BACKGROUND: Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes. MATERIALS AND METHODS: A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine. RESULTS: The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P = .038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P < .001). The mortality rate in the protocol group was significantly reduced from 23.8% to 12.5% (P = .046). CONCLUSION: The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD.
RCT Entities:
BACKGROUND: Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes. MATERIALS AND METHODS: A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine. RESULTS: The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P = .038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P < .001). The mortality rate in the protocol group was significantly reduced from 23.8% to 12.5% (P = .046). CONCLUSION: The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD.
Authors: Felix Balzer; Björn Weiß; Oliver Kumpf; Sascha Treskatsch; Claudia Spies; Klaus-Dieter Wernecke; Alexander Krannich; Marc Kastrup Journal: Crit Care Date: 2015-04-28 Impact factor: 9.097
Authors: Zoran Trogrlić; Mathieu van der Jagt; Jan Bakker; Michele C Balas; E Wesley Ely; Peter H J van der Voort; Erwin Ista Journal: Crit Care Date: 2015-04-09 Impact factor: 9.097
Authors: Lilian Maria Sobreira Tanaka; Luciano Cesar Pontes Azevedo; Marcelo Park; Guilherme Schettino; Antonio Paulo Nassar; Alvaro Réa-Neto; Luana Tannous; Vicente Ces de Souza-Dantas; André Torelly; Thiago Lisboa; Claudio Piras; Frederico Bruzzi Carvalho; Marcelo de Oliveira Maia; Fabio Poianas Giannini; Flavia Ribeiro Machado; Felipe Dal-Pizzol; Alexandre Guilherme Ribeiro de Carvalho; Ronaldo Batista dos Santos; Paulo Fernando Guimarães Morando Marzocchi Tierno; Marcio Soares; Jorge Ibrain Figueira Salluh Journal: Crit Care Date: 2014-07-21 Impact factor: 9.097
Authors: Özgür Özmen; Fatih Özçelik; Mehmet Ali Kaygın; Habip Yılmaz; Muhammet Ahmet Karakaya Journal: Turk Gogus Kalp Damar Cerrahisi Derg Date: 2019-06-21 Impact factor: 0.332
Authors: Suzanne Forsyth Herling; Ingrid E Greve; Eduard E Vasilevskis; Ingrid Egerod; Camilla Bekker Mortensen; Ann Merete Møller; Helle Svenningsen; Thordis Thomsen Journal: Cochrane Database Syst Rev Date: 2018-11-23