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Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists.

Luetz A, Balzer F, Radtke FM, Jones C, Citerio G, Walder B, Weiss B, Wernecke KD, Spies C - PLoS ONE (2014)

Bottom Line: Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations.Every fifth patient was suffering from pain.In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.

ABSTRACT
Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1) and 868 patients (part 2) were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%). In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524) and approved by the ethical committee.

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Related in: MedlinePlus

Consort diagram for questionnaire part 2.This part of the survey gathered actual practice on analgesia, delirium and sedation management among included patients. Not allocable  =  there was either no allocable token for questionnaire part one or most of the data were entered incorrectly (e.g. RASS  = 10, BPS  = −2).
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pone-0110935-g003: Consort diagram for questionnaire part 2.This part of the survey gathered actual practice on analgesia, delirium and sedation management among included patients. Not allocable  =  there was either no allocable token for questionnaire part one or most of the data were entered incorrectly (e.g. RASS  = 10, BPS  = −2).

Mentions: One thousand and four questionnaires were submitted out of which 868 were fully completed and included in data analysis (figure 3). We summarized the charactaristics of patients in table 4.


Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists.

Luetz A, Balzer F, Radtke FM, Jones C, Citerio G, Walder B, Weiss B, Wernecke KD, Spies C - PLoS ONE (2014)

Consort diagram for questionnaire part 2.This part of the survey gathered actual practice on analgesia, delirium and sedation management among included patients. Not allocable  =  there was either no allocable token for questionnaire part one or most of the data were entered incorrectly (e.g. RASS  = 10, BPS  = −2).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232258&req=5

pone-0110935-g003: Consort diagram for questionnaire part 2.This part of the survey gathered actual practice on analgesia, delirium and sedation management among included patients. Not allocable  =  there was either no allocable token for questionnaire part one or most of the data were entered incorrectly (e.g. RASS  = 10, BPS  = −2).
Mentions: One thousand and four questionnaires were submitted out of which 868 were fully completed and included in data analysis (figure 3). We summarized the charactaristics of patients in table 4.

Bottom Line: Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations.Every fifth patient was suffering from pain.In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.

ABSTRACT
Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1) and 868 patients (part 2) were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%). In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524) and approved by the ethical committee.

Show MeSH
Related in: MedlinePlus