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: 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 scores in the tests evaluating global cognitive , motor speed , and attention functions . The 12-month time to death was 363 days in the dexmedetomidine group vs 188 days in the lorazepam group ( P = .48 ) . CONCLUSION In mechanically ventilated ICU patients managed with individualized targeted sedation , use of a dexmedetomidine infusion result ed in more days alive without delirium or coma and more time at the targeted level of sedation than with a lorazepam infusion . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00095251 A r and omised crossover study was undertaken to compare the quality and cost of controlled versus empirical sedation with midazolam in critically ill patients . Patients ( n = 40 ) entering the ICU were enrolled provided they satisfied the strict entry criteria . During 90 hours of midazolam sedation , patients received r and omly allocated 10-hour periods of controlled or empirical sedation . With empirical sedation , the mean dose of midazolam  and the cost of sedation were almost double those with controlled sedation . The quality of sedation was superior with the controlled method . In a separate study on 352 patients , a cost-benefit analysis of controlled sedation with midazolam or propofol infusion or bolus injections of morphine plus diazepam showed that the quality of sedation achieved with propofol was superior to the other two regimens and that , with morphine plus diazepam , the quality of sedation was unacceptably poor . Although the direct purchase price of propofol was higher than that of other agents , the total cost of sedation with propofol was lower than that for midazolam for short-term intensive care ( less than 24 hours ) and comparable to midazolam for longer-term use . However , indirect benefits of sedation with propofol include a much shorter ICU stay with the attendant reduced nursing costs and greater throughout the patients , and this more than compensates for the higher purchase price of the agent Objective : In critically ill patients receiving mechanical ventilation , daily interruption of sedative infusions decreases duration of mechanical ventilation and intensive care unit length of stay . Whether this sedation strategy reduces the incidence of complications commonly associated with critical illness is not known . Design : Blinded , retrospective chart review . Setting : University-based hospital in Chicago , IL . Patients : One hundred twenty-eight patients receiving mechanical ventilation and continuous infusions of sedative drugs in a medical intensive care unit . Interventions : None . Measurements and Main Results : We performed a blinded , retrospective evaluation of the data base from our previous trial of 128 patients r and omized to daily interruption of sedative infusions vs. sedation as directed by the medical intensive care unit team without this strategy . Seven distinct complications associated with mechanical ventilation and critical illness were identified : a ) ventilator-associated pneumonia ; b ) upper gastrointestinal hemorrhage ; c ) bacteremia ; d ) barotrauma ; e ) venous thromboembolic disease ; and f ) cholestasis or g ) sinusitis requiring surgical intervention . The incidence of complications was evaluated for each patient ’s hospital course . One hundred twenty-six of 128 charts were available for review . Patients undergoing daily interruption of sedative infusions experienced 13 complications ( 2.8 % ) vs. 26 ( 6.2 % ) in those subjected to conventional sedation techniques ( p = .04 ) . Conclusions : Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation reduces intensive care unit length of stay and , in turn , decreases the incidence of complications of critical illness associated with prolonged intubation and mechanical ventilation OBJECTIVE To compare a practice of protocol -directed sedation during mechanical ventilation implemented by nurses with traditional non- protocol -directed sedation administration . DESIGN R and omized , controlled clinical trial . SETTING Medical intensive care unit ( 19 beds ) in an urban teaching hospital . PATIENTS Patients requiring mechanical ventilation ( n = 321 ) . INTERVENTIONS Patients were r and omly assigned to receive either protocol -directed sedation ( n = 162 ) or non- protocol -directed sedation ( n = 159 ) . MEASUREMENTS AND MAIN RESULTS The median duration of mechanical ventilation