Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.
Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, QC, Canada.
Can J Anaesth. 2024 Feb;71(2):264-273. doi: 10.1007/s12630-023-02666-1. Epub 2023 Dec 21.
Agitation is a common behavioural problem following traumatic brain injury (TBI). Intensive care unit (ICU) physicians' perspectives regarding TBI-associated agitation are unknown. Our objective was to describe physicians' beliefs and perceived importance of TBI-associated agitation in critically ill patients.
Following current standard guidance, we built an electronic, self-administrated, 42-item survey, pretested it for reliability and validity, and distributed it to 219 physicians working in 18 ICU level-1 trauma centres in Canada. We report the results using descriptive statistics.
The overall response rate was 93/219 (42%), and 76/93 (82%) respondents completed the full survey. Most respondents were men with ten or more years of experience. Respondents believed that pre-existing dementia (90%) and regular recreational drug use (86%) are risk factors for agitation. Concerning management, 91% believed that the use of physical restraints could worsen agitation, 90% believed that having family at the bedside reduces agitation, and 72% believed that alpha-2 adrenergic agonists are efficacious for managing TBI agitation. Variability was observed in beliefs on epidemiology, sex, gender, age, socioeconomic status, and other pharmacologic options. Respondents considered TBI agitation frequent enough to justify the implementation of management protocols (87%), perceived the current level of clinical evidence on TBI agitation management to be insufficient (84%), and expressed concerns about acute and long-term detrimental outcomes and burden to patients, health care professionals, and relatives (85%).
Traumatic brain injury-associated agitation in critically ill patients was perceived as an important issue for most ICU physicians. Physicians agreed on multiple approaches to manage TBI-associated agitation although agreement on epidemiology and risk factors was variable.
激越是创伤性脑损伤（TBI）后常见的行为问题。重症监护病房（ICU）医生对与 TBI 相关的激越的看法尚不清楚。我们的目的是描述医生对重症患者中与 TBI 相关的激越的信念和感知重要性。
根据当前的标准指南，我们构建了一个电子的、自我管理的、包含 42 个项目的调查，对其进行了可靠性和有效性的预测试，并将其分发给在加拿大 18 个 1 级创伤中心的 219 名 ICU 医生。我们使用描述性统计报告结果。
总体回复率为 93/219（42%），76/93（82%）的受访者完成了完整的调查。大多数受访者是有 10 年以上经验的男性。受访者认为，预先存在的痴呆症（90%）和经常使用娱乐性药物（86%）是激越的风险因素。关于管理，91%的人认为使用身体约束会加重激越，90%的人认为让家人在床边会减轻激越，72%的人认为 α-2 肾上腺素能激动剂对治疗 TBI 激越有效。在流行病学、性别、年龄、社会经济地位和其他药物选择方面的信念存在差异。受访者认为 TBI 激越足够频繁，需要实施管理方案（87%），认为目前关于 TBI 激越管理的临床证据水平不足（84%），并对急性和长期的不良后果以及对患者、医疗保健专业人员和家属的负担表示担忧（85%）。
对于大多数 ICU 医生来说，重症患者中与 TBI 相关的激越被认为是一个重要问题。尽管对流行病学和危险因素的一致性存在差异，但医生在治疗与 TBI 相关的激越方面达成了多个共识。
