Topic
De-escalation
About: De-escalation is a research topic. Over the lifetime, 427 publications have been published within this topic receiving 4997 citations.
Papers published on a yearly basis
Papers
TL;DR: The proper foundations for appropriate training for de-escalation are detailed and intervention guidelines are provided, using the “10 domains of de- escalation,” to avoid coercive interventions that escalate agitation.
Abstract: Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally de-escalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1) ensure the safety of the patient, staff, and others in the area; (2) help the patient manage his emotions and distress and maintain or regain control of his behavior; (3) avoid the use of restraint when at all possible; and (4) avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the “10 domains of de-escalation.”
486 citations
TL;DR: De-escalation was the most important cause of antibiotic modification, being more feasible in early-onset pneumonia and less frequent in the presence of nonfermenting Gram-negative bacillus.
Abstract: Objective:To evaluate de-escalation of antibiotic therapy in patients with ventilator-associated pneumonia.Design:Prospective observational study during a 43-month period.Setting:Medical-surgical intensive care unit.Patients:One hundred and fifteen patients admitted to the intensive care unit with c
276 citations
1 Jan 2014
TL;DR: In this article, the safety and the impact on in-hospital and 90-day mortality of antibiotic de-escalation in patients admitted to the ICU with severe sepsis or septic shock were assessed.
Abstract: Purposes: We set out to assess the safety and the impact on in- hospital and 90-day mortality of antibiotic de-escalation in patients admitted to the ICU with severe sep- sis or septic shock Methods: We carried out a prospective observational study enrolling patients admitted to the ICU with severe sepsis or septic shock De-escalation was defined as discon- tinuation of an antimicrobial agent or change of antibiotic to one with a narrower spectrum once culture results were available To control for con- founding variables, we performed a conventional regression analysis and a propensity score (PS) adjusted-multi- variable analysis Results: A total of 712 patients with severe sepsis or septic shock at ICU admission were treated empirically with broad-spec- trum antibiotics Of these, 628 were evaluated (84 died before cultures were available) De-escalation was applied in 219 patients (349 %) By multivariate analysis, factors inde- pendently associated with in-hospital mortality were septic shock, SOFA score the day of culture results, and inadequate empirical antimicrobial therapy, whereas de-escalation ther- apy was a protective factor (Odds- Ratio (OR) 058; 95 % confidence interval (CI) 036-093) Analysis of the 403 patients with adequate empir- ical therapy revealed that the factor associated with mortality was SOFA score on the day of culture results, whereas de-escalation therapy was a protective factor (OR 054; 95 % CI 033-089) The PS-adjusted logistic regression models confirmed that de- escalation therapy was a protective factor in both analyses De-escalation therapy was also a protective factor for 90-day mortality Conclusions: De- escalation therapy for severe sepsis and septic shock is a safe strategy associated with a lower mortality Efforts to increase the frequency of this strategy are fully justified
188 citations
TL;DR: HPV-driven cancers have significantly better survival than traditional head and neck cancers and current treatments are reassessed to develop less toxic strategies with good oncological outcomes.
172 citations
TL;DR: Based upon the most recent evidence, ICUs would benefit from employing empiric guidelines for antibiotic use, collecting appropriate specimens and implementing molecular diagnostics, optimizing the dosing of antibiotics, and reducing the duration of total therapy.
Abstract: Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections. Optimizing antibiotic dosing through prolonged infusions can be beneficial in intensive care populations with altered pharmacokinetics. Antimicrobial stewardship teams can assist ICU providers in managing and implementing these tactics. This review will discuss the current literature on antibiotic use in the IC...
155 citations
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Performance Metrics
| Year | Papers |
|---|---|
| 2025 | 126 |
| 2024 | 143 |
| 2023 | 107 |
| 2022 | 99 |
| 2021 | 56 |
| 2020 | 58 |