was 55.9 hrs ( 95 % confidence interval , 41.0 - 90.0 hrs ) for patients managed with protocol -directed sedation and 117.0 hrs ( 95 % confidence interval , 96.0 - 155.6 hrs ) for patients receiving non- protocol -directed sedation . Kaplan-Meier analysis demonstrated that patients in the protocol -directed sedation group had statistically shorter duration s of mechanical ventilation than patients in the non- protocol -directed sedation group ( chi-square = 7.00 , p = .008 , log rank test ; chi-square = 8.54 , p = .004 , Wilcoxon 's test ; chi-square = 9.18 , p = .003 , -2 log test ) . Lengths of stay in the intensive care unit ( 5.7+/-5.9 days vs. 7.5+/-6.5 days ; p = .013 ) and hospital ( 14.0+/-17.3 days vs. 19.9+/-24.2 days ; p < .001 ) were also significantly shorter among patients in the protocol -directed sedation group . Among the 132 patients ( 41.1 % ) receiving continuous intravenous sedation , those in the protocol -directed sedation group ( n = 66 ) had a significantly shorter duration of continuous intravenous sedation than those in the non- protocol -directed sedation group ( n = 66 ) ( 3.5+/-4.0 days vs. 5.6+/-6.4 days ; p = .003 ) . Patients in the protocol -directed sedation group also had a significantly lower tracheostomy rate compared with patients in the non- protocol -directed sedation group ( 10 of 162 patients [ 6.2 % ] vs. 21 of 159 patients [ 13.2 % ] , p = .038 ) . CONCLUSIONS The use of protocol -directed sedation can reduce the duration of mechanical ventilation , the intensive care unit and hospital lengths of stay , and the need for tracheostomy among critically ill patients with acute respiratory failure Objective : To determine whether use of a sedation algorithm to promote a high level of tolerance to the intensive care environment and preserve consciousness affected time to arousal and duration of mechanical ventilation in patients without acute brain injury . Design : Two-phase , prospect i ve , controlled study . Setting : University-affiliated medical intensive care unit . Patients : Patients without acute brain injury requiring mechanical ventilation for at least 24 hrs . Interventions : During the control phase , sedatives and analgesics were adjusted according to the physician ’s decision . During the algorithm phase , sedatives and analgesics were adjusted according to an algorithm developed by a multidisciplinary team including nurses and physicians . The algorithm was based on regular assessment s of consciousness and tolerance to the intensive care unit environment using the Adaptation to Intensive Care Environment instrument and was design ed to achieve tolerance and maintain a high level of consciousness . St and ard practice s , including weaning from the ventilator , were the same during both study phases . Measurements and Main Results : A total of 102 patients were enrolled ( control group , n = 54 ; algorithm group , n = 48 ) . Median duration of mechanical ventilation was significantly shorter in the algorithm group ( 4.4 days [ interquartile range , 2.1–9.8 ] ) compared with the control group ( 10.3 days [ 3.5–17.2 ] , p = .014 ) , representing a 57.3 % reduction . In Cox multivariate analysis , the risk of remaining on mechanical ventilation was 0.48 times ( 95 % confidence interval , 0.29–0.78 ) lower for algorithm patients compared with controls . The median time to arousal was also significantly shorter in patients in the algorithm group ( 2 days [ 2–5 ] ) compared with the control group ( 4 days [ 2–9 ] , p = .006 ) . Conclusions : The use of a sedation algorithm to promote tolerance to the intensive care environment and preserve consciousness in patients without acute brain injury result ed in a marked decrease in the duration of mechanical ventilation . This reduction was at least partly attributable to a shorter time to arousal after initiation of mechanical ventilation OBJECTIVE : To measure the effect of evidence -based intensive care unit ( ICU ) sedation guidelines and interventions by a pharmacist to promote these guidelines on the weaning time from mechanical ventilation and sedation drug cost . DESIGN : Before-after study . SETTING : A 15-bed medical-surgical ICU at a tertiary-care teaching hospital . PATIENTS : 100 patients ( 2 groups of 50 consecutive patients ) on mechanical ventilation ( assist or pressure control mode for ≥6 h ) who were successfully discharged from the ICU . METHODS : ICU sedation guidelines were developed through physician , nursing , and pharmacy consensus using a physician survey and literature overview as points of reference and were implemented into practice . Prospect ively , data on the time required to wean patients from mechanical ventilation ( successful trial of T-piece , pressure support , or intermittent m and atory ventilation leading to extubation ) and total drug costs for sedation were measured and compared between groups . All prospect i ve ICU pharmacist interventions pertaining to sedation were documented . RESULTS : New sedation guidelines promoted lorazepam use in preference to midazolam and suggested propofol for patients not successfully se date d with high-dose lorazepam , haloperidol , or morphine . Over the 2-month collection periods , there was no difference in the median weaning time between the pre- ( 16 h , range 2–607 ) and post- ( 18 h , range 1–284 ) guideline groups . Total sedation drug costs decreased from $ 4515 to $ 1152 ( $ US ) ( p = 0.081 ) . Median sedation drug costs decreased from $ 11.27 ( range $ 0–1340 ) to $ 3.55 ( range $ 0–250 ) , with the amount ( mg ) of midazolam and propofol used decreasing by 86 % and 100 % , respectively . The ICU pharmacist successfully recommended a change from midazolam to lorazepam in 12 of 50 patients , 5 of whom had received midazolam for more than 24 hours . CONCLUSIONS : High compliance with ICU sedation guidelines promoting lorazepam rather than midazolam or propofol in mechanically ventilated patients led to a 75 % decrease in sedation drug costs and did not adversely affect the clinicians ' ability to wean patients from mechanical ventilation Objective : While the use of a protocol to guide sedation and analgesia therapy in the intensive care unit has been shown to improve patient outcomes , compliance is often poor . We hypothesized that a formal , consistent intervention by pharmacists to promote adherence to our institution 's sedation guidelines would improve clinical outcomes . The purpose of this study was to document the impact of daily pharmacist interventions on clinical outcomes of intensive care unit patients prescribed continuous sedative therapy .  Design : Before-after study . Setting : Two medical intensive care units ( total of 18 beds 
    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: 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 scores in the tests evaluating global cognitive , motor speed , and attention functions . The 12-month time to death was 363 days in the dexmedetomidine group vs 188 days in the lorazepam group ( P = .48 ) . CONCLUSION In mechanically ventilated ICU patients managed with individualized targeted sedation , use of a dexmedetomidine infusion result ed in more days alive without delirium or coma and more time at the targeted level of sedation than with a lorazepam infusion . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00095251 A r and omised crossover study was undertaken to compare the quality and cost of controlled versus empirical sedation with midazolam in critically ill patients . Patients ( n = 40 ) entering the ICU were enrolled provided they satisfied the strict entry criteria . During 90 hours of midazolam sedation , patients received r and omly allocated 10-hour periods of controlled or empirical sedation . With empirical sedation , the mean dose of midazolam  and the cost of sedation were almost double those with controlled sedation . The quality of sedation was superior with the controlled method . In a separate study on 352 patients , a cost-benefit analysis of controlled sedation with midazolam or propofol infusion or bolus injections of morphine plus diazepam showed that the quality of sedation achieved with propofol was superior to the other two regimens and that , with morphine plus diazepam , the quality of sedation was unacceptably poor . Although the direct purchase price of propofol was higher than that of other agents , the total cost of sedation with propofol was lower than that for midazolam for short-term intensive care ( less than 24 hours ) and comparable to midazolam for longer-term use . However , indirect benefits of sedation with propofol include a much shorter ICU stay with the attendant reduced nursing costs and greater throughout the patients , and this more than compensates for the higher purchase price of the agent Objective : In critically ill patients receiving mechanical ventilation , daily interruption of sedative infusions decreases duration of mechanical ventilation and