Enhancing European Management of Analgesia, Sedation, and Delirium: A Multinational, Prospective, Interventional Before-After Trial

Overview

Journal Neurocrit Care

Specialty Critical Care

Date 2023 Sep 11

PMID 37697129

Authors

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

Bjorn Weiss

Affiliations

Soon will be listed here.

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.

Citing Articles

[Post-Intensive Care Syndrome: functional impairments of critical illness survivors].

Paul N, Weiss B Anaesthesiologie. 2024; 74(1):3-14.

PMID: 39680127 DOI: 10.1007/s00101-024-01483-5.

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