Penang Hospital , Malaysia . A total of 28 patients who underwent cardiac surgeries were r and omly assigned to receive either dexmedetomidine or morphine . Both groups were similar in terms of preoperative baseline characteristics . Efficacy measures included sedation scores and pain intensity and requirements for additional sedative/analgesic . Mean heart rate and arterial blood pressure were used as safety measures . Other measures were additional inotropes , extubation time and other concurrent medications . Results The mean dose of dexmedetomidine infused was 0.12 [ SD 0.03 ] μg kg−1 h−1 , while that of morphine was 13.2 [ SD 5.84 ] μg kg−1 h−1 . Dexmedetomidine group showed more benefits in sedation and pain levels , additional sedative/analgesic requirements , and extubation time . No significant differences between the two groups for the outcome measures , except heart rate , which was significantly lower in the dexmedetomidine group . Conclusion This preliminary study suggests that dexmedetomidine was at least comparable to morphine in terms of efficacy and safety among cardiac surgery patients . Further studies with larger sample s are recommended in order to determine the significant effects of the outcome measures BACKGROUND Patients and medical staff are exposed to high noise levels in ICUs , which may have a negative impact on their health . Due to the diversity of noise sources present , including the operating noise of medical devices , staff conversations and the unwrapping of disposables , noise profiles are varied . Psychoacoustics deals with the analysis of sound , focusing on its effects on physiological perception and stress . OBJECTIVES The aim of our study was to examine and to classify noise and its psychoacoustic properties in different locations in our ICU at different times . The impact of noise on subjective parameters and stress-related physiological data was also assessed with and without interventional methods . DESIGN A r and omised , controlled , single-blinded clinical trial . SETTING University Hospital , from November 2010 to May 2011 . PATIENTS One hundred and forty-four patients in the ICU . INTERVENTIONS In the first part , multidisciplinary psychoacoustic measurement was performed on the patients in our ICU . In the subsequent clinical trial , patients were equipped with effective earplugs , less effective earplugs and no earplugs . Thereafter , active noise cancellation headphones with or without sound masking were employed on a third patient population . MAIN OUTCOME MEASURES Cortisol and & agr;-amylase in saliva , skin conductance measures , vital signs , psychoacoustic analyses and two st and ardised question naires [ State-Trait Anxiety Inventory ( STAI ) and Hospital Anxiety and Depression Scale ( HADS ) ] were assessed . RESULTS In the first part , the mean ± st and ard deviation ( SD ) subjective loudness was 9.2 ± 4.0 sone . Although absolute sound pressure level and loudness were lower during the night , the number of loud events increased significantly . Skin conductance in the earplug groups was significantly reduced in comparison to that in the control population but not the active noise reduction groups . Nevertheless , noise reduction was found to be comfortable for most patients . CONCLUSION Noise in the ICU is of high clinical relevance . Diverse noise reduction methods , such as earplugs and active noise cancellation , are available . The avoidance of unnecessary noise , however , should be the primary focus . TRIAL REGISTRATION German Clinical Trials Register ( DRKS00000534 ) Background and Aims : Patients on ventilatory support in intensive care unit ( ICU ) require sedation and analgesia to facilitate mechanical ventilation and endotracheal tube tolerance . The selection of the agent should be such that it does not interfere with the early extubation of the patients . We compared the efficacy of dexmedetomidine with midazolam to facilitate extubation of patients from mechanical ventilation in terms of the sedative properties , cardiovascular responses , ventilation , and extubation characteristics and safety profile . Material s and Methods : A total of 40 adult , mechanically ventilated patients of either sex , aged 18 - 60 years , meeting the st and ard criteria for weaning , r and omized into 2 groups of 20 patients each , received intravenous infusion of dexmedetomidine ( 0.2 - 0.7 mcg/kg/h ) or midazolam ( 0.04 - 0.2 mg/kg/h ) as needed for Ramsay sedation scale 2 - 4 . Extubation