[Current state of sedation, analgesia and blood glucose management in intensive care units of county hospitals: a multicenter cross-sectional survey in Guizhou Province of China].

Abstract

To investigate the current state of sedation, analgesia and blood glucose management in intensive care units (ICUs) of county hospitals in Guizhou Province of China, and to provide the evidences for improving quality control in critical care medicine. In March 2018, 3-4 ICUs of hospitals in every prefecture (one hospital per county) in Guizhou Province were visited to do the field survey. The patients' nursing records within 24 hours after ICU admission were reviewed, and the information such as gender, age, major diagnosis at the ICU admission, the time of admission, were collected. Moreover, the conditions about sedation and analgesia drug use and monitoring, blood pressure, blood glucose as well as and the usage of insulin and ventilator were recorded. Because not all the needed information of every ICU or patient was obtained, only the numbers of the ICUs and patients whose required information had been obtained were analyzed. Twenty-eight county hospitals in nine prefectures of Guizhou Province and 152 ICU patients were surveyed. There was a median of 5 (4, 7) patients stayed in every ICU on the day of survey. A total of 152 patients were enrolled, with 102 male (67.1%) and 50 female (32.9%); the median age was 65.0 (51.5, 74.8) years old; the major diagnosis at ICU admission was mainly cerebral diseases which accounted for 50.0% (76/152), and the second place was digestive system diseases which accounted for 13.8% (21/152); 53.8% (78/145) of patients were admitted to ICUs during 08:00-18:00. The percentages of ICUs which had patients received sedation and analgesia were 92.6% (25/27) and 88.9% (24/27) respectively, while only 44.4% (12/27) and 18.5% (5/27) of them were evaluated the depth of sedation and the level of pain respectively. There was 49.0% (71/145) of patients received sedation, and 33.8% (24/71) of them was evaluated by sedation scores; 49.7% (72/145) of patients received analgesia, and 13.9% (10/72) of them were evaluated by pain scores. The proportions of invasive mechanical ventilation in the patients with sedation or analgesia were both higher than those in the patients without sedation or analgesia [sedation compared with non-sedation: 85.9% (61/71) vs. 21.6% (16/74), analgesia compared with non-analgesia: 87.5% (63/72) vs. 19.2% (14/73), both P < 0.01]. The incidence of hypotension was similar between the sedated patients and the non-sedated patients [55.9% (38/68) vs. 40.3% (29/72), P > 0.05], while the incidence of hypotension was higher in the patients with analgesia as compared with that in the patients without analgesia with significant difference [56.9% (41/72) vs. 38.2% (26/68), P < 0.05]. Within 24 hours after ICU admission, there were 40.7% (59/145) and 5.5% (8/145) of patients had hyperglycemia (random blood glucose level ≥ 11.1 mmol/L) or hypoglycemia (random blood glucose level ≤ 3.9 mmol/L) respectively. No insulin was used to control the blood glucose level in the patients who had hypoglycemia or did not have hyperglycemia. However, only 23.7% (14/59) of patients with hyperglycemia were treated with insulin, the initiation of insulin therapy was triggered when median blood glucose level was 19.8 (16.8, 24.5) mmol/L. The evaluation of analgesia and sedation in the ICUs of county hospitals in Guizhou Province was seriously inadequate and needed to be strengthened urgently. Moreover, the strategy of blood glucose management was also needed to be improved.