Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT)

Pilot and Feasibility Studies

for the Canadian Critical Care Trials Group¹  Sangeeta Mehta²  Mar Saavedra Mitjans³  Gabrielle Cataford³  David R. Williamson³  Sofia Ihsenne Cherifa³  Anne Julie Frenette³  Lisa Burry⁴  Julia Lainer Palacios⁵  Emmanuel Charbonney⁵  Virginie Williams⁵  Francis Bernard⁵  Caroline Arbour⁵ 

[1] ;Department of Medicine, Sinai Health System, and Interdepartmental Division of Critical Care Medicine, University of Toronto;Faculté de Pharmacie, Université de Montréal;Leslie Dan Faculty of Pharmacy, University of Toronto;Research centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l’île-de-Montréal;

关键词: Traumatic brain injury;    Agitation;    Confusion;    Aggressiveness;    Feasibility;    Intensive care;   

DOI  :  10.1186/s40814-020-00736-5

来源: DOAJ

【 摘 要 】

Abstract Background Agitated behaviors are problematic in intensive care unit (ICU) patients recovering from traumatic brain injury (TBI) as they create substantial risks and challenges for healthcare providers. To date, there have been no studies evaluating their epidemiology and impact in the ICU. Prior to planning a multicenter study, assessment of recruitment, feasibility, and pilot study procedures is needed. In this pilot study, we aimed to evaluate the feasibility of conducting a large multicenter prospective cohort study. Methods This feasibility study recruited adult patients admitted to the ICU with TBI and an abnormal cerebral CT scan. In all patients, we documented Richmond Agitation Sedation Score (RASS) and agitated behaviors every 8-h nursing shift using a dedicated tool documenting 14 behaviors. Our feasibility objectives were to obtain consent from at least 2 patients per month; completion of screening logs for agitated behaviors by bedside nurses for more than 90% of 8-h shifts; completion of data collection in an average of 6 h or less; and obtain 6-month follow-up for surviving patients. The main clinical outcome was the incidence of agitation and individual agitated behaviors. Results In total, 47 eligible patients were approached for inclusion and 30 (64% consent rate) were recruited over a 10-month period (3 patients/month). In total, 794 out of 827 (96%) possible 8-h periods of agitated behavior logs were completed by bedside nurses, with a median of 24 observations (IQR 28.0) per patient. During the ICU stay, 17 of 30 patients developed agitation (56.7%; 95% CI 0.37–0.75) defined as RASS ≥ 2 during at least one observation period and for a median of 4 days (IQR 5.5). At 6 months post-TBI, among the 24 available patients, an unfavorable score (GOS-E < 5 including death) was reported in 12 patients (50%). In the 14 patients who were alive and available at 6 months, the median QOLIBRI score was 74.5 (IQR 18.5). Conclusions This study demonstrates the feasibility of conducting a larger cohort study to evaluate the epidemiology and impact of agitated behaviors in critically ill TBI patients. This study also shows that agitated behaviors are frequent and are associated with adverse events.

【 授权许可】

Unknown