Kotfis Katarzyna, Zegan-Barańska Małgorzata, Żukowski Maciej, Kusza Krzysztof, Kaczmarczyk Mariusz, Ely E Wesley
Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland.
Department of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences University, Poznań, Poland.
BMC Anesthesiol. 2017 Sep 2;17(1):120. doi: 10.1186/s12871-017-0415-2.
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.
A national postal survey was conducted in all Polish ICUs in early 2016.
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) were propofol and fentanyl infusions and benzodiazepines (midazolam) and morphine for longer 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.
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.
大多数重症患者在重症监护病房（ICU）住院期间会感到痛苦，这是由全身性疾病、多种干预措施和环境因素导致的。提供人文关怀应兼顾疼痛、躁动和谵妄的治疗。镇静的使用及ICU谵妄的处理方法应依据结构化指南进行监测。然而，在波兰等东欧国家，这些理念的遵循程度尚不清楚。本研究的目的是评估作为东欧地区代表的波兰ICU中的镇静和谵妄处理情况，特别是镇静和ICU谵妄筛查工具的实施情况、书面镇静指南的可用性、镇静和谵妄治疗药物的选择。
2016年初对波兰所有ICU进行了全国性邮政调查。
在436个被调查的单位中，共收到165份回复（37.8%）。在做出回复的ICU中，波兰仅有11.9%的单位对谵妄进行监测。仅有46.1%的单位使用镇静监测工具。仅有19.4%的ICU有书面的镇静方案，32.1%的单位未进行每日镇静中断。短期镇静（<24小时）最常用的药物是丙泊酚和芬太尼输注，长效镇静（>24小时）则使用苯二氮䓬类药物（咪达唑仑）和吗啡。谵妄治疗的首选药物是氟哌啶醇（77.6%）、右美托咪定（43.6%）和喹硫平（19.4%）。近三分之一（32.7%）的受访者选择苯二氮䓬类药物（地西泮）用于ICU谵妄治疗。仅有45%的受访者报告了ICU谵妄的非药物治疗。
大多数波兰ICU未遵循关于镇静和谵妄处理的国际指南。镇静和谵妄监测工具的使用仍然不足。苯二氮䓬类药物在镇静和ICU谵妄治疗中的高使用率表明非循证实践依然存在。本研究应促使对其他东欧国家进行进一步评估，并有助于形成集体应对措施，以更新患者安全和舒适度的这些方面。
