ICU Physicians' Perception of Patients' Tolerance Levels in Light Sedation Impacts Sedation Practice for Mechanically Ventilated Patients

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2019 Nov 5

PMID 31681782

Citations 4

Authors

Yichun Gong

Huilong Yang

Junqing Xie

Jingtao Liu

Jianxin Zhou

Penglin Ma

Affiliations

Soon will be listed here.

Abstract

To investigate physicians' perception of patients' tolerance levels regarding sedation, which could affect sedation practice for mechanically ventilated (MV) patients. This is a questionnaire survey combined with a 24 h cross-sectional study. The physician's propensity score for light sedation (PS-) was estimated by his/her response to the given answers for each item of the questionnaire, which tested the levels of interviewee's desire to manage MV patient with light sedation. Thereby, the mean physicians' PS- of each participating ICU (ICU-PS-) was calculated. The practical measurements of all variables listed on the questionnaire were used to semi-quantitatively assess stimulus intensity of what the recruited patients suffered (i.e., semi-quantitative stimulus intensity, SSI). Sedation depth was assessed by Richmond Agitation Sedation Scale (RASS). 555 of 558 (99.5%) physicians from 102 ICUs were concerned with patients' tolerance levels regarding sedation while titrating sedation depth. The physician's PS- was non-normally distributed with median (IQR) of 3 (0-5). ICU-PS- was calculated in 92 out of 102 ICUs participating in the cross-sectional study, which was ranged from -5 to 7 with a median (IQR) of 2.37 (0.16-4.33). A significant increasing trend in prevalence of light sedation was observed over increasing ICU-PS- quartiles (from Q1 to Q4, χ-test for trend, = 0.002). Moreover, odds ratio for probability of light sedation remained significant in MV patients from Q4 ICUs vs. Q1 ICUs, adjusted by APACHE II score (OR, 2.332; 95% CI: 1.463-3.717; p < 0.001) or SSI score (OR, 2.445; 95% CI: 1.468-4.074; = 0.001). Notably, adjusted OR for mortality was significant in deeply sedated MV patients (OR, 2.034; 95% CI: 1.435-2.884; < 0.001). ICU physician's individualized perception for patients' tolerance levels regarding sedation, in light sedation affected sedation practice for MV patients.

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References

Coursin D, Skrobik Y . What Is Safe Sedation in the ICU?. N Engl J Med. 2019; 380(26):2577-2578. DOI: 10.1056/NEJMe1906522. View

Barr J, Fraser G, Puntillo K, Wesley Ely E, Gelinas C, Dasta J . Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2012; 41(1):263-306. DOI: 10.1097/CCM.0b013e3182783b72. View

Treggiari M, Romand J, Yanez N, Deem S, Goldberg J, Hudson L . Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 2009; 37(9):2527-34. DOI: 10.1097/CCM.0b013e3181a5689f. View

Rose L, Fitzgerald E, Cook D, Kim S, Steinberg M, Devlin J . Clinician perspectives on protocols designed to minimize sedation. J Crit Care. 2014; 30(2):348-52. DOI: 10.1016/j.jcrc.2014.10.021. View

Oddo M, Crippa I, Mehta S, Menon D, Payen J, Taccone F . Optimizing sedation in patients with acute brain injury. Crit Care. 2016; 20(1):128. PMC: 4857238. DOI: 10.1186/s13054-016-1294-5. View

Mehta S, McCullagh I, Burry L . Current sedation practices: lessons learned from international surveys. Anesthesiol Clin. 2011; 29(4):607-24. DOI: 10.1016/j.anclin.2011.09.003. View

Jaber S, Chanques G, Altairac C, Sebbane M, Vergne C, Perrigault P . A prospective study of agitation in a medical-surgical ICU: incidence, risk factors, and outcomes. Chest. 2005; 128(4):2749-57. DOI: 10.1378/chest.128.4.2749. View

Shehabi Y, Howe B, Bellomo R, Arabi Y, Bailey M, Bass F . Early Sedation with Dexmedetomidine in Critically Ill Patients. N Engl J Med. 2019; 380(26):2506-2517. DOI: 10.1056/NEJMoa1904710. View

Sneyers B, Laterre P, Perreault M, Wouters D, Spinewine A . Current practices and barriers impairing physicians' and nurses' adherence to analgo-sedation recommendations in the intensive care unit--a national survey. Crit Care. 2014; 18(6):655. PMC: 4324789. DOI: 10.1186/s13054-014-0655-1. View

10.

Celis-Rodriguez E, Birchenall C, de la Cal M, Castorena Arellano G, Hernandez A, Ceraso D . Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients. Med Intensiva. 2013; 37(8):519-74. DOI: 10.1016/j.medin.2013.04.001. View

11.

Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P . Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. Ger Med Sci. 2015; 13:Doc19. PMC: 4645746. DOI: 10.3205/000223. View

12.

Luetz A, Balzer F, Radtke F, Jones C, Citerio G, Walder B . Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists. PLoS One. 2014; 9(11):e110935. PMC: 4232258. DOI: 10.1371/journal.pone.0110935. View

13.

Abou El Fadl M, OPhelan K . Management of Traumatic Brain Injury: An Update. Neurosurg Clin N Am. 2018; 29(2):213-221. DOI: 10.1016/j.nec.2017.11.002. View

14.

Peitz G, Balas M, Olsen K, Pun B, Wesley Ely E . Top 10 myths regarding sedation and delirium in the ICU. Crit Care Med. 2013; 41(9 Suppl 1):S46-56. DOI: 10.1097/CCM.0b013e3182a168f5. View

15.

Strom T, Martinussen T, Toft P . A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010; 375(9713):475-80. DOI: 10.1016/S0140-6736(09)62072-9. View

16.

Shehabi Y, Bellomo R, Kadiman S, Ti L, Howe B, Reade M . Sedation Intensity in the First 48 Hours of Mechanical Ventilation and 180-Day Mortality: A Multinational Prospective Longitudinal Cohort Study. Crit Care Med. 2018; 46(6):850-859. DOI: 10.1097/CCM.0000000000003071. View

17.

Jackson D, Proudfoot C, Cann K, Walsh T . The incidence of sub-optimal sedation in the ICU: a systematic review. Crit Care. 2009; 13(6):R204. PMC: 2811948. DOI: 10.1186/cc8212. View

18.

Murray M, DeBlock H, Erstad B, Gray A, Jacobi J, Jordan C . Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med. 2016; 44(11):2079-2103. DOI: 10.1097/CCM.0000000000002027. View

19.

Shehabi Y, Bellomo R, Reade M, Bailey M, Bass F, Howe B . Early goal-directed sedation versus standard sedation in mechanically ventilated critically ill patients: a pilot study*. Crit Care Med. 2013; 41(8):1983-91. DOI: 10.1097/CCM.0b013e31828a437d. View

20.

Kerson A, Demaria R, Mauer E, Joyce C, Gerber L, Greenwald B . Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children. J Intensive Care. 2016; 4:65. PMC: 5080705. DOI: 10.1186/s40560-016-0189-5. View