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.

چکیده اصلی

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.

ترجمه فارسی چکیده

هدف این مطالعه توصیف سیاست‌های سازمانی و اجرای بهترین شیوه‌های درد، اضطراب و دیسکره‌ای (PAD) قبل از همه‌گیری کووید-19 و تغییرات percepated در طول همه‌گیری بود. این یک مطالعه پرسشنامه‌ای سطح سایت بین‌المللی بود. ۹۳ مرکز مراقبت‌های ویژه که بیماران بالغ را در ۷۹ بیمارستان در ۲۷ کشور اروپا و آمریکای شمالی و جنوبی مراقبت می‌کردند، شرکت کردند. داده‌ها شامل ویژگی‌های سایت، نیروی انسانی، اجرای پروتکل‌های PAD و ابزارهای ارزیابی قبل از همه‌گیری و تغییرات percepated در طول همه‌گیری بود. بیش از ۷۵٪ از مراکز از مقیاس‌های معتبر PAD استفاده روتین گزارش کردند. پروتکل‌ها بیشتر برای آزمایش‌های تنفس خودبه‌خودی و بی‌حسی در دسترس بودند. وجود پروتکل ترک تنفس با شانس بالاتر قطع بی‌حسی روزانه مرتبط بود. نزدیک به نیمی از مراکز گزارش دادند کمبود دارو در طول همه‌گیری.

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