Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: A randomized clinical trial

Mansouri, Parisa; Javadpour, Shohreh; Zand, Farid; Ghodsbin, Fariba; Sabetian, Golnar; Masjedi, Mansoor; Tabatabaee, Hamid Reza

doi:10.1016/j.jcrc.2013.06.019

Cited by 85 publications

(70 citation statements)

References 41 publications

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“…Implementing sedation protocols to achieve light sedation has been proven feasible and reproducible [32,33]. This evidence is important because deep sedation still seems to be current practice in many ICUs worldwide [5,13] and is present in 35% of the patients enrolled in the present study.…”

Section: Discussionmentioning

confidence: 84%

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

et al. 2014

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IntroductionSedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV).MethodsA secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality.ResultsA total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P = 0.001) despite similar PaO2/FiO2 ratios and acute respiratory distress syndrome (ARDS) severity. In a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% CI, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; CI 95%, 1.00 to 1.04), severe ARDS (OR 1.44; CI 95%, 1.09 to 1.91) and deep sedation (OR 2.36; CI 95%, 1.31 to 4.25) were independently associated with increased hospital mortality.ConclusionsEarly deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.

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Section: Discussionmentioning

confidence: 84%

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

et al. 2014

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“…The panel of experts reviewed the instrument and confirmed that the individual items included were appropriate, accurate, and representative of the content domain being evaluated within the study. The reliability and validity of RASS was acceptable in another research done by Mansouri et al (2013) , the Pearson correlation coefficients obtained was 0.92. [29] Of the available observational pain scales, the CPOT has shown superior reliability and validity when used in nonverbal critically ill adults.…”

Section: Validity and Reliability Of Study Toolsmentioning

confidence: 75%

“…The reliability and validity of RASS was acceptable in another research done by Mansouri et al (2013) , the Pearson correlation coefficients obtained was 0.92. [29] Of the available observational pain scales, the CPOT has shown superior reliability and validity when used in nonverbal critically ill adults. The interrater reliability of CPOT was assessed by Gélinas and Johnson (2007) and found to be 0.80-0.93.…”

Section: Validity and Reliability Of Study Toolsmentioning

confidence: 75%

Towards a Standardized Approach for Critical Care Nursing Practices: Development of Evidence Based Analgo-Sedation Guidelines for Adult Mechanically Ventilated Patients

Othman¹,

El-Hady²,

Ahmed³

et al. 2016

IOSR

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“…Mansouri P et al demonstrated a decrease of 3 days in ICU stay with the use of protocols and scales for analgesia and sedation. 20 According to Larson EG et al, the use of scales improves communication within the multidisciplinary team, and thus the therapeutic plan and patient management. 22 Only one recent study, by Curley MAW et al, showed that the use of protocol did not alter the duration of mechanical ventilation, but with a complex relation between pain, agitation, and alertness, and a lower use of medication, with no more adverse events.…”

Section: Resultsmentioning

confidence: 99%

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

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Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: A randomized clinical trial

Cited by 85 publications

References 41 publications

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

Towards a Standardized Approach for Critical Care Nursing Practices: Development of Evidence Based Analgo-Sedation Guidelines for Adult Mechanically Ventilated Patients

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

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