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Multicenter Study
. 2019 Sep;38(3):156-162.

Occurrence and Practices for Pain, Agitation, and Delirium in Intensive Care Unit Patients

Carmen Mabel Arroyo-Novoa  1 , Milagros I Figueroa-Ramos  1 , Kathleen A Puntillo  2
Affiliations
Multicenter Study

Occurrence and Practices for Pain, Agitation, and Delirium in Intensive Care Unit Patients

Carmen Mabel Arroyo-Novoa et al. P R Health Sci J. 2019 Sep.

Abstract
in English, Spanish

Objective: Our study described the occurrence, assessment, prevention, and management practices of pain, agitation, and delirium (PAD) in four intensive care units (ICUs) from the Puerto Rico Medical Center and compared findings with the 2013 PAD guidelines.

Methods: A descriptive study, with repeated bedside measures (two times a day/two times a week) of PAD and review of patient clinical records.

Results: Eighty ICU patients (20 per ICU) were evaluated, (median 3 times [IQR, 2-7]). At least once during the assessment period, 57% percent of patients had significant pain and 34% had delirium. Moreover, 46% were deeply sedated, 17.5% had agitation, and 52.5% of patients were within the recommended Richmond Agitation-Sedation Scale (RASS) scores. The Numeric Rating Scale and RASS were the most common tools used by clinicians to evaluate pain and agitation/sedation levels, respectively. Clinicians did not assess pain in patients unable to self-report with any guideline-recommended tools, as was the case for delirium. Fentanyl and morphine were the most commonly used analgesics, while benzodiazepines were used for sedation.

Conclusion: Although pain, agitation, and delirium occurrence were similar to other studies, patients continue to suffer. A gap exists between clinical practices in these ICUs and current guidelines. Strategies that contribute to integrating guidelines into these ICUs should be developed, studied, and implemented.

Objetivos:: Se describió la ocurrencia, estimado, prevención y prácticas de manejo de dolor, agitación y delirium (DAD) en cuatro unidades de cuidado intensivo (UCI) del Centro Médico de Puerto Rico y comparó los hallazgos con las guías de DAD del 2013.

Metodología:: Estudio descriptivo con medidas repetidas (dos veces al día/dos veces en semana) de DAD y la revisión de expedientes clínicos.

Resultados:: Ochenta pacientes de UCI (20/unidad) fueron evaluados (mediana 3 veces, [IQR, 2–7]). Al menos una vez durante el periodo de estimado, el 57% de los pacientes tenía dolor significativo y el 34% tenía delirium. Además, el 46% estaba profundamente sedado, el 17.5% tenía agitación y el 52.5% de los pacientes se encontraban dentro de los niveles recomendados en la Escala de Agitación-Sedación de Richmond (RASS). La Escala de Valoración Numérica y el RASS fueron las herramientas más comúnmente utilizadas por los clínicos para evaluar los niveles de dolor y agitación/sedación, respectivamente. Los clínicos no evaluaron el dolor en pacientes incapaces de auto-reportarlo usando instrumentos recomendados por las guías, como fue el caso con el delirium. El fentanilo y la morfina fueron los medicamentos más utilizados para la analgesia, mientras que las benzodiacepinas se utilizaron para la sedación.

Conclusiones:: Aunque la ocurrencia de DAD es similar a otros estudios, los pacientes continúan sufriendo estos fenómenos. Existe una brecha entre las prácticas clínicas de las UCI y las guías actuales. Se deben desarrollar, estudiar e implementar estrategias que contribuyan a la integración de estas guías en las UCI.

Keywords: Agitation; Analgesia; Delirium; Intensive care unit; Pain; Sedation.

PubMed Disclaimer

Conflict of interest statement

The author/s has/have no conflict/s of interest to disclose. This study was funded by Capacity Advancement in Research Infrastructure University of Puerto Rico UPR MFP-6251123.

Figures

Figure 1.
Figure 1.
Patients recruitment process. Legend: *neurologic deficit, no family available for consent, patient or family refused to participate, and other exclusion criteria; **difficult to assess.
Figure 2.
Figure 2.
Frequency of analgesics administered. Note: Some patients received more than one type of analgesic.
Figure 3.
Figure 3.
Frequency of sedatives administered. Note: Some patients received more than one type of sedative. In one of the sites fentanyl was given for sedation purpose.
See this image and copyright information in PMC

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