Management of analgesia, sedation and delirium in Spanish Intensive Care Units: A national two-part survey

García-Sánchez, M; Caballero, Jesús; Ceniceros-Rozalén, I; Vich, Carola Giménez-Esparza; Romera-Ortega, M A; Pardo-Rey, C; Muñoz-Martínez, T.; Escudero, D.; Torrado, Herminia; Chamorro-Jambrina, C.; Palencia-Herrejón, E; Gtsad, miembros del

doi:10.1016/j.medine.2019.03.008

Cited by 15 publications

(24 citation statements)

References 40 publications

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“…42,44,45,47,48,50,53,54,56 Bundle recommendations concerning choice of analgesic and sedative drugs prioritize analgesia, and encourage light sedation and avoidance of benzodiazepines because of their deliriogenic effect. 1,8,58 Unlike other authors' findings, [37][38][39]67,68 our findings show that ICUs implement these recommendations, in line with several publications that show a decrease in benzodiazepine use and an increase in propofol and dexmedetomidine use. 19,36,38,41,69 Opioids, specifically morphine, were the most commonly used analgesics in this study, corroborating the findings of some studies, 19,35,38,39,67,69 but contrary to others that found that fentanyl 21,36,37,68 and remifentanil 41 are most prevalent.…”

Section: Discussionsupporting

confidence: 87%

“…Bundle recommendations concerning choice of analgesic and sedative drugs prioritize analgesia, and encourage light sedation and avoidance of benzodiazepines because of their deliriogenic effect 1,8,58 . Unlike other authors' findings, 37‐39,67,68 our findings show that ICUs implement these recommendations, in line with several publications that show a decrease in benzodiazepine use and an increase in propofol and dexmedetomidine use 19,36,38,41,69 …”

Section: Discussionsupporting

confidence: 82%

“…Other studies have reached the same conclusion regarding the low use of pain assessment tools in non-communicative patients. 24,35,37,57 Various authors [58][59][60] 42 [35][36][37][38][39][40][41][42][43][44] 29 0.01 22 [21][22][23][24] 41 <0.001 24 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] 40 [25][26][27][28][29][30][31][32][33][34][35][36][37][38]…”

Section: Discussionmentioning

confidence: 99%

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The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study

Frade-Mera

Arias-Rivera

García

et al. 2022

Nursing in Critical Care

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Background:The ABCDE bundle is a set of evidence-based practices to systematically reduce the risks of sedation, delirium, and immobility in intensive care patients.Implementing the bundle improves clinical outcome. Aims andObjectives: To investigate the association between patient outcomes and compliance with bundle components ABC (analgosedation algorithms), D (delirium protocol), and E (early mobilization protocol). Design: A Spanish multicentre cohort study of adult patients receiving invasive mechanical ventilation (IMV) for ≥48 h until extubation. Methods: The primary outcome was pain level, cooperation to permit Medical Research Council Scale administration, patient days of delirium, and mobility. The secondary outcome was cumulative drug dosing by IMV days. Tertiary outcomes (ICU days, IMV days, bed rest days, ICU mortality, ICUAW) and independent variables (analgosedation, delirium, early mobilization protocols) were also studied. Results: Data were collected from 605 patients in 80 ICUs and 5214 patient days with IMV. Two-thirds of the ICUs studied applied no protocols. Pain was not assessed on 83.6% of patient days. Patient cooperation made scale administration feasible on 20.7% of days. Delirium and immobility were found on 4.2% and 69.9% of days, respectively. Patients had shorter stays in ICUs with bundle protocols and fewer days of IMV in ICUs with delirium and mobilization bundle components (P = 0.006 and P = 0.03, respectively). Analgosedation protocols were associated with more opioid dosing

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study

Frade-Mera

Arias-Rivera

García

et al. 2022

Nursing in Critical Care

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“…( 31 ) Reports around Europe show differences in benzodiazepine use. For example, midazolam is more frequently used in some countries, such as Spain, ( 15 ) France, ( 14 ) Poland ( 11 ) (respectively: 16.7%; 75%, >90% of patients), and less frequently used in the UK and Nordic countries, ( 13 ) where propofol occupies the leading position (in 80-98% of cases). Dexmedetomidine has been available in Portugal since 2011 but was used in a smaller number of patients (4.6%), possibly due to cost issues or lack of experience.…”

Section: Discussionmentioning

confidence: 99%

Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study

Paulino¹,

Costa²,

Neves³

et al. 2022

RBTI

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Objective To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice. Methods A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices. Results A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%. Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients. Conclusion The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.

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“…In a multisite study of nurse‐reported practice of the ABCDE bundle in the United States, about three‐quarters of nurses routinely complied with a sedation protocol (Boehm et al, 2020). A national survey revealed that the number of ICUs using sedation protocols were 102/166 (61.4%) in Spain and 32/165 (19.4%) in Poland (García‐Sánchez et al, 2019; Kotfis et al, 2017). Sedation protocols are not used pervasively in Japan.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of nurse‐initiated sedation management in an intensive care unit: A two‐phase prospective study in Japan

Kanda

Nakano

Naraba

et al. 2022

Japan Journal Nursing Sci

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This study aimed to evaluate whether nurse-initiated sedation management could provide more appropriate sedation compared to usual care in a Japanese intensive care unit (ICU). Methods: We conducted a single-center, prospective observational study before and after implementing nurse-initiated sedation using instruction sheets. Patients who had been admitted to a general adult ICU were enrolled.Before our ICU started nurse-initiated sedation (pre-implementation care), adjustment of sedatives and analgesics was performed only by a physician's written or verbal order; however, after implementing nurse-initiated sedation, nurses titrated drugs using instruction sheets. The primary outcome was the efficacy of nurse-initiated sedation, evaluated by the proportion achieving the target Richmond Agitation-Sedation Scale (RASS) score. The analgesic status evaluated by Critical-Care Pain Observation Tool (CPOT), days of delirium, ventilator days, ICU mortality and hospital mortality were also evaluated. Results:The study examined 30 patients in the pre-implementation care phase and 30 patients in the nurse-initiated sedation phase. The proportions achieving the target RASS were 68% in the nurse-initiated sedation group and 42% in the pre-implementation care group (mean difference, 25%; 95% confidence interval, 13.4%-37.5%; P <.001). Almost all measured CPOT were within the range of 0-3 during both phases. Days of delirium, ventilator days, ICU survival, and hospital survival did not differ significantly between the two groups.Conclusions: Nurse-initiated sedation management achieved a significantly higher degree of target sedation status and was incorporated as part of the care in our ICU. It is a safe approach in countries, such as Japan, where sedation protocols are not widely used.

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Management of analgesia, sedation and delirium in Spanish Intensive Care Units: A national two-part survey

Cited by 15 publications

References 40 publications

The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study

The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study

Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study

The efficacy and safety of nurse‐initiated sedation management in an intensive care unit: A two‐phase prospective study in Japan

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