Enhancing european management of analgesia, sedation, and delirium

• Verfasst von: Paul, Nicolas [VerfasserIn]
• Verfasst von: Grunow, Julius [VerfasserIn]
• Verfasst von: Rosenthal, Max [VerfasserIn]
• Verfasst von: Spies, Claudia D. [VerfasserIn]
• Verfasst von: Page, Valerie [VerfasserIn]
• Verfasst von: Hanison, James [VerfasserIn]
• Verfasst von: Patel, Brijesh [VerfasserIn]
• Verfasst von: Rosenberg, Alex [VerfasserIn]
• Verfasst von: Haken, Rebecca von [VerfasserIn]
• Verfasst von: Pietsch, Urs [VerfasserIn]
• Verfasst von: Schrag, Claudia [VerfasserIn]
• Verfasst von: Waydhas, Christian [VerfasserIn]
• Verfasst von: Schellongowski, Peter [VerfasserIn]
• Verfasst von: Lobmeyr, Elisabeth [VerfasserIn]
• Verfasst von: Sander, Michael [VerfasserIn]
• Verfasst von: Piper, Sophie K. [VerfasserIn]
• Verfasst von: Conway, Daniel [VerfasserIn]
• Verfasst von: Totzeck, Andreas [VerfasserIn]
• Verfasst von: Weiss, Björn [VerfasserIn]
• Titel: Enhancing european management of analgesia, sedation, and delirium
• Titelzusatz: a multinational, prospective, interventional before-after trial
• Verf.angabe: Nicolas Paul, Julius J. Grunow, Max Rosenthal, Claudia D. Spies, Valerie J. Page, James Hanison, Brijesh Patel, Alex Rosenberg, Rebecca von Haken, Urs Pietsch, Claudia Schrag, Christian Waydhas, Peter Schellongowski, Elisabeth Lobmeyr, Michael Sander, Sophie K. Piper, Daniel Conway, Andreas Totzeck and Björn Weiss
• E-Jahr: 2023
• Jahr: 11 September 2023
• Umfang: 11 S.
• Illustrationen: Illustrationen
• Fussnoten: Online veröffentlicht: 11. September 2023 ; Gesehen am 08.12.2023
• Titel Quelle: Enthalten in: Neurocritical care
• Ort Quelle: New York, NY : Springer, 2004
• Jahr Quelle: 2023
• Band/Heft Quelle: (2023), online ahead of print
• ISSN Quelle: 1556-0961
• DOI: doi:10.1007/s12028-023-01837-8
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Critical care
• Sach-SW: Delirium
• Sach-SW: Delivery of health care
• Sach-SW: Europe
• Sach-SW: Intensive care units
• K10plus-PPN: 1872923518

Abstract

Background: The objective of this study was to analyze the impact of a structured educational intervention on the implementation of guideline-recommended pain, agitation, and delirium (PAD) assessment. Methods: This was a prospective, multinational, interventional before-after trial conducted at 12 intensive care units from 10 centers in Germany, Austria, Switzerland, and the UK. Intensive care units underwent a 6-week structured educational program, comprising online lectures, instructional videos, educational handouts, and bedside teaching. Patient-level PAD assessment data were collected in three 1-day point-prevalence assessments before (T1), 6 weeks after (T2), and 1 year after (T3) the educational program. Results: A total of 430 patients were included. The rate of patients who received all three PAD assessments changed from 55% (107/195) at T1 to 53% (68/129) at T2, but increased to 73% (77/106) at T3 (p = 0.003). The delirium screening rate increased from 64% (124/195) at T1 to 65% (84/129) at T2 and 77% (82/106) at T3 (p = 0.041). The pain assessment rate increased from 87% (170/195) at T1 to 92% (119/129) at T2 and 98% (104/106) at T3 (p = 0.005). The rate of sedation assessment showed no signficiant change. The proportion of patients who received nonpharmacological delirium prevention measures increased from 58% (114/195) at T1 to 80% (103/129) at T2 and 91% (96/106) at T3 (p < 0.001). Multivariable regression revealed that at T3, patients were more likely to receive a delirium assessment (odds ratio [OR] 2.138, 95% confidence interval [CI] 1.206–3.790; p = 0.009), sedation assessment (OR 4.131, 95% CI 1.372–12.438; p = 0.012), or all three PAD assessments (OR 2.295, 95% CI 1.349–3.903; p = 0.002) compared with T1. Conclusions: In routine care, many patients were not assessed for PAD. Assessment rates increased significantly 1 year after the intervention. Clinical trial registration ClinicalTrials.gov: NCT03553719.