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

Nicolas Paul; Julius J Grunow; Max Rosenthal; Claudia D Spies; Valerie J Page; James Hanison; Brijesh Patel; Alex Rosenberg; Rebecca von Haken; Urs Pietsch; Claudia Schrag; Christian Waydhas; Peter Schellongowski; Elisabeth Lobmeyr; Michael Sander; Sophie K Piper; Daniel Conway; Andreas Totzeck; Björn Weiss

doi:10.1007/s12028-023-01837-8

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

Neurocrit Care. 2023 Sep 11. doi: 10.1007/s12028-023-01837-8. Online ahead of print.

Authors

Nicolas Paul^#¹, Julius J Grunow^#^{1

2}, Max Rosenthal¹, Claudia D Spies¹, Valerie J Page³, James Hanison⁴, Brijesh Patel⁵, Alex Rosenberg⁶, Rebecca von Haken⁷, Urs Pietsch⁸, Claudia Schrag⁹, Christian Waydhas^{10

11}, Peter Schellongowski¹², Elisabeth Lobmeyr¹², Michael Sander¹³, Sophie K Piper^{2

14

15}, Daniel Conway⁴, Andreas Totzeck¹⁶, Björn Weiss¹⁷

Affiliations

¹ Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
² Berlin Institute of Health, Berlin, Germany.
³ Department of Anaesthesia, Watford General Hospital, Watford, Hertfordshire, UK.
⁴ Manchester Royal Infirmary, Manchester University National Health Service Foundation Trust, Manchester, UK.
⁵ Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK.
⁶ Royal Brompton and Harefield National Health Service Foundation Trust, London, UK.
⁷ Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany.
⁸ Department of Anesthesiology and Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
⁹ Clinic of Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
¹⁰ Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany.
¹¹ Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
¹² Department of Medicine I, Medical University of Vienna, Vienna, Austria.
¹³ Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen, UKGM, Justus-Liebig University Giessen, Giessen, Germany.
¹⁴ Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
¹⁵ Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
¹⁶ Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany.
¹⁷ Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. bjoern.weiss@charite.de.

^# Contributed equally.

PMID: 37697129
DOI: 10.1007/s12028-023-01837-8

Abstract

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 < 0.001). Multivariable regression revealed that at T3, patients were more likely to receive a delirium assessment (odds ratio [OR] 2.138, 95% confidence interval [CI] 1.206-3.790; p = 0.009), sedation assessment (OR 4.131, 95% CI 1.372-12.438; p = 0.012), or all three PAD assessments (OR 2.295, 95% CI 1.349-3.903; p = 0.002) compared with T1.

Conclusions: In routine care, many patients were not assessed for PAD. Assessment rates increased significantly 1 year after the intervention. Clinical trial registration ClinicalTrials.gov: NCT03553719.

Keywords: Critical care; Delirium; Delivery of health care; Europe; Intensive care units.

Associated data

ClinicalTrials.gov/NCT03553719

Grants and funding

NEXT Start-up Grant/European Society of Intensive Care Medicine