Sedation, sleep-promotion, and non-verbal and verbal communication techniques in critically ill intubated or tracheostomized patients: results of a survey.
Communication
Intensive care
Mechanical ventilation
Sedation
Sleep management
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
12 Dec 2022
12 Dec 2022
Historique:
received:
20
06
2022
accepted:
25
10
2022
entrez:
12
12
2022
pubmed:
13
12
2022
medline:
15
12
2022
Statut:
epublish
Résumé
The aim of this survey was to describe, on a patient basis, the current practice of sedation, pharmacologic and non-pharmacologic measures to promote sleep and facilitation of communication in critically ill patients oro-tracheally intubated or tracheostomized. Cross-sectional online-survey evaluating sedation, sleep management and communication in oro-tracheally intubated (IP) or tracheostomized (TP) patients in intensive care units on a single point. Eighty-one intensive care units including 447 patients (IP: n = 320, TP: n = 127) participated. A score of ≤ -2 on the Richmond Agitation Sedation Scale (RASS) was prevalent in 58.2% (IP 70.7% vs. TP 26.8%). RASS -1/0 was present in 32.2% (IP 25.9% vs. TP 55.1%) of subjects. Propofol and alpha-2-agonist were the predominant sedatives used while benzodiazepines were applied in only 12.1% of patients. For sleep management, ear plugs and sleeping masks were rarely used (< 7%). In half of the participating intensive care units a technique for phonation was used in the tracheostomized patients. The overall rate of moderate and deep sedation appears high, particularly in oro-tracheally intubated patients. There is no uniform sleep management and ear plugs and sleeping masks are only rarely applied. The application of phonation techniques in tracheostomized patients during assisted breathing is low. More efforts should be directed towards improved guideline implementation. The enhancement of sleep promotion and communication techniques in non-verbal critically ill patients may be a focus of future guideline development.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this survey was to describe, on a patient basis, the current practice of sedation, pharmacologic and non-pharmacologic measures to promote sleep and facilitation of communication in critically ill patients oro-tracheally intubated or tracheostomized.
METHODS
METHODS
Cross-sectional online-survey evaluating sedation, sleep management and communication in oro-tracheally intubated (IP) or tracheostomized (TP) patients in intensive care units on a single point.
RESULTS
RESULTS
Eighty-one intensive care units including 447 patients (IP: n = 320, TP: n = 127) participated. A score of ≤ -2 on the Richmond Agitation Sedation Scale (RASS) was prevalent in 58.2% (IP 70.7% vs. TP 26.8%). RASS -1/0 was present in 32.2% (IP 25.9% vs. TP 55.1%) of subjects. Propofol and alpha-2-agonist were the predominant sedatives used while benzodiazepines were applied in only 12.1% of patients. For sleep management, ear plugs and sleeping masks were rarely used (< 7%). In half of the participating intensive care units a technique for phonation was used in the tracheostomized patients.
CONCLUSIONS
CONCLUSIONS
The overall rate of moderate and deep sedation appears high, particularly in oro-tracheally intubated patients. There is no uniform sleep management and ear plugs and sleeping masks are only rarely applied. The application of phonation techniques in tracheostomized patients during assisted breathing is low. More efforts should be directed towards improved guideline implementation. The enhancement of sleep promotion and communication techniques in non-verbal critically ill patients may be a focus of future guideline development.
Identifiants
pubmed: 36503427
doi: 10.1186/s12871-022-01887-z
pii: 10.1186/s12871-022-01887-z
pmc: PMC9743767
doi:
Substances chimiques
Hypnotics and Sedatives
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
384Informations de copyright
© 2022. The Author(s).
