System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Multicenter Study Epublish

PubMed: 42695271 DOI: 10.1097/CCE.0000000000001479

Characteristics and Reported Practices of ICUs Participating in the Sedation, Analgesia and Delirium Management International Study: Variability in Site-Level Management of Mechanically Ventilated Patients.

Crit Care Explor 8(9):e1479

Authors: Sangeeta Mehta, Sherihane Bensemmane, Kiyan Heybati, Nanki Ahluwalia, Michelle S Chew, Lisa Burry, Federico Carlos Carini, Giuseppe Citerio, Dylan deLange, Ib Jammer, Geert Meyfroidt, Jorge Salluh, Fabio Silvio Taccone, Bjorn Weiss, Lara Prisco

Affiliations

  • Department of Medicine, Sinai Health, Toronto, ON, Canada.
  • Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  • European Society of Intensive Care Medicine, Sciensano, Brussels, Belgium.
  • Health Services Research, Epidemiology and Public health, Sciensano, Brussels, Belgium.
  • Department of Internal Medicine, Mayo Clinic, Rochester, MN.
  • Department of Medicine, Sinai Health System, Toronto, ON, Canada.
  • Department of Perioperative Medicine, Karolinska University Hospital, Stockholm, Sweden.
  • Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
  • Departments of Pharmacy and Medicine, Sinai Health, Toronto, ON, Canada.
  • Interdepartmental Division of Critical Care Medicine, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
  • Department of Medicine, Sinai Health System, Toronto, ON, Canada. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  • School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
  • NeuroIntensive Care Unit, Department Neuroscience, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy.
  • Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Department of Anaesthesia and Intensive Care Medicine, Haukeland University Hospital, Bergen, Norway.
  • Department of Intensive Care Medicine, University of Leuven, Leuven, Belgium.
  • Department of Critical Care, D'OR Institute for Research and Education, Rio de Janeiro, Brazil.
  • Department of Intensive Care, Hôpital Erasme, Brussels, Belgium.
  • Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Berlin University Hospital, Berlin, Germany.
  • Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
  • Neurosciences Intensive Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.

Abstract

OBJECTIVE

To describe site-level ICU organizational policies and implementation of pain, agitation, and delirium (PAD) best practices before the COVID-19 pandemic, and perceived changes during the pandemic.

DESIGN

International site-level questionnaire study.

SETTING

Participating sites completed a standardized electronic Case Report Form between January 5, 2022 and March 31, 2023.

PATIENTS/CENTERS

Ninety-three ICUs caring for adult patients from 79 hospitals across 27 countries in North America, South America, and Europe.

INTERVENTIONS

Each ICU submitted data on site characteristics, staffing, implementation of PAD protocols and assessment tools prepandemic, and perceived changes during the COVID-19 pandemic. Descriptive statistics and multivariable logistic regressions were performed using R.

MEASUREMENTS AND MAIN RESULTS

Of 93 ICUs, 63% were university-affiliated, and 59% reported a closed physician staffing model. Most managed mixed patient populations (78%), with a nurse-to-patient ratio for ventilated patients of 1:2 (45%) or 1:1 (39%). Physiotherapists and pharmacists were available in 83% and 68% of ICUs, respectively. Over 75% reported routine use of validated PAD scales, most commonly Richmond Agitation Sedation Scale (86%), Confusion Assessment Method for ICU (59%), and Numeric Rating Scale (44%). Protocols were most available for spontaneous breathing trials (60%) and sedation (58%), followed by delirium (53%), mobilization (47%), and pain (46%). University affiliation and 1:1 nurse staffing was associated with reported use of delirium or mobilization protocols. The presence of a weaning protocol was associated with higher odds of daily sedation interruption (adjusted odds ratio [aOR] 3.80; 95% CI, 1.43-10.89; p = 0.009), and use of sedation protocols (aOR 5.95; 95% CI, 2.29-16.86; p < 0.001). Nearly one-half of ICUs reported drug shortages during the pandemic, and 62% prohibited any visitation.

CONCLUSIONS

ICU organizational structures and reported PAD practices vary widely worldwide. Despite international guidelines, many ICUs lack consistent implementation of evidence-based sedation, analgesia, and delirium management strategies.

MeSH

Nurses, Delirium, Pain, Analgesia, Pandemics, Intensive Care Units, Workforce