Wang Jing, Peng Zhi-Yong, Zhou Wen-Hai, Hu Bo, Rao Xin, Li Jian-Guo
Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.
Department of Clinical Medicine, City College, Wuhan university of Science and Technology, Wuhan, Hubei 430083, China.
Chin Med J (Engl). 2017 May 20;130(10):1182-1188. doi: 10.4103/0366-6999.205852.
The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China.
A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016. The questionnaire focused on the assessment and management of PAD by the clinicians in ICUs. The practice of PAD was compared among the four regions of China (North, Southeast, Northwest, and Southwest). The data were expressed as percentage and frequency. The Chi-square test, Fisher's exact test, and line-row Chi-square test were used.
Of the 1011 valid questionnaire forms, the response rate was 80.37%. The clinicians came from 704 hospitals across 158 cities of China. The rate of PAD assessment was 75.77%, 90.21%, and 66.77%, respectively. The rates of PAD scores were 45.8%, 68.94%, and 34.03%, respectively. The visual analog scale, Richmond agitation-sedation scale, and confusion assessment method for the ICU were the first choices of scales for PAD assessment. Fentanyl, midazolam, and dexmedetomidine were the first choices of agents for analgesic, sedation, and delirium treatment. While choosing analgesics and sedatives, the clinicians put the pharmacological characteristics of drugs in the first place (66.07% and 76.36%). Daily interruption for sedation was carried out by 67.26% clinicians. Most of the clinicians (87.24%) used analgesics while using sedatives. Of the 738 (73%) clinicians titrating the sedatives on the basis of the proposed target sedation level, 268 (26.61%) clinicians just depended on their clinical experience. Totally, 519 (51.34%) clinicians never used other nondrug strategies for PAD. The working time of clinicians was an important factor in the management of analgesia and sedation rather than their titles and educational background. The ratios of pain score and sedation score in the Southwest China were the highest and the North China were the lowest. The ratios of delirium assessment and score were the same in the four regions of China. Moreover, the first choices of scales for PAD in the four regions were the same. However, the top three choices of agents in PAD treatment in the four regions were not the same.
The practice of PAD in China follows the international guidelines; however, the pain assessment should be improved. The PAD practice is a little different across the four regions of China; however, the trend is consistent.
The study is registered at http://www.clinicaltrials.gov (No. ChiCTR-OOC-16009014, www.chictr. org.cn/index.aspx.).
重症监护病房（ICU）中疼痛、躁动和谵妄（PAD）的管理对患者有益，在临床实践中广泛应用。以往研究表明，ICU中PAD的临床实践正在改善；然而在中国，相关信息相对较少。本研究旨在调查中国ICU中PAD的实践情况。
于2016年9月19日至12月18日采用临床医生指导的问卷进行了一项多中心、全国性调查。问卷聚焦于ICU临床医生对PAD的评估和管理。对中国四个地区（北方、东南、西北和西南）的PAD实践情况进行了比较。数据以百分比和频数表示。采用卡方检验、Fisher精确检验和行×列卡方检验。
在1011份有效问卷中，应答率为80.37%。临床医生来自中国158个城市的704家医院。PAD评估率分别为75.77%、90.21%和66.77%。PAD评分率分别为45.8%、68.94%和34.03%。视觉模拟量表、Richmond躁动 - 镇静量表和ICU谵妄评估方法是PAD评估量表的首选。芬太尼、咪达唑仑和右美托咪定分别是镇痛、镇静和谵妄治疗药物的首选。在选择镇痛药和镇静药时，临床医生将药物的药理学特性放在首位（分别为66.07%和76.36%）。67.26%的临床医生进行每日镇静中断。大多数临床医生（87.24%）在使用镇静药时使用镇痛药。在738名（73%）根据建议的目标镇静水平滴定镇静药的临床医生中，268名（26.61%）临床医生仅依靠临床经验。共有519名（51.34%）临床医生从未使用其他非药物策略治疗PAD。临床医生的工作时间是镇痛和镇静管理的重要因素，而非他们的职称和教育背景。中国西南地区的疼痛评分和镇静评分比例最高，华北地区最低。中国四个地区的谵妄评估和评分比例相同。此外，四个地区PAD评估量表的首选相同。然而，四个地区PAD治疗药物的前三选择不同。
中国PAD的实践遵循国际指南；然而，疼痛评估应予以改善。中国四个地区的PAD实践略有不同；然而趋势一致。
本研究在http://www.clinicaltrials.gov注册（注册号：ChiCTR - OOC - 16009014，www.chictr.org.cn/index.aspx.）
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