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

• Published in: Neurocritical care 2024-06, Vol.40 (3), p.898-908
• Main Authors: Paul, Nicolas, Grunow, Julius J., Rosenthal, Max, Spies, Claudia D., Page, Valerie J., Hanison, James, Patel, Brijesh, Rosenberg, Alex, von Haken, Rebecca, Pietsch, Urs, Schrag, Claudia, Waydhas, Christian, Schellongowski, Peter, Lobmeyr, Elisabeth, Sander, Michael, Piper, Sophie K., Conway, Daniel, Totzeck, Andreas, Weiss, Björn
• Format: Article
• Language: English
• Subjects: Adult; Aged; Algorithms; Analgesia - methods; Anesthesia; Austria; Conscious Sedation; Critical Care - standards; Critical Care Medicine; Data collection; Delirium; Delirium - therapy; Europe; Female; Germany; Humans; Intensive; Intensive care; Intensive Care Units; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Neurosurgery; Nurses; Original Work; Pain; Pain Management - methods; Pain Measurement; Patients; Prospective Studies; Psychomotor Agitation - therapy; Switzerland; Training; United Kingdom; Ventilators
• ISSN: 1541-6933; 1556-0961; 1556-0961
• DOI: 10.1007/s12028-023-01837-8

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