A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China

Background: The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available i...

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Main Authors: Jing Wang, Zhi-Yong Peng, Wen-Hai Zhou, Bo Hu, Xin Rao, Jian-Guo Li
Format: Article
Language:English
Published: Wolters Kluwer 2017-01-01
Series:Chinese Medical Journal
Subjects:
Online Access:http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=10;spage=1182;epage=1188;aulast=Wang
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spelling doaj-44213fbf7e324ebe938b92a9e69a7ea82020-11-24T20:40:32ZengWolters KluwerChinese Medical Journal0366-69992017-01-01130101182118810.4103/0366-6999.205852A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in ChinaJing WangZhi-Yong PengWen-Hai ZhouBo HuXin RaoJian-Guo LiBackground: The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China. Methods: A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016. The questionnaire focused on the assessment and management of PAD by the clinicians in ICUs. The practice of PAD was compared among the four regions of China (North, Southeast, Northwest, and Southwest). The data were expressed as percentage and frequency. The Chi-square test, Fisher's exact test, and line-row Chi-square test were used. Results: Of the 1011 valid questionnaire forms, the response rate was 80.37%. The clinicians came from 704 hospitals across 158 cities of China. The rate of PAD assessment was 75.77%, 90.21%, and 66.77%, respectively. The rates of PAD scores were 45.8%, 68.94%, and 34.03%, respectively. The visual analog scale, Richmond agitation-sedation scale, and confusion assessment method for the ICU were the first choices of scales for PAD assessment. Fentanyl, midazolam, and dexmedetomidine were the first choices of agents for analgesic, sedation, and delirium treatment. While choosing analgesics and sedatives, the clinicians put the pharmacological characteristics of drugs in the first place (66.07% and 76.36%). Daily interruption for sedation was carried out by 67.26% clinicians. Most of the clinicians (87.24%) used analgesics while using sedatives. Of the 738 (73%) clinicians titrating the sedatives on the basis of the proposed target sedation level, 268 (26.61%) clinicians just depended on their clinical experience. Totally, 519 (51.34%) clinicians never used other nondrug strategies for PAD. The working time of clinicians was an important factor in the management of analgesia and sedation rather than their titles and educational background. The ratios of pain score and sedation score in the Southwest China were the highest and the North China were the lowest. The ratios of delirium assessment and score were the same in the four regions of China. Moreover, the first choices of scales for PAD in the four regions were the same. However, the top three choices of agents in PAD treatment in the four regions were not the same. Conclusions: The practice of PAD in China follows the international guidelines; however, the pain assessment should be improved. The PAD practice is a little different across the four regions of China; however, the trend is consistent. Trial Registration: The study is registered at http://www.clinicaltrials.gov (No. ChiCTR-OOC-16009014, www.chictr. org.cn/index.aspx.).http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=10;spage=1182;epage=1188;aulast=WangAgitation; Delirium; Intensive Care Unit; Pain; Sedation
collection DOAJ
language English
format Article
sources DOAJ
author Jing Wang
Zhi-Yong Peng
Wen-Hai Zhou
Bo Hu
Xin Rao
Jian-Guo Li
spellingShingle Jing Wang
Zhi-Yong Peng
Wen-Hai Zhou
Bo Hu
Xin Rao
Jian-Guo Li
A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China
Chinese Medical Journal
Agitation; Delirium; Intensive Care Unit; Pain; Sedation
author_facet Jing Wang
Zhi-Yong Peng
Wen-Hai Zhou
Bo Hu
Xin Rao
Jian-Guo Li
author_sort Jing Wang
title A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China
title_short A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China
title_full A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China
title_fullStr A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China
title_full_unstemmed A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China
title_sort national multicenter survey on management of pain, agitation, and delirium in intensive care units in china
publisher Wolters Kluwer
series Chinese Medical Journal
issn 0366-6999
publishDate 2017-01-01
description Background: The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China. Methods: A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016. The questionnaire focused on the assessment and management of PAD by the clinicians in ICUs. The practice of PAD was compared among the four regions of China (North, Southeast, Northwest, and Southwest). The data were expressed as percentage and frequency. The Chi-square test, Fisher's exact test, and line-row Chi-square test were used. Results: Of the 1011 valid questionnaire forms, the response rate was 80.37%. The clinicians came from 704 hospitals across 158 cities of China. The rate of PAD assessment was 75.77%, 90.21%, and 66.77%, respectively. The rates of PAD scores were 45.8%, 68.94%, and 34.03%, respectively. The visual analog scale, Richmond agitation-sedation scale, and confusion assessment method for the ICU were the first choices of scales for PAD assessment. Fentanyl, midazolam, and dexmedetomidine were the first choices of agents for analgesic, sedation, and delirium treatment. While choosing analgesics and sedatives, the clinicians put the pharmacological characteristics of drugs in the first place (66.07% and 76.36%). Daily interruption for sedation was carried out by 67.26% clinicians. Most of the clinicians (87.24%) used analgesics while using sedatives. Of the 738 (73%) clinicians titrating the sedatives on the basis of the proposed target sedation level, 268 (26.61%) clinicians just depended on their clinical experience. Totally, 519 (51.34%) clinicians never used other nondrug strategies for PAD. The working time of clinicians was an important factor in the management of analgesia and sedation rather than their titles and educational background. The ratios of pain score and sedation score in the Southwest China were the highest and the North China were the lowest. The ratios of delirium assessment and score were the same in the four regions of China. Moreover, the first choices of scales for PAD in the four regions were the same. However, the top three choices of agents in PAD treatment in the four regions were not the same. Conclusions: The practice of PAD in China follows the international guidelines; however, the pain assessment should be improved. The PAD practice is a little different across the four regions of China; however, the trend is consistent. Trial Registration: The study is registered at http://www.clinicaltrials.gov (No. ChiCTR-OOC-16009014, www.chictr. org.cn/index.aspx.).
topic Agitation; Delirium; Intensive Care Unit; Pain; Sedation
url http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=10;spage=1182;epage=1188;aulast=Wang
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