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. 2019 Apr 24:7:25.
doi: 10.1186/s40560-019-0379-z. eCollection 2019.

International Analgesia, Sedation, and Delirium Practices: a prospective cohort study

Gary D Owen  1 , Joanna L Stollings  1   2 , Shayan Rakhit  2   3   4 , Li Wang  5 , Chang Yu  5 , Morgan A Hosay  2   6 , James W Stewart  2   7 , Fernando Frutos-Vivar  8   9 , Oscar Peñuelas  8   9 , Andres Esteban  8   9 , Antonio R Anzueto  10 , Konstantinos Raymondos  11 , Fernando Rios  12 , Arnaud W Thille  13 , Marco González  14 , Bin Du  15 , Salvatore M Maggiore  16 , Dimitrios Matamis  17 , Fekri Abroug  18 , Pravin Amin  19 , Amine Ali Zeggwagh  20 , Mayur B Patel  2   3   4   21   22
Affiliations

International Analgesia, Sedation, and Delirium Practices: a prospective cohort study

Gary D Owen et al. J Intensive Care. .

Abstract

Background: While understanding of critical illness and delirium continue to evolve, the impact on clinical practice is often unknown and delayed. Our purpose was to provide insight into practice changes by characterizing analgesia and sedation usage and occurrence of delirium in different years and international regions.

Methods: We performed a retrospective analysis of two multicenter, international, prospective cohort studies. Mechanically ventilated adults were followed for up to 28 days in 2010 and 2016. Proportion of days utilizing sedation, analgesia, and performance of a spontaneous awakening trial (SAT), and occurrence of delirium were described for each year and region and compared between years.

Results: A total of 14,281 patients from 6 international regions were analyzed. Proportion of days utilizing analgesia and sedation increased from 2010 to 2016 (p < 0.001 for each). Benzodiazepine use decreased in every region but remained the most common sedative in Africa, Asia, and Latin America. Performance of SATs increased overall, driven mostly by the US/Canada region (24 to 35% of days with sedation, p < 0.001). Any delirium during admission increased from 7 to 8% of patients overall and doubled in the US/Canada region (17 to 36%, p < 0.001).

Conclusions: Analgesia and sedation practices varied widely across international regions and significantly changed over time. Opportunities for improvement in care include increasing delirium monitoring, performing SATs, and decreasing use of sedation, particularly benzodiazepines.

Keywords: Agitation; Analgesia; Critical illness; Delirium; Mechanical ventilation.

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Conflict of interest statement

The study was approved by IRBs at individual ISMV study sites and Vanderbilt University Medical Center.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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