Multicenter assessment of sedation and delirium practices in the intensive care units in Poland - is this common practice in Eastern Europe?

Kotfis, Katarzyna; Zegan-Barańska, Małgorzata; Żukowski, Maciej; Kusza, Krzysztof; Kaczmarczyk, Mariusz; Ely, E. Wesley

doi:10.1186/s12871-017-0415-2

Cited by 45 publications

(56 citation statements)

References 26 publications

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“…The occurrence of ICU delirium increases mortality, length of hospital stay and mechanical ventilation, treatment costs and incidences of cognitive disturbances [1][2][3]. The questionnaire study conducted by Kotfis et al [4] regarding the diagnosis and treatment of ICU delirium as well as attitudes to sedation in Poland has revealed the extent of the problem in our country. The findings were alarming showing inadequate knowledge about the problem among ICU staff members.…”

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confidence: 99%

“…The findings were alarming showing inadequate knowledge about the problem among ICU staff members. ICU delirium is monitored only in 12% of ICUs; sedation > 24 h is predominantly induced with benzodiazepines which are also often used to treat delirium [4]. The study by Morandi et al [5] evaluating the same aspect of management worldwide has demonstrated that monitoring of delirium was implemented in 70% of ICUs while a proven diagnostic tool was used only in 42% of them.…”

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confidence: 99%

“…Some of the implicated causes of the situation observed in Poland are inadequate training and delayed implementation of tools for identification of delirium and for its algorithm-based treatment. The recommendations of the authors` group that aimed to improve the diagnosis and treatment of ICU delirium in our country included: 1) improvement of education among ICU staff members, starting with physicians, 2) introduction of guidelines for monitoring and treatment of delirium and sedation (the role of the Polish Society of Anaesthesiology and Intensive Therapy), and 3) everyday use of tools assessing delirium and sedation translated into Polish [4]. We reckon that disorders of consciousness occurring in ICU patients constitute a serious problem due to their sudden development and attributable poor prognosis; therefore, they should be diagnosed early and treated dynamically.…”

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confidence: 99%

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ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Kotfis

Marra

Ely

2018

Anaesthesiol Intensive Ther

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125

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ICU delirium is a common medical problem occurring in patients admitted to the intensive care units (ICUs). Studies have shown that ICU delirium is associated with increased mortality, prolonged hospitalization, prolonged mechanical ventilation, costs and the occurrence of cognitive disoders after discharge from ICU. The tools available for ICU delirium screening and diagnosis are validated tests available for all members if the medical team (physicians, nurses, physiotherapists). Their use for routine patient assessment is recommended by international medical and scientific societies. They have been implemented as Pain, Agitation, Delirium (PAD) Guidelines by the Society of Critical Care Medicine. Apart from monitoring, a strategy of prevention and treatment is recommended, based on non-pharmacological approach (restoration of senses, early mobilization, physiotherapy, improvement in sleep hygiene and family involvement) as well as pharmacological treatment (typical and atypical antipsychotics and dexmedetomidine). In this article, we present the risk factors of ICU delirium, available tools for monitoring, as well as options for prevention and treatment of delirium that can be used to improve care over critically ill patients.

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ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Kotfis

Marra

Ely

2018

Anaesthesiol Intensive Ther

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125

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“…Recent study (Kotfis et al, 2017) exposed than midazolam is one of the most selected sedative drugs for more than 24-hour treatments and the preferred agent for delirium treatment was haloperidol.…”

Section: Discussionmentioning

confidence: 99%

Midazolam and haloperidol for palliative sedation: physicochemical stability and compatibility of parenteral admixtures

Estan-Cerezo

Lucena

Chirivella

et al. 2019

Braz. J. Pharm. Sci.

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This study was done to determine the time while the binary admixtures with midazolam and haloperidol drugs are administered by perfusion to the patients in the clinical routine. Samples with different concentrations of both drugs were prepared following the usual clinical practice. Solvents used were 0.9 % sodium chloride solution and 5% dextrose, and viaflo plastic bags were used as the containers of the admixtures. Samples were not protected from light and were stored at 20 ºC or at 4 ºC. Compatibility and physicochemical stability were studied by visual inspection, turbidity measurement, pH determination and ultraviolet detection high performance liquid chromatography (UV-HPLC) was used to determine midazolam and haloperidol concentrations. The assay was validated following the FDA and EMA guidelines. Darunavir was used as internal standard (IS). For the studied admixtures, turbidity measurements and pH determinations showed little changes in function of the time. Haloperidol and midazolam concentrations determined by HPLC are within the acceptable range of drug concentrations, which are considered stable for four days in case of admixtures stored at 20 ºC and for seven days for refrigerated admixtures. Taking into account the microbiological risk matrix, the compatibility and the chemical and microbiological stability of the midazolam and haloperidol in the co-administered admixtures in viaflo plastic bags with 0.9 % sodium chloride solution and 5% dextrose can be set as 48 hours when samples are stored at 20 ºC and one week if they are refrigerated.

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“…Analyses were performed using the Statistical Package for the Social Sciences, version 25 (SPSS, v. 25) and R version 3.5.3 and the "survival" package (R Foundation for Statistical Computing, Vienna, Austria).…”

Section: Methodsmentioning

confidence: 99%

The challenge of managing severe delirium: an observational study of the effects of pharmacological and supportive care on delirium duration and resolution in 602 patients

Zipser

Hayoz

Knöpfel³

et al. 2019

Preprint

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Background: Delirium is the most common neuropsychiatric disorder seen in hospitalised patients. Current guidelines recommend only using antipsychotics with distressed patients. Nonetheless, in routine clinical practice, multiple psychotropics are commonly administered. More evidence on the short-term benefits of various management approaches in patients with delirium is required. Methods: In this observational cohort study, 602 delirious patients were followed for twenty days. Supportive care was provided to all patients in addition to either no psychotropic therapy, monotherapy, dual therapy, or polytherapy defined as three or more psychotropic drugs. The effectiveness of interventions regarding delirium resolution and symptom severity was determined by Cox proportional hazards regression and generalized estimating equation models. Results: Psychotropics were commonly used to manage delirium. In total, 12.1% of patients received polytherapy, 37.2% dual therapy, 37.7% monotherapy, and 12.1% supportive care alone (i.e., almost half of the patients received ≥ two psychotropics). Patients who received polytherapy had higher initial baseline delirium severity and exposed the mixed subtype more often; with the latter delirium lasted longer and recovery was less frequent than in mild delirium. Providing supportive care alone in mild delirium was superior to all psychotropic approaches. Conclusions: In routine clinical practice, the use of multiple psychotropics is common. In our study, however, despite combined supportive management and polypharmacy, patients with severe delirium suffer longer from delirium and have lower resolution rates. For the management of patients with mild delirium supportive care alone can be considered. When psychotropics are considered, single psychotropics and dose optimisation are recommended. These findings underline the challenge of managing severe delirium.

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Multicenter assessment of sedation and delirium practices in the intensive care units in Poland - is this common practice in Eastern Europe?

Cited by 45 publications

References 26 publications

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Midazolam and haloperidol for palliative sedation: physicochemical stability and compatibility of parenteral admixtures

The challenge of managing severe delirium: an observational study of the effects of pharmacological and supportive care on delirium duration and resolution in 602 patients

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