intensive care unit length of stay . Whether this sedation strategy reduces the incidence of complications commonly associated with critical illness is not known . Design : Blinded , retrospective chart review . Setting : University-based hospital in Chicago , IL . Patients : One hundred twenty-eight patients receiving mechanical ventilation and continuous infusions of sedative drugs in a medical intensive care unit . Interventions : None . Measurements and Main Results : We performed a blinded , retrospective evaluation of the data base from our previous trial of 128 patients r and omized to daily interruption of sedative infusions vs. sedation as directed by the medical intensive care unit team without this strategy . Seven distinct complications associated with mechanical ventilation and critical illness were identified : a ) ventilator-associated pneumonia ; b ) upper gastrointestinal hemorrhage ; c ) bacteremia ; d ) barotrauma ; e ) venous thromboembolic disease ; and f ) cholestasis or g ) sinusitis requiring surgical intervention . The incidence of complications was evaluated for each patient ’s hospital course . One hundred twenty-six of 128 charts were available for review . Patients undergoing daily interruption of sedative infusions experienced 13 complications ( 2.8 % ) vs. 26 ( 6.2 % ) in those subjected to conventional sedation techniques ( p = .04 ) . Conclusions : Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation reduces intensive care unit length of stay and , in turn , decreases the incidence of complications of critical illness associated with prolonged intubation and mechanical ventilation OBJECTIVE To compare a practice of protocol -directed sedation during mechanical ventilation implemented by nurses with traditional non- protocol -directed sedation administration . DESIGN R and omized , controlled clinical trial . SETTING Medical intensive care unit ( 19 beds ) in an urban teaching hospital . PATIENTS Patients requiring mechanical ventilation ( n = 321 ) . INTERVENTIONS Patients were r and omly assigned to receive either protocol -directed sedation ( n = 162 ) or non- protocol -directed sedation ( n = 159 ) . MEASUREMENTS AND MAIN RESULTS The median duration of mechanical ventilation was 55.9 hrs ( 95 % confidence interval , 41.0 - 90.0 hrs ) for patients managed with protocol -directed sedation and 117.0 hrs ( 95 % confidence interval , 96.0 - 155.6 hrs ) for patients receiving non- protocol -directed sedation . Kaplan-Meier analysis demonstrated that patients in the protocol -directed sedation group had statistically shorter duration s of mechanical ventilation than patients in the non- protocol -directed sedation group ( chi-square = 7.00 , p = .008 , log rank test ; chi-square = 8.54 , p = .004 , Wilcoxon 's test ; chi-square = 9.18 , p = .003 , -2 log test ) . Lengths of stay in the intensive care unit ( 5.7+/-5.9 days vs. 7.5+/-6.5 days ; p = .013 ) and hospital ( 14.0+/-17.3 days vs. 19.9+/-24.2 days ; p < .001 ) were also significantly shorter among patients in the protocol -directed sedation group . Among the 132 patients ( 41.1 % ) receiving continuous intravenous sedation , those in the protocol -directed sedation group ( n = 66 ) had a significantly shorter duration of continuous intravenous sedation than those in the non- protocol -directed sedation group ( n = 66 ) ( 3.5+/-4.0 days vs. 5.6+/-6.4 days ; p = .003 ) . Patients in the protocol -directed sedation group also had a significantly lower tracheostomy rate compared with patients in the non- protocol -directed sedation group ( 10 of 162 patients [ 6.2 % ] vs. 21 of 159 patients [ 13.2 % ] , p = .038 ) . CONCLUSIONS The use of protocol -directed sedation can reduce the duration of mechanical ventilation , the intensive care unit and hospital lengths of stay , and the need for tracheostomy among critically ill patients with acute respiratory failure Objective : To determine whether use of a sedation algorithm to promote a high level of tolerance to the intensive care environment and preserve consciousness affected time to arousal and duration of mechanical ventilation in patients without acute brain injury . Design : Two-phase , prospect i ve , controlled study . Setting : University-affiliated medical intensive care unit . Patients : Patients without acute brain injury requiring mechanical ventilation for at least 24 hrs . Interventions : During the control phase , sedatives and analgesics were adjusted according to the physician ’s decision . During the algorithm phase , sedatives and analgesics were adjusted according to an algorithm developed by a multidisciplinary team including nurses and physicians . The algorithm was based on regular assessment s of consciousness and tolerance to the intensive care unit environment using the Adaptation to Intensive Care Environment instrument and was design ed to achieve tolerance and maintain a high level of consciousness . St and ard practice s , including weaning from the ventilator , were the same during both study phases . Measurements and Main Results : A total of 102 patients were enrolled ( control group , n = 54 ; algorithm group , n = 48 ) . Median duration of mechanical ventilation was significantly shorter in the algorithm group ( 4.4 days [ interquartile range , 2.1–9.8 ] ) compared with the control group ( 10.3 days [ 3.5–17.2 ] , p = .014 ) , representing a 57.3 % reduction . In Cox multivariate analysis , the risk of remaining on mechanical ventilation was 0.48 times ( 95 % confidence interval , 0.29–0.78 ) lower for algorithm patients compared with controls . The median time to arousal was also significantly shorter in patients in the algorithm group ( 2 days [ 2–5 ] ) compared with the control group ( 4 days [ 2–9 ] , p = .006 ) . Conclusions : The use of a sedation algorithm to promote tolerance to the intensive care environment and preserve consciousness in patients without acute brain injury result ed in a marked decrease in the duration of mechanical ventilation . This reduction was at least partly attributable to a shorter time to arousal after initiation of mechanical ventilation OBJECTIVE : To measure the effect of evidence -based intensive care unit ( ICU ) sedation guidelines and interventions by a pharmacist to promote these guidelines on the weaning time from mechanical ventilation and sedation drug cost . DESIGN : Before-after study . SETTING : A 15-bed medical-surgical ICU at a tertiary-care teaching hospital . PATIENTS : 100 patients ( 2 groups of 50 consecutive patients ) on mechanical ventilation ( assist or pressure control mode for ≥6 h ) who were successfully discharged from the ICU . METHODS : ICU sedation guidelines were developed through physician , nursing , and pharmacy consensus using a physician survey and literature overview as points of reference and were implemented into practice . Prospect ively , data on the time required to wean patients from mechanical ventilation ( successful trial of T-piece , pressure support , or intermittent m and atory ventilation leading to extubation ) and total drug costs for sedation were measured and compared between groups . All prospect i ve ICU pharmacist interventions pertaining to sedation were documented . RESULTS : New sedation guidelines promoted lorazepam use in preference to midazolam and suggested propofol for patients not successfully se date d with high-dose lorazepam , haloperidol , or morphine . Over the 2-month collection periods , there was no difference in the median weaning time between the pre- ( 16 h , range 2–607 ) and post- ( 18 h , range 1–284 ) guideline groups . Total sedation drug costs decreased from $ 4515 to $ 1152 ( $ US ) ( p = 0.081 ) . Median sedation drug costs decreased from $ 11.27 ( range $ 0–1340 ) to $ 3.55 ( range $ 0–250 ) , with the amount ( mg ) of midazolam and propofol used decreasing by 86 % and 100 % , respectively . The ICU pharmacist successfully recommended a change from midazolam to lorazepam in 12 of 50 patients , 5 of whom had received midazolam for more than 24 hours . CONCLUSIONS : High compliance with ICU sedation guidelines promoting lorazepam rather than midazolam or propofol in mechanically ventilated patients led to a 75 % decrease in sedation drug costs and did not adversely affect the clinicians ' ability to wean patients from mechanical ventilation Objective : While the use of a protocol to guide sedation and analgesia therapy in the intensive care unit has been shown to improve patient outcomes , compliance is often poor . We hypothesized that a formal , consistent intervention by pharmacists to promote adherence to our institution 's sedation guidelines would improve clinical outcomes . The purpose of this study was to document the impact of daily pharmacist interventions on clinical outcomes of intensive care unit patients prescribed continuous sedative therapy .  Design : Before-after study . Setting : Two medical intensive care units ( total of 18 beds 
    Output:
    