Implementation of the PADIS 2018 Guidelines: a National Multicenter Survey in the Adults Intensive Care Units in Mainland China

Abstract

Backgroud: In the diagnosis and treatment of critical ill patients, the management of sedation, analgesia and delirium is an indispensable part. Many guidelines provide relevant suggestion, but there is still a lack of evaluation on the compliance of medical staff. This was a national multicenter survey to assess the training frequency, the familiarity of the guidelines, prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in the ICU. Methods: This survey used a self-administered questionnaire online to provide data for evaluating the compliance with the PADIS guidelines. We grouped the answers that were similar in degree in order to analysis, and only complete questionnaires were included in the final analysis.Results: The respondents from 758 hospitals across 270 cities were distributed 5763 questionnaires.The response rate was 95%. Two thirds of the respondents were trained in the relevant content but only half of them had sufficient knowledge of the PADIS guidelines. The assessment frequency of pain and sedation was better than that of delirium. 83% of the respondents used physical restraint without deep sedation, 63% underwent regular treatment to improve sleep, and only 32% had opted for out-of-bed rehabilitation. Only 50% had increased family communication and early family care. The doctors provided better responses than nurses in most items, while nurses performed better in immobility, sleep disruption, and family empowerment. Also, most of the items showed better responses by University-affiliated hospitals than others, and the implementation in “large” cities with larger populations was better than that in “medium” or “small” cities.Conclusions: Most of the Chinese medical staff complied with PADIS guidelines satisfactorily, but immobility, sleep disruption, and family empowerment could be improved further. Trial registration: The survey was open and anonymous, and it was registered in the Chinese Clinical Trial Registry (Registration Number: NCT04217915. Registered 6 January 2020)