Delirium Bibliography

Reference Information

Title

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

Authors

Kotfis, K. Zegan-Barańska, M. Zukowski, M. Kusza, K. Kaczmarczyk, M. Ely, E. W.

Year

2017

Journal

BMC Anesthesiology

Abstract

Background: The majority of critically ill patients experience distress during their stay in the Intensive Care Unit (ICU), resulting from systemic illness, multiple interventions and environmental factors. Providing humane care should address concomitant treatment of pain, agitation and delirium. The use of sedation and approaches to ICU delirium should be monitored according to structured guidelines. However, it is unknown to what extent these concepts are followed in Eastern European countries like Poland. The aim of this study was to evaluate sedation and delirium practices in ICUs in Poland, as a representative of the Eastern European block, particularly the implementation of sedation and ICU delirium screening tools, availability of written sedation guidelines, choice of sedation and delirium treatment agents. Methods: A national postal survey was conducted in all Polish ICUs in early 2016. Results: A total of 165 responses out of 436 addressed units were received (37.8%). Out of responding ICUs delirium is monitored in only 11.9% of the units in Poland. Sedation monitoring tool is used in only 46.1% of units. Only 19.4% of ICUs have written protocols for sedation and 32.1% do not practice daily sedation interruption. The most frequently used agents for short-term sedation (24 h). The preferred agents for delirium treatment were haloperidol (77.6%), dexmedetomidine (43.6%) and quetiapine (19.4%). Close to one-third (32.7%) of respondents chose a benzodiazepine (diazepam) for ICU delirium treatment. Non-pharmacological treatment for ICU delirium was reported by only 45% of the respondents. Conclusions: A majority of Polish ICUs do not adhere to international guidelines regarding sedation and delirium practices. There continues to be inadequate use of sedation and delirium monitoring tools. High usage of benzodiazepines for sedation and ICU delirium treatment reveals persistence of non-evidence-based practice. This study should prompt further assessment of other Eastern Europe countries and help generate a collective response to update these aspects of patient safety and comfort.

PMID

28865447

Keywords

benzodiazepine derivative
dexmedetomidine
diazepam
fentanyl
haloperidol
midazolam
morphine
nalbuphine
oxycodone
propofol
quetiapine
remifentanil
tramadol
adult
anesthesist
article
clinical protocol
confusion assessment method for intensive care unit
delirium
drug choice
drug preference
DSM-IV
evidence based practice
human
ICD-10
intensive care
Intensive Care Delirium Screening Checklist
intensivist
monitoring
neurologic disease assessment
occupational therapy
patient safety
physiotherapy
Poland
protocol compliance
Ramsay Sedation Scale
Richmond Agitation Sedation Scale
sedation

Page(s)

Volume

17

Issue

1