Background: Critical patients in ICU have to experience pain, anxiety, and sleep deprivation which always cause delirium, which will prolong the hospital stay and come up with higher mortality. Analgesia based sedation can reduce the accumulation of sedative effects, and shorten ventilator time and ICU length of stay. Process management of analgesia and sedation can reduce the incidence of delirium. Objectives: To explore the clinical benefits of procedural analgesia and sedation for critical ill patients. Methods: This is a prospective, two-phase study that focuses on patients who required mechanical ventilation after surgery. Comparing patients’ pain and agitation scores, the species and dosage of sedative and analgesic, the incidence of delirium in the observation period and intervention period, data in two groups were collected and analyzed. Results: During the observational and interventional periods, we enrolled 213 patients before protocol implantation and 196 patients after protocol implantation. We found that there existed impropriate pain and sedation assessment in patients involved, and after training for procedural protocol, the average dosage of sedatives was decreased (p > 0.05). The percentage of reaching standard COPT score was 73.7% vs 84.1% (p > 0.05) and RASS score was 70.9% vs 79.6% (p > 0.05) in the observation period and intervention period, and the incidence of delirium was significantly reduced (31.9% vs 23.5%, p < 0.05). Conclusion: We concluded that protocol implantation of analgesia and sedation can reduce the incidence of delirium.
References
[1]
Zaal, I.J. and Slooter, A.J. (2014) Light Levels of Sedation and DSM-5 Criteria for Delirium. Intensive Care Medicine, 40, 300-301.
https://doi.org/10.1007/s00134-013-3192-5
[2]
Taskforce, D.A.S., Baron, R., Binder, A., Biniek, R., Braune, S., Buerkle, H., Dall, P., Demirakca, S., Eckardt, R., Eggers, V., et al. (2015) Evidence and Consensus Based Guideline for the Management of Delirium, Analgesia, and Sedation in Intensive Care Medicine. Revision 2015 (DAS-Guideline 2015)-Short Version. GMS German Medical Science, 13.
[3]
Lucas da Silva, P.S. and de Carvalho, W.B. (2010) Unplanned Extubation in Pediatric Critically Ill Patients: A Systematic Review and Best Practice Recommendations. Pediatric Critical Care Medicine, 11, 287-294.
https://doi.org/10.1097/PCC.0b013e3181b80951
[4]
Randolph, A.G., Wypij, D., Venkataraman, S.T., Hanson, J.H., Gedeit, R.G., Meert, K.L., Luckett, P.M., Forbes, P., Lilley, M., Thompson, J., et al. (2002) Effect of Mechanical Ventilator Weaning Protocols on Respiratory Outcomes in Infants and Children: A Randomized Controlled Trial. The Journal of the American Medical Association, 288, 2561-2568. https://doi.org/10.1001/jama.288.20.2561
[5]
Vincent, J.L., Shehabi, Y., Walsh, T.S., Pandharipande, P.P., Ball, J.A., Spronk, P., Longrois, D., Strom, T., Conti, G., Funk, G.C., et al. (2016) Comfort and Patient-Centred Care without Excessive Sedation: The eCASH Concept. Intensive Care Medicine, 42, 962-971. https://doi.org/10.1007/s00134-016-4297-4
[6]
McNicoll, L., Pisani, M.A., Zhang, Y., Ely, E.W., Siegel, M.D. and Inouye, S.K. (2003) Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients. Journal of the American Geriatrics Society, 51, 591-598.
https://doi.org/10.1034/j.1600-0579.2003.00201.x
[7]
Fong, T.G., Jones, R.N., Marcantonio, E.R., Tommet, D., Gross, A.L., Habtemariam, D., Schmitt, E., Yap, L. and Inouye, S.K. (2012) Adverse Outcomes after Hospitalization and Delirium in Persons with Alzheimer Disease. Annals of Internal Medicine, 156, 848-856. https://doi.org/10.7326/0003-4819-156-12-201206190-00005
[8]
Barr, J., Fraser, G.L., Puntillo, K., Ely, E.W., Gelinas, C., Dasta, J.F., Davidson, J.E., Devlin, J.W., Kress, J.P., Joffe, A.M., et al. (2013) Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine, 41, 263-306.
https://doi.org/10.1097/CCM.0b013e3182783b72
[9]
Devlin, J.W., Skrobik, Y., Gelinas, C., Needham, D.M., Slooter, A.J.C., Pandharipande, P.P., Watson, P.L., Weinhouse, G.L., Nunnally, M.E., Rochwerg, B., et al. (2018) Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine, 46, 1532-1548.
https://doi.org/10.1097/CCM.0000000000003298
[10]
Karabinis, A., Mandragos, K., Stergiopoulos, S., Komnos, A., Soukup, J., Speelberg, B. and Kirkham, A.J. (2004) Safety and Efficacy of Analgesia-Based Sedation with Remifentanil versus Standard Hypnotic-Based Regimens in Intensive Care Unit Patients with Brain Injuries: A Randomised, Controlled Trial [ISRCTN50308308]. Critical Care Medicine, 8, R268-R280. https://doi.org/10.1186/cc2896
[11]
Carson, S.S., Kress, J.P., Rodgers, J.E., Vinayak, A., Campbell-Bright, S., Levitt, J., Bourdet, S., Ivanova, A., Henderson, A.G., Pohlman, A., et al. (2006) A Randomized Trial of Intermittent Lorazepam versus Propofol with Daily Interruption in Mechanically Ventilated Patients. Critical Care Medicine, 34, 1326-1332.
https://doi.org/10.1097/01.CCM.0000215513.63207.7F
[12]
Girard, T.D., Exline, M.C., Carson, S.S., Hough, C.L., Rock, P., Gong, M.N., et al. (2018) Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. The New England Journal of Medicine, 379, 2506-2516.
https://doi.org/10.1056/NEJMoa1808217
