I-SAVE Study: Impact of Sedation, Analgesia, and Delirium Protocols Evaluated in the Intensive Care Unit: An Economic Evaluation

Awissi, Don-Kelena; Bégin, Cindy; Moisan, Julie; Lachaine, J.; Skrobik, Yoanna

doi:10.1345/aph.1q284

Cited by 73 publications

(29 citation statements)

References 19 publications

(22 reference statements)

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“…However, there is evidence that when delirium screening is applied as part of a broader protocol initiative that includes active management of sedatives and analgesics as well as nonpharmacological measures, such as music and reassurance, several clinical benefits may ensue, such as shorter duration of mechanical ventilation, lower ICU and hospital stay, and lower 30-day mortality [49]. The protocol also is associated with cost savings [50]. …”

Section: Assessment Of Deliriummentioning

confidence: 99%

Delirium in the ICU: an overview

Cavallazzi

Saad

Marik

2012

Ann. Intensive Care

211

155

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Delirium is characterized by a disturbance of consciousness with accompanying change in cognition. Delirium typically manifests as a constellation of symptoms with an acute onset and a fluctuating course. Delirium is extremely common in the intensive care unit (ICU) especially amongst mechanically ventilated patients. Three subtypes have been recognized: hyperactive, hypoactive, and mixed. Delirium is frequently undiagnosed unless specific diagnostic instruments are used. The CAM-ICU is the most widely studied and validated diagnostic instrument. However, the accuracy of this tool may be less than ideal without adequate training of the providers applying it. The presence of delirium has important prognostic implications; in mechanically ventilated patients it is associated with a 2.5-fold increase in short-term mortality and a 3.2-fold increase in 6-month mortality. Nonpharmacological approaches, such as physical and occupational therapy, decrease the duration of delirium and should be encouraged. Pharmacological treatment for delirium traditionally includes haloperidol; however, more data for haloperidol are needed given the paucity of placebo-controlled trials testing its efficacy to treat delirium in the ICU. Second-generation antipsychotics have emerged as an alternative for the treatment of delirium, and they may have a better safety profile. Dexmedetomidine may prove to be a valuable adjunctive agent for patients with delirium in the ICU.

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Section: Assessment Of Deliriummentioning

confidence: 99%

Delirium in the ICU: an overview

Cavallazzi

Saad

Marik

2012

Ann. Intensive Care

211

155

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“…Awissi and coworkers concluded that establishing protocols for the management of sedation, analgesia, and delirium is a cost-effective practice and allows savings of nearly $1000 per hospitalization (13). Thus, we strongly recommend that strategies such as administering the right drugs in the right dose to the right patient at the right time for the right reasons should be defined to establish a practice protocol.…”

mentioning

confidence: 99%

Pain Management in the Intensive Care Unit: Do We Need Special Protocols?

Hajiesmaeili

Safari

2012

Anesth Pain

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“…At least three studies performed in surgical, trauma, and medical ICUs report that a protocolized approach to assess and manage pain, agitation, and delirium [20] is associated with a reduced duration of mechanical ventilation, ICU acquired infections, length of stay and costs in ICU, and hospital as well as 30-day mortality [8,18-21]; accordingly, the guidelines recommend protocolized pain screening and assessing analgesic needs first to palliate the current under-recognition and treatment of pain [22]. …”

Section: Reviewmentioning

confidence: 99%

“…There is emerging understanding that excessive sedation, even when limited to 48 hours [65], is common and is associated with increased morbidity, mortality, and expenditure [65,66]. Daily interruption of sedative infusions, titration of sedative dose and opiates to symptoms [8,20,67], and minimization of drug administration is associated with patient benefit, reduced costs [21], and does not lead to accidental device removal or psychological stress [68]. The contrast to earlier guidelines is the explicit statement that harm is likely with iatrogenic coma; this point is made both in the sedation and delirium sections.…”

Section: Reviewmentioning

confidence: 99%

The pain, agitation, and delirium practice guidelines for adult critically ill patients: a post-publication perspective

Skrobik

Chanques

2013

Ann Intensive Care

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The recently published Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit differ from earlier guidelines in the following ways: literature searches were performed in eight databases by a professional librarian; psychometric validation of assessment scales was considered in their recommendation; discrepancies in recommendation votes by guideline panel members are available in online supplements; and all recommendations were made exclusively on the basis of evidence available until December of 2010. Pain recognition and management remains challenging in the critically ill. Patient outcomes improve with routine pain assessment, use of co-analgesics and administration as well as dose adjustment of opiates to patient needs. Thoracic epidurals help ease patients undergoing abdominal aortic surgery. Little data exists to guide clinicians as to the type or dose of co-analgesics; no opiate choice is associated with better patient outcomes. Lighter or no sedation is beneficial, and interruption is desirable in patients who require deep sedation for specific pathologic states. Delirium screening is probably useful; no treatment modality can be unequivocally recommended, and the benefit of prophylaxis is established only for early mobilization. The details of these recommendations, as well as more recent publications that complement the guidelines, are provided in this commentary.

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I-SAVE Study: Impact of Sedation, Analgesia, and Delirium Protocols Evaluated in the Intensive Care Unit: An Economic Evaluation

Abstract: Establishing protocols for patient-driven management of sedation, analgesia, and delirium is a cost-effective practice and allows savings of nearly $1000 per hospitalization.

Cited by 73 publications

References 19 publications

Delirium in the ICU: an overview

Delirium in the ICU: an overview

Pain Management in the Intensive Care Unit: Do We Need Special Protocols?

The pain, agitation, and delirium practice guidelines for adult critically ill patients: a post-publication perspective

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