A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China

Overview

Journal Chin Med J (Engl)

Specialty General Medicine

Date 2017 May 10

PMID 28485318

Citations 10

Authors

Jing Wang

Zhi-Yong Peng

Wen-Hai Zhou

Bo Hu

Xin Rao

Jian-Guo Li

Affiliations

Soon will be listed here.

Abstract

Background: The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China.

Methods: A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016. The questionnaire focused on the assessment and management of PAD by the clinicians in ICUs. The practice of PAD was compared among the four regions of China (North, Southeast, Northwest, and Southwest). The data were expressed as percentage and frequency. The Chi-square test, Fisher's exact test, and line-row Chi-square test were used.

Results: Of the 1011 valid questionnaire forms, the response rate was 80.37%. The clinicians came from 704 hospitals across 158 cities of China. The rate of PAD assessment was 75.77%, 90.21%, and 66.77%, respectively. The rates of PAD scores were 45.8%, 68.94%, and 34.03%, respectively. The visual analog scale, Richmond agitation-sedation scale, and confusion assessment method for the ICU were the first choices of scales for PAD assessment. Fentanyl, midazolam, and dexmedetomidine were the first choices of agents for analgesic, sedation, and delirium treatment. While choosing analgesics and sedatives, the clinicians put the pharmacological characteristics of drugs in the first place (66.07% and 76.36%). Daily interruption for sedation was carried out by 67.26% clinicians. Most of the clinicians (87.24%) used analgesics while using sedatives. Of the 738 (73%) clinicians titrating the sedatives on the basis of the proposed target sedation level, 268 (26.61%) clinicians just depended on their clinical experience. Totally, 519 (51.34%) clinicians never used other nondrug strategies for PAD. The working time of clinicians was an important factor in the management of analgesia and sedation rather than their titles and educational background. The ratios of pain score and sedation score in the Southwest China were the highest and the North China were the lowest. The ratios of delirium assessment and score were the same in the four regions of China. Moreover, the first choices of scales for PAD in the four regions were the same. However, the top three choices of agents in PAD treatment in the four regions were not the same.

Conclusions: The practice of PAD in China follows the international guidelines; however, the pain assessment should be improved. The PAD practice is a little different across the four regions of China; however, the trend is consistent.

Trial Registration: The study is registered at http://www.clinicaltrials.gov (No. ChiCTR-OOC-16009014, www.chictr. org.cn/index.aspx.).

Citing Articles

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Blended teaching mode based on small private online course and case-based learning in analgesia and sedation education in China: a comparison with an offline mode.

Li S, Su L, Lou R, Liu Y, Zhang H, Jiang L BMC Med Educ. 2024; 24(1):28.

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A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis.

Wen J, Ding X, Liu C, Jiang W, Xu Y, Wei X PLoS One. 2023; 18(11):e0294292.

PMID: 37963140 PMC: 10645332. DOI: 10.1371/journal.pone.0294292.

Agitation is a Common Barrier to Recovery of ICU Patients.

Prendergast N, Onyemekwu C, Potter K, Tiberio P, Turnbull A, Girard T J Intensive Care Med. 2022; 38(2):208-214.

PMID: 36300248 PMC: 10443676. DOI: 10.1177/08850666221134262.

Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation.

Wojnar-Gruszka K, Sega A, Plaszewska-Zywko L, Wojtan S, Potocka M, Kozka M Int J Environ Res Public Health. 2022; 19(17).

PMID: 36078609 PMC: 9517797. DOI: 10.3390/ijerph191710894.

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