强化欧洲镇痛、镇静和谵妄管理：一项多中心、前瞻性、干预前后试验。

Enhancing European Management of Analgesia, Sedation, and Delirium: A Multinational, Prospective, Interventional Before-After Trial.

机构信息

Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

Berlin Institute of Health, Berlin, Germany.

出版信息

Neurocrit Care. 2024 Jun;40(3):898-908. doi: 10.1007/s12028-023-01837-8. Epub 2023 Sep 11.

DOI:10.1007/s12028-023-01837-8

PMID:37697129

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11147880/

Abstract

BACKGROUND

The objective of this study was to analyze the impact of a structured educational intervention on the implementation of guideline-recommended pain, agitation, and delirium (PAD) assessment.

METHODS

This was a prospective, multinational, interventional before-after trial conducted at 12 intensive care units from 10 centers in Germany, Austria, Switzerland, and the UK. Intensive care units underwent a 6-week structured educational program, comprising online lectures, instructional videos, educational handouts, and bedside teaching. Patient-level PAD assessment data were collected in three 1-day point-prevalence assessments before (T1), 6 weeks after (T2), and 1 year after (T3) the educational program.

RESULTS

A total of 430 patients were included. The rate of patients who received all three PAD assessments changed from 55% (107/195) at T1 to 53% (68/129) at T2, but increased to 73% (77/106) at T3 (p = 0.003). The delirium screening rate increased from 64% (124/195) at T1 to 65% (84/129) at T2 and 77% (82/106) at T3 (p = 0.041). The pain assessment rate increased from 87% (170/195) at T1 to 92% (119/129) at T2 and 98% (104/106) at T3 (p = 0.005). The rate of sedation assessment showed no signficiant change. The proportion of patients who received nonpharmacological delirium prevention measures increased from 58% (114/195) at T1 to 80% (103/129) at T2 and 91% (96/106) at T3 (p < 0.001). Multivariable regression revealed that at T3, patients were more likely to receive a delirium assessment (odds ratio [OR] 2.138, 95% confidence interval [CI] 1.206-3.790; p = 0.009), sedation assessment (OR 4.131, 95% CI 1.372-12.438; p = 0.012), or all three PAD assessments (OR 2.295, 95% CI 1.349-3.903; p = 0.002) compared with T1.

CONCLUSIONS

In routine care, many patients were not assessed for PAD. Assessment rates increased significantly 1 year after the intervention. Clinical trial registration ClinicalTrials.gov: NCT03553719.

摘要

背景

本研究旨在分析结构化教育干预对指南推荐的疼痛、躁动和谵妄（PAD）评估实施的影响。

方法

这是一项在德国、奥地利、瑞士和英国的 10 个中心的 12 个重症监护病房进行的前瞻性、多国、干预前后试验。重症监护病房接受了为期 6 周的结构化教育计划，包括在线讲座、教学视频、教育讲义和床边教学。在教育计划前（T1）、6 周后（T2）和 1 年后（T3）进行了三次为期 1 天的 PAD 评估患者水平的点 prevalence 评估。

结果

共纳入 430 例患者。接受所有三次 PAD 评估的患者比例从 T1 的 55%（107/195）增加到 T2 的 53%（68/129），但增加到 T3 的 73%（77/106）（p=0.003）。谵妄筛查率从 T1 的 64%（124/195）增加到 T2 的 65%（84/129）和 T3 的 77%（82/106）（p=0.041）。疼痛评估率从 T1 的 87%（170/195）增加到 T2 的 92%（119/129）和 T3 的 98%（104/106）（p=0.005）。镇静评估率无显著变化。接受非药物性谵妄预防措施的患者比例从 T1 的 58%（114/195）增加到 T2 的 80%（103/129）和 T3 的 91%（96/106）（p<0.001）。多变量回归显示，在 T3，患者更有可能接受谵妄评估（比值比[OR]2.138，95%置信区间[CI]1.206-3.790；p=0.009）、镇静评估（OR 4.131，95%CI 1.372-12.438；p=0.012）或所有三次 PAD 评估（OR 2.295，95%CI 1.349-3.903；p=0.002）与 T1 相比。