following st and ard extubation protocol was done . Time for extubation and vital parameters were regularly recorded . Results : The time to extubation in the dexmedetomidine group was significantly lower than in the midazolam group . Heart rate and blood pressure was significantly lower in dexmedetomidine group than the midazolam group at most of the times . Conclusions : Dexmedetomidine has clinical ly relevant benefits compared with midazolam in facilitating extubation due to its shorter time to extubation , more hemodynamic stability , easy arousability , and lack of respiratory depression Introduction This study hypothesised that a reduction of sound during the night using earplugs could be beneficial in the prevention of intensive care delirium .  Two research questions were formulated . First , does the use of earplugs during the night reduce the onset of delirium or confusion in the ICU ? Second , does the use of earplugs during the night improve the quality of sleep in the ICU ? Methods A r and omized clinical trial included adult intensive care patients in an intervention group of 69 patients sleeping with earplugs during the night and a control group of 67 patients sleeping without earplugs during the night . The research ers were blinded during data collection . Assignment was performed by an independent nurse research er using a computer program . Eligible patients had an expected length of stay in the ICU of more than 24 hours , were Dutch- or English-speaking and scored a minimum Glasgow Coma Scale of 10 .  Delirium was assessed using the vali date d NEECHAM scale , sleep perception was reported by the patient in response to five questions . Results The use of earplugs during the night lowered the incidence of confusion in the studied intensive care patients . A vast improvement was shown by a Hazard Ratio of 0.47 ( 95 % confidence interval ( CI ) 0.27 to 0.82 ) . Also , patients sleeping with earplugs developed confusion later than the patients sleeping without earplugs . After the first night in the ICU , patients sleeping with earplugs reported a better sleep perception . Conclusions Earplugs may be a useful instrument in the prevention of confusion or delirium . The beneficial effects seem to be strongest within 48 hours after admission . The relation between sleep , sound and delirium , however , needs further research .Trial registration Current Controlled Trials IS RCT CONTEXT Lorazepam is currently recommended for sustained sedation of mechanically ventilated intensive care unit ( ICU ) patients , but this and other benzodiazepine drugs may contribute to acute brain dysfunction , ie , delirium and coma , associated with prolonged hospital stays , costs , and increased mortality . Dexmedetomidine induces sedation via different central nervous system receptors than the benzodiazepine drugs and may lower the risk of acute brain dysfunction . OBJECTIVE To determine whether dexmedetomidine reduces the duration of delirium and coma in mechanically ventilated ICU patients while providing adequate sedation as compared with lorazepam . DESIGN , SETTING , PATIENTS , AND INTERVENTION Double-blind , r and omized controlled trial of 106 adult mechanically ventilated medical and surgical ICU patients at 2 tertiary care centers between August 2004 and April 2006 . Patients were se date d with dexmedetomidine or lorazepam for as many as 120 hours . Study drugs were titrated to achieve the desired level of sedation , measured using the Richmond Agitation-Sedation Scale ( RASS ) . Patients were monitored twice daily for delirium using the Confusion Assessment Method for the ICU ( CAM-ICU ) . MAIN OUTCOME MEASURES Days alive without delirium or coma and percentage of days spent within 1 RASS point of the sedation goal . RESULTS Sedation with dexmedetomidine result ed in more days alive without delirium or coma ( median days , 7.0 vs 3.0 ; P = .01 ) and a lower prevalence of coma ( 63 % vs 92 % ; P < .001 ) than sedation with lorazepam . Patients se date d with dexmedetomidine spent more time within 1 RASS point of their sedation goal compared with patients se date d with lorazepam ( median percentage of days , 80 % vs 67 % ; P = .04 ) . The 28-day mortality in the dexmedetomidine group was 17 % vs 27 % in the lorazepam group ( P = .18 ) and cost of care was similar between groups . More patients in the dexmedetomidine group ( 42 % vs 31 % ; P = .61 ) were able to complete post-ICU neuropsychological testing , with similar 
    Output:
    