Multicenter assessment of sedation and delirium practices in the intensive care units in Poland - is this common practice in Eastern Europe?

BMC Anesthesiology

Research Article

Małgorzata Zegan-Barańska¹  Katarzyna Kotfis¹  Maciej Żukowski¹  Krzysztof Kusza²  Mariusz Kaczmarczyk³  E. Wesley Ely⁴ 

[1] Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland;Department of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences University, Poznań, Poland;Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland;Department of Medicine/Allergy, Pulmonary and Critical Care, Vanderbilt University School ofMedicine, Vetaran’s Affairs Geriatric Research Education Clinical Center (GRECC) for Tennessee Valley, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA;

关键词: Sedation;    ICU delirium;    Guidelines;    CAM-ICU;   

DOI  :  10.1186/s12871-017-0415-2

 received in 2017-06-16, accepted in 2017-08-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe majority of critically ill patients experience distress during their stay in the Intensive Care Unit (ICU), resulting from systemic illness, multiple interventions and environmental factors. Providing humane care should address concomitant treatment of pain, agitation and delirium. The use of sedation and approaches to ICU delirium should be monitored according to structured guidelines. However, it is unknown to what extent these concepts are followed in Eastern European countries like Poland. The aim of this study was to evaluate sedation and delirium practices in ICUs in Poland, as a representative of the Eastern European block, particularly the implementation of sedation and ICU delirium screening tools, availability of written sedation guidelines, choice of sedation and delirium treatment agents.MethodsA national postal survey was conducted in all Polish ICUs in early 2016.ResultsA total of 165 responses out of 436 addressed units were received (37.8%). Out of responding ICUs delirium is monitored in only 11.9% of the units in Poland. Sedation monitoring tool is used in only 46.1% of units. Only 19.4% of ICUs have written protocols for sedation and 32.1% do not practice daily sedation interruption. The most frequently used agents for short-term sedation (<24 h) were propofol and fentanyl infusions and benzodiazepines (midazolam) and morphine for longer sedation (>24 h). The preferred agents for delirium treatment were haloperidol (77.6%), dexmedetomidine (43.6%) and quetiapine (19.4%). Close to one-third (32.7%) of respondents chose a benzodiazepine (diazepam) for ICU delirium treatment. Non-pharmacological treatment for ICU delirium was reported by only 45% of the respondents.ConclusionsA majority of Polish ICUs do not adhere to international guidelines regarding sedation and delirium practices. There continues to be inadequate use of sedation and delirium monitoring tools. High usage of benzodiazepines for sedation and ICU delirium treatment reveals persistence of non-evidence-based practice. This study should prompt further assessment of other Eastern Europe countries and help generate a collective response to update these aspects of patient safety and comfort.

【 授权许可】

CC BY   
© The Author(s). 2017