Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists

Abstract

Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1) and 868 patients (part 2) were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%). In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524) and approved by the ethical committee.

Conflict of interest statement

Competing Interests: Statistical analysis has been supervised by Professor Klaus-Dieter Wernecke, PhD, former head of the Institute of Medical Biometry at Charit Universitaetsmedizin Berlin and owner of Sostana GmbH. There are no restrictions on sharing of data and this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Consort diagram for questionnaire part one.

This part of the survey gathered general information about the participating hospitals as well as (non-)pharmacological strategies for the management of analgesia, delirium and sedation.

Figure 2. Monitoring of sedation, analgesia and delirium with validated scores.

Mosaic plot: The areas of the mosaic tiles are proportional to the observed frequency of groups. Both, sedation and pain monitoring. None, no sedation and no pain monitoring.

Figure 3. Consort diagram for questionnaire part 2.

This part of the survey gathered actual practice on analgesia, delirium and sedation management among included patients. Not allocable  =  there was either no allocable token for questionnaire part one or most of the data were entered incorrectly (e.g. RASS  = 10, BPS  = −2).