title: Agitation during prolonged mechanical ventilation at a long-term acute care hospital: risk factors, treatments, and outcomes.
abstract: BACKGROUND
  The prevalence, risk factors, treatment practices, and outcomes of agitation in patients undergoing prolonged mechanical ventilation (PMV) in the long-term acute care hospital (LTACH) setting are not well understood. We compared agitation risk factors, management strategies, and outcomes between patients who developed agitation and those who did not, in LTACH patients undergoing PMV.
  
  
  METHODS
  Patients admitted to an LTACH for PMV over a 1-year period were categorized into agitated and nonagitated groups. The presence of agitation risk factors, management strategies, and relevant outcomes were extracted and compared between the 2 groups.
  
  
  RESULTS
  A total of 80 patients were included, 41% (33) with agitation and 59% (47) without. Compared to the nonagitated group, the agitated group had a lower Sequential Organ Failure Assessment score (P < .0006), a greater transfer rate from an academic center (P = .05), a greater delirium frequency at both baseline (P = .04) and during admission (P < .001), and a greater rate of benzodiazepine discontinuation (P = .02). Although the use of scheduled antipsychotic (P = .0005) or restraint (P = .002) therapy was more common in the agitated group, use of benzodiazepines (P = .16), opioids (P = .11), or psychiatric evaluation (P = .90) was not. Weaning success, duration of LTACH stay, and daily costs were similar.
  
  
  CONCLUSIONS
  Agitation among the LTACH patients undergoing PMV is associated with greater delirium and use of antipsychotics and restraints but does not influence weaning success or LTACH stay. Strategies focused on agitation prevention and treatment in this population need to be developed and formally evaluated.
authors.affiliation: Rose Kalman Research Center, New England Sinai Hospital, Stoughton, MA, USA Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: O'Connor
authors.affiliation: Northeastern University School of Pharmacy, Boston, MA, USA.
authors.forename: Nada S
authors.initials: NS
authors.lastname: Al-Qadheeb
authors.affiliation: Rose Kalman Research Center, New England Sinai Hospital, Stoughton, MA, USA Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: White
authors.affiliation: Northeastern University School of Pharmacy, Boston, MA, USA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Thaker
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA Northeastern University School of Pharmacy, Boston, MA, USA j.devlin@neu.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D003422:Critical Care; D003693:Delirium / Q000150:complications; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D011595:Psychomotor Agitation / Q000209:etiology* / Q000628:therapy*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012149:Restraint, Physical; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines
keywords: LTACH; agitation; antipsychotic; benzodiazepine; cost; delirium; opioid; outcome; prolonged mechanical ventilation; restraints