Agitation on Recovery From Sedation, Delirium, Pain
Conditions
Keywords
pain, agitation, sedation, delirium, protocol
Brief summary
The investigators proposed that pain, agitation, delirium and sleep deprivation protocol (PADS) will help improve the patients' outcomes (shortening ICU length of stay, improving ventilator free days, increasing delirium free days) in critically ill patients, a university hospital, Thailand.
Detailed description
Pain is frequently reported in patients admitted to an ICU, with an incidence of up to 50% in medical patients during admission, and increasing up to 80% during standard care procedures. Agitation was also reported in 52% of the patients, typically within 4-9 days after admission. However, there were studies reporting inadequate pain, agitation and delirium assessment and management in real-world clinical practice. The clinical practice guideline for the management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU was recently published in 2018 and emphasized routinely monitoring pain, agitation and delirium during ICU admissions. Also, appropriate management of pain and agitation in critically ill patients resulted in reduction in ICU length of stay, hospital length of stay, delirium and mortality. Therefore, structural pain, agitation/sedation, delirium assessment and treatment in the ICUs, Thailand might be necessary. Since pain, agitation/sedation and delirium protocol has not yet been initiated in ICUs, Thailand, this study is designed as a before-after study in order to assess outcomes by comparing between before and after protocol initiation. The objectives of the study were to document the impact of pain, agitation/sedation, delirium protocol on clinical outcomes of ICU patients admitted to ICUs at Ramathibodi Hospital, a university hospital, Thailand
Interventions
OTHERPADS protocol
Assessment and management per PADS protocol
Sponsors
Mahidol University
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
A before-after study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults (18 years and older) * Patients admitted to medical or surgical intensive care units
Exclusion criteria
* Terminal ill patients, or patients unlikely to survive \> 24 hours
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| ICU free days | During ICU stay or death or a maximum of 28 days | Days alive and not stay in ICU |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Delirium free days | During ICU stay or death or a maximum of 28 days | Day alive and free of delirium |
| Frequency of pain, agitation/sedation, delirium, sleep deprivation assessement | During ICU stay or death or a maximum of 28 days | Times per patient-days of evaluations during ICU stay |
| Incidence of in-target pain, agitation/sedation, delirium | During ICU stay or death or a maximum of 28 days | Times per patient-days of in-target pain, agitation/sedation, delirium during ICU stay |
| Compliance to PADS protocol | During ICU stay or death or a maximum of 28 days | Times per patient-days of PADS protocol use by healthcare providers during ICU stay |
| Mechanical ventilator free days | During ICU stay or death or a maximum of 28 days | Day alive and free of mechanical ventilator |
| Antipsychotics use | During ICU stay or death or a maximum of 28 days | Type and dose of antipsychotics during ICU stay |
| Non-benzodiazepines use | During ICU stay or death or a maximum of 28 days | Type and dose of non-benzodiazepines during ICU stay |
| Benzodiazepines use | During ICU stay or death or a maximum of 28 days | Type and dose of non-benzodiazepines during ICU stay |
| All-cause hospital mortality | During hospital stay or death or a maximum of 90 days | Rates of all-cause mortality during hospital stay |
Countries
Thailand
Outcome results
None listed