Practices in sedation, analgesia, mobilization, delirium, and sleep deprivation in adult intensive care units (SAMDS-ICU): an international survey before and during the COVID-19 pandemic

Annals of Intensive Care

Carolina Gimenez-Esparza Vich¹  Joanna L. Stollings²  Roberta Esteves Vieira de Castro³  Sheila Nainan Myatra⁴  Audrey De Jong⁵  Gérald Chanques⁵  Yahya Shehabi⁶  Jorge Salluh⁷  Eugene Wesley Ely⁸  John Kress⁹  Caio Araujo^1,10  Bruna Brandão Barreto^1,11  Dimitri Gusmao-Flores^1,11  Mariana Luz^1,12  Wilson Mphandi^1,13  Federico Carini^1,14  Eduardo Tobar^1,15  Felipe Dal-Pizzol^1,16  Pedro Povoa^1,17  Kelly Drumright^1,18 

[1] Critical Care Department, Vega Baja Orihuela Hospital, Alicante, Spain;Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA;Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA;Departamento de Pediatria, Hospital Universitário Pedro Ernesto, Universidade Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil;Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India;Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France;Department of Critical Care and Perioperative Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia;Department of Critical Care and Postgraduate Program in Translational Medicine, D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil;Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil;Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA;Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA;Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA;Geriatric Research Education and Clinical Center (GRECC) Service at the Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA;Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA;Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA;Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil;Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, CEP: 40411-900, Salvador, BA, Brazil;Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil;Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, CEP: 40411-900, Salvador, BA, Brazil;Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil;Intensive Care Unit, Hospital Universitário Professor Edgard Santos, Salvador, Brazil;Intensive Care Unit, Hospital Américo Boavida, Luanda, Angola;Intensive Care Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;Internal Medicine Department, Critical Care Unit, Hospital Clínico Universidad de Chile, Santiago, Chile;Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil;Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal;CHRC, CEDOC, NOVA Medical School, New University of Lisbon, Lisbon, Portugal;Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark;Tennessee Valley Healthcare System VA Medical Center, Nashville, TN, USA;

关键词: Sedation;    Analgesia;    Mobilization;    Delirium;    Sleep deprivation;    COVID-19;   

DOI  :  10.1186/s13613-022-00985-y

来源: Springer

【 摘 要 】

BackgroundSince the publication of the 2018 Clinical Guidelines about sedation, analgesia, delirium, mobilization, and sleep deprivation in critically ill patients, no evaluation and adequacy assessment of these recommendations were studied in an international context. This survey aimed to investigate these current practices and if the COVID-19 pandemic has changed them.MethodsThis study was an open multinational electronic survey directed to physicians working in adult intensive care units (ICUs), which was performed in two steps: before and during the COVID-19 pandemic.ResultsWe analyzed 1768 questionnaires and 1539 (87%) were complete. Before the COVID-19 pandemic, we received 1476 questionnaires and 292 were submitted later. The following practices were observed before the pandemic: the Visual Analog Scale (VAS) (61.5%), the Behavioral Pain Scale (BPS) (48.2%), the Richmond Agitation Sedation Scale (RASS) (76.6%), and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (66.6%) were the most frequently tools used to assess pain, sedation level, and delirium, respectively; midazolam and fentanyl were the most frequently used drugs for inducing sedation and analgesia (84.8% and 78.3%, respectively), whereas haloperidol (68.8%) and atypical antipsychotics (69.4%) were the most prescribed drugs for delirium treatment; some physicians regularly prescribed drugs to induce sleep (19.1%) or ordered mechanical restraints as part of their routine (6.2%) for patients on mechanical ventilation; non-pharmacological strategies were frequently applied for pain, delirium, and sleep deprivation management. During the COVID-19 pandemic, the intensive care specialty was independently associated with best practices. Moreover, the mechanical ventilation rate was higher, patients received sedation more often (94% versus 86.1%, p < 0.001) and sedation goals were discussed more frequently in daily rounds. Morphine was the main drug used for analgesia (77.2%), and some sedative drugs, such as midazolam, propofol, ketamine and quetiapine, were used more frequently.ConclusionsMost sedation, analgesia and delirium practices were comparable before and during the COVID-19 pandemic. During the pandemic, the intensive care specialty was a variable that was independently associated with the best practices. Although many findings are in accordance with evidence-based recommendations, some practices still need improvement.

【 授权许可】

CC BY