Evaluation of Sedative and Analgesic Practices and Outcomes in Mechanically Ventilated Patients

INTRODUCTION: Sedative and analgesic agents are used for patient comfort during mechanical ventilation (MV) but can cause deleterious effects such as prolonged MV and delirium. Maintaining light sedation and performing daily awakening trials (DATs) can reduce untoward effects. We assessed the relationship between sedative and analgesic dose and 28-day MV-free survival in medical ICU (MICU), surgical ICU (SICU), and cardiac (CICU) patients, hypothesizing that higher doses would be associated with lower 28-day MV-free survival. METHOD(S): In this single-center retrospective study, MICU, SICU, and CICU patients admitted to a tertiary care hospital from 1/1/21-6/30/21 and on MV admitted for 1-7 days were randomly selected if their goal Sedation Agitation Scale (SAS) score was 3-4. Baseline demographics and clinical characteristics were collected. The primary outcome was correlation between average sedative or analgesic dose and 28-day MV-free survival. Secondary outcomes included time at goal SAS score, DAT completion, and deep sedation (SAS < 3) within 48 hours of intubation. The primary outcome was evaluated using linear regression;secondary outcomes were assessed with descriptive statistics. RESULT(S): 411 subjects, including 99 MICU, 54 SICU, and 27 CICU patients, were evaluated. 53% were male and the median age and weight were 66.5 years (IQR, 56-77) and 84 kg (IQR 70-100), respectively. 8% of MICU patients but no SICU or CICU patients had Covid-19. A history of chronic opioid use was most common in MICU and SICU patients (19% and 17%, respectively) and CICU patients most often had a history of chronic kidney disease (33%). Doses of dexmedetomidine, propofol, midazolam, and fentanyl demonstrated poor correlation with 28-day MV-free survival among all patients, with R-squared values of 0.002, 0.06, 0.01, and 0.1, respectively. The association of sedative dose was strongest for midazolam in MICU patients, with each 1mg/hr increase corresponding to a 0.6 day reduction in 28- day MV-free survival. SAS scores were 3-4 70% of the time, SATs were completed in 73% of appropriate cases, and 57% of patients were deeply sedated within 48 hours of intubation. CONCLUSION(S): In this regression analysis, sedative and analgesic doses were not associated with 28-day MV-free survival in a mixed critically ill population.

Facilitating Children's Social and Emotional Development in Virtual Preschool Learning: Implications for In-Person Teaching

The authors discuss the challenges and opportunities for teachers in facilitating social and emotional development in preschool children, creating partnerships with their families, and addressing their impeded progress induced by COVID-19. The authors further illuminate lessons learned and provide implications for partnering with families during in-person instruction. © 2022 Kappa Delta Pi.

Evaluation of the Antibody Response Induced by the Pfizer-BioNTech COVID-19 Vaccine and the Effect Prior COVID-19 Infection has on the Response Elicited by the Vaccine

Introduction Understanding the immune memory of individuals who have naturally contracted SARS CoV-2 versus naïve individuals might help to optimise the vaccination campaigns. Here we describe the Anti-SARS-CoV-2 IgG response induced by the Pfizer-BioNTech COVID-19 Vaccine in both naive individuals and those with prior confirmed SARS-CoV-2 infection. We also look at the durability of that response over a six-month period. Methods This study enrolled a total of 219 participants who had completed the full course of the Pfizer BioNTech BNT162b1 COVID 19 vaccine. SARS CoV-2 IgG levels were measured at two different stages over a period of six months using Abbott Architect SARS-CoV-2 IgG II quantitative assay. Results After two doses of the Pfizer BioNTech BNT162b1 COVID 19 vaccine, the median SARS CoV-2 IgG concentration from all participants was 4866 AU/mL (IQR 2738-8424). Median IgG levels in naïve individuals were 4219 AU/mL (IQR 2450-7602). Median SARS CoV-2 IgG levels were significantly higher in those with a previous SARS CoV-2 infection at 8323 AU/mL (IQR 4728-16579 p<0.001). Median SARS-CoV-2 IgG levels decreased to 953 AU/mL (IQR 512-1730) after six months post vaccination. This represented a median decrease of 80% between the two testing periods Conclusion Our findings suggest that those with natural infection before vaccination produce a higher IgG response than naïve individuals as shown by a nearly 2-fold increase in the mean concentrations between the two groups.SARS-CoV-2 IgG levels showed a median decline of 2% per day. © 2021, Irish Medical Association. All rights reserved.