Multicenter assessment of sedation and delirium practices in the intensive care units in Poland - is this common practice in Eastern Europe?

Mariusz Kaczmarczyk,Krzysztof Kusza,Maciej Żukowski,Katarzyna Kotfis,Małgorzata Zegan-Barańska,E. Wesley Ely

doi:10.1186/s12871-017-0415-2

Abstract

BackgroundThe majority of critically ill patients experience distress during their stay in the Intensive Care Unit (ICU), resulting from systemic illness, multiple interventions and environmental factors. Providing humane care should address concomitant treatment of pain, agitation and delirium. The use of sedation and approaches to ICU delirium should be monitored according to structured guidelines. However, it is unknown to what extent these concepts are followed in Eastern European countries like Poland. The aim of this study was to evaluate sedation and delirium practices in ICUs in Poland, as a representative of the Eastern European block, particularly the implementation of sedation and ICU delirium screening tools, availability of written sedation guidelines, choice of sedation and delirium treatment agents.MethodsA national postal survey was conducted in all Polish ICUs in early 2016.ResultsA total of 165 responses out of 436 addressed units were received (37.8%). Out of responding ICUs delirium is monitored in only 11.9% of the units in Poland. Sedation monitoring tool is used in only 46.1% of units. Only 19.4% of ICUs have written protocols for sedation and 32.1% do not practice daily sedation interruption. The most frequently used agents for short-term sedation (<24 h) were propofol and fentanyl infusions and benzodiazepines (midazolam) and morphine for longer sedation (>24 h). The preferred agents for delirium treatment were haloperidol (77.6%), dexmedetomidine (43.6%) and quetiapine (19.4%). Close to one-third (32.7%) of respondents chose a benzodiazepine (diazepam) for ICU delirium treatment. Non-pharmacological treatment for ICU delirium was reported by only 45% of the respondents.ConclusionsA majority of Polish ICUs do not adhere to international guidelines regarding sedation and delirium practices. There continues to be inadequate use of sedation and delirium monitoring tools. High usage of benzodiazepines for sedation and ICU delirium treatment reveals persistence of non-evidence-based practice. This study should prompt further assessment of other Eastern Europe countries and help generate a collective response to update these aspects of patient safety and comfort.

Highlights

The majority of critically ill patients experience distress during their stay in the Intensive Care Unit (ICU), resulting from systemic illness, multiple interventions and environmental factors
Current international sedation guidelines concentrate on eliminating benzodiazepines in favor of strategies based on analgesia and use of propofol or dexmedetomidine to improve clinical outcome in critically ill patients, namely decreased ICU and hospital treatment time, decreased likelihood of developing delirium and post-ICU cognitive impairment [5, 6]
To make the results of this study more meaningful in providing better outcome for ICU patients in Poland we propose a set actions to change practices: 1. better education of intensivists, 2. introduction of national delirium and sedation guidelines and 3. the use of delirium screening and sedation assessment scales translated into Polish and validated in Polish

Summary

Introduction

The majority of critically ill patients experience distress during their stay in the Intensive Care Unit (ICU), resulting from systemic illness, multiple interventions and environmental factors. Sedation can be used to maintain comfort for the patient and minimize agitation and anxiety It can represent a whole spectrum of approaches from light sedation (when the patient is able to follow simple commands and is arousable) to deep sedation (when the patient is not able to respond to painful stimuli) [2]. Both deep sedation and the initiation of sedation within first 48 h of ICU admission is associated with increased in-hospital mortality, prolonged ICU and hospital stay, prolonged mechanical ventilation, and decreased two-year follow-up survival [4]. Minimizing sedation, engaging strategies targeting light sedation and using validated sedation assessment tools is the goal of modern ICU treatment [2, 6,7,8]

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