Références
Crit Care Med. 2005 Nov;33(11):2527-33
pubmed: 16276177
J Intensive Care Med. 2021 Dec;36(12):1450-1457
pubmed: 32954939
Crit Care Med. 2009 Sep;37(9):2527-34
pubmed: 19602975
J Gen Intern Med. 2021 Oct;36(10):3179-3187
pubmed: 33886027
PLoS One. 2014 Nov 14;9(11):e110935
pubmed: 25398099
Crit Care. 2007;11(6):R124
pubmed: 18062820
Am J Crit Care. 2020 Mar 1;29(2):140-144
pubmed: 32114616
Crit Care. 2019 Apr 17;23(1):130
pubmed: 30995940
Enferm Intensiva (Engl Ed). 2020 Jan - Mar;31(1):3-18
pubmed: 31003871
Med Intensiva (Engl Ed). 2019 May;43(4):225-233
pubmed: 30704803
Crit Care Med. 2013 Jan;41(1):263-306
pubmed: 23269131
J Clin Nurs. 2020 Jul;29(13-14):2107-2124
pubmed: 32243007
Acta Anaesthesiol Scand. 2007 Jul;51(6):671-8
pubmed: 17567267
Nurs Crit Care. 2013 Jul;18(4):166-75
pubmed: 23782110
Heart Lung. 2015 Jan-Feb;44(1):45-9
pubmed: 25261939
Ger Med Sci. 2015 Nov 12;13:Doc19
pubmed: 26609286
Crit Care Med. 2017 Nov;45(11):e1111-e1122
pubmed: 28787293
Crit Care Med. 2018 Sep;46(9):e825-e873
pubmed: 30113379
Thorax. 2021 Nov;76(11):1089-1098
pubmed: 33859048
Aust Crit Care. 2019 Sep;32(5):373-377
pubmed: 30348488
PLoS One. 2021 Apr 15;16(4):e0249889
pubmed: 33857185
Crit Care. 2005 Apr;9(2):R117-23
pubmed: 15774043
J Intensive Care Soc. 2016 Feb;17(1):19-26
pubmed: 28979454
Crit Care Res Pract. 2020 May 07;2020:4750615
pubmed: 32455009
Ups J Med Sci. 2019 Aug;124(3):199-202
pubmed: 31119971
Ann Intensive Care. 2022 Feb 4;12(1):9
pubmed: 35122204
Am J Crit Care. 2020 Mar 1;29(2):122-129
pubmed: 32114614
BMC Anesthesiol. 2017 Sep 2;17(1):120
pubmed: 28865447
Ann Burns Fire Disasters. 2017 Jun 30;30(2):135-142
pubmed: 29021727
Crit Care Med. 2016 Jun;44(6):1075-81
pubmed: 26855430
Crit Care. 2022 Mar 31;26(1):88
pubmed: 35361254
N Engl J Med. 2000 May 18;342(20):1471-7
pubmed: 10816184
Crit Care Med. 2002 Apr;30(4):746-52
pubmed: 11940739
Intensive Crit Care Nurs. 2015 Jun;31(3):179-86
pubmed: 25579081
Med Klin Intensivmed Notfmed. 2021 Feb;116(1):17-28
pubmed: 31822943
Intensive Crit Care Nurs. 2017 Oct;42:88-96
pubmed: 28365174
Ann Intern Med. 2011 Mar 15;154(6):373-83
pubmed: 21403073
Crit Care. 2021 Jul 7;25(1):238
pubmed: 34233748
Am J Crit Care. 2018 Jan;27(1):32-42
pubmed: 29292273
West J Nurs Res. 2004 Feb;26(1):85-103; discussion 104-12
pubmed: 14984652
Ger Med Sci. 2017 Aug 01;15:Doc10
pubmed: 28794694
Scand J Caring Sci. 2015 Jun;29(2):205-14
pubmed: 25376648
Chest. 1998 Aug;114(2):541-8
pubmed: 9726743
Intensive Care Med. 2016 Jun;42(6):962-71
pubmed: 27075762
Crit Care Med. 2018 Jun;46(6):1003-1004
pubmed: 29762397
BMC Anesthesiol. 2021 Feb 25;21(1):61
pubmed: 33627067