title: Management of autism in the adult intensive care unit.
abstract: Autism comprises a growing segment of the population and can be a management challenge in the intensive care unit (ICU). We present the case of a 22-year-old male with severe autism and intellectual disorder who developed respiratory failure and required a prolonged ICU course. This patient exhibited severe distress, aggression, and self-injurious behavior. Management challenges included sedation, weaning from sedation, and liberation from mechanical ventilation. Success was achieved with a multispecialty team and by tailoring the environment and interactions to the patient's known preferences. The use of dexmedetomidine to wean high-dose benzodiazepines and opiates also permitted successful liberation from mechanical ventilation.
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Hsieh
authors.forename: Scott S
authors.initials: SS
authors.lastname: Oh
authors.forename: Parkavi
authors.initials: P
authors.lastname: Chellappa
authors.forename: Roxy
authors.initials: R
authors.lastname: Szeftel
authors.forename: Heather D
authors.initials: HD
authors.lastname: Jones
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001321:Autistic Disorder / Q000628:therapy*; D001569:Benzodiazepines / Q000627:therapeutic use; D016292:Procedural Sedation; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008607:Intellectual Disability; D007362:Intensive Care Units; D008297:Male; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000150:complications; D016896:Treatment Outcome; D015300:Ventilator Weaning; D055815:Young Adult
chemical_list: D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D001569:Benzodiazepines; D020927:Dexmedetomidine
keywords: acute respiratory distress syndrome (ARDS); autism; dexmedetomidine; intensive care unit