1
|
Hume NE, Zerfas I, Wong A, Klein-Fedyshin M, Smithburger PL, Buckley MS, Devlin JW, Kane-Gill SL. Clinical Impact of the Implementation Strategies Used to Apply the 2013 Pain, Agitation/Sedation, Delirium or 2018 Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption Guideline Recommendations: A Systematic Review and Meta-Analysis. Crit Care Med 2024; 52:626-636. [PMID: 38193764 PMCID: PMC10939834 DOI: 10.1097/ccm.0000000000006178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES To summarize the effectiveness of implementation strategies for ICU execution of recommendations from the 2013 Pain, Agitation/Sedation, Delirium (PAD) or 2018 PAD, Immobility, Sleep Disruption (PADIS) guidelines. DATA SOURCES PubMed, CINAHL, Scopus, and Web of Science were searched from January 2012 to August 2023. The protocol was registered with PROSPERO (CRD42020175268). STUDY SELECTION Articles were included if: 1) design was randomized or cohort, 2) adult population evaluated, 3) employed recommendations from greater than or equal to two PAD/PADIS domains, and 4) evaluated greater than or equal to 1 of the following outcome(s): short-term mortality, delirium occurrence, mechanical ventilation (MV) duration, or ICU length of stay (LOS). DATA EXTRACTION Two authors independently reviewed articles for eligibility, number of PAD/PADIS domains, quality according to National Heart, Lung, and Blood Institute assessment tools, implementation strategy use (including Assess, prevent, and manage pain; Both SAT and SBT; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; Family engagement and empowerment [ABCDEF] bundle) by Cochrane Effective Practice and Organization of Care (EPOC) category, and clinical outcomes. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. DATA SYNTHESIS Among the 25 of 243 (10.3%) full-text articles included ( n = 23,215 patients), risk of bias was high in 13 (52%). Most studies were cohort ( n = 22, 88%). A median of 5 (interquartile range [IQR] 4-7) EPOC strategies were used to implement recommendations from two (IQR 2-3) PAD/PADIS domains. Cohort and randomized studies were pooled separately. In the cohort studies, use of EPOC strategies was not associated with a change in mortality (risk ratio [RR] 1.01; 95% CI, 0.9-1.12), or delirium (RR 0.92; 95% CI, 0.82-1.03), but was associated with a reduction in MV duration (weighted mean difference [WMD] -0.84 d; 95% CI, -1.25 to -0.43) and ICU LOS (WMD -0.77 d; 95% CI, -1.51 to 0.04). For randomized studies, EPOC strategy use was associated with reduced mortality and MV duration but not delirium or ICU LOS. CONCLUSIONS Using multiple implementation strategies to adopt PAD/PADIS guideline recommendations may reduce mortality, duration of MV, and ICU LOS. Further prospective, controlled studies are needed to identify the most effective strategies to implement PAD/PADIS recommendations.
Collapse
Affiliation(s)
- Nicole E Hume
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Isabelle Zerfas
- Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI
| | - Adrian Wong
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Pamela L Smithburger
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
- Department of Pharmacy and Therapeutics, UPMC, Pittsburgh, PA
| | - Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ
| | - John W Devlin
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Pharmacy and Therapeutics, School of Pharmacy, Northeastern University, Boston, MA
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
- Department of Pharmacy and Therapeutics, UPMC, Pittsburgh, PA
| |
Collapse
|
2
|
Bourdiol A, Legros V, Vardon-Bounes F, Rimmele T, Abraham P, Hoffmann C, Dahyot-Fizelier C, Jonas M, Bouju P, Cirenei C, Launey Y, Le Gac G, Boubeche S, Lamarche E, Huet O, Bezu L, Darrieussecq J, Szczot M, Delbove A, Schmitt J, Lasocki S, Auchabie J, Petit L, Kuhn-Bougouin E, Asehnoune K, Ingles H, Roquilly A, Cinotti R. Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study. Crit Care 2023; 27:199. [PMID: 37226261 DOI: 10.1186/s13054-023-04491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Prevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated. METHODS We performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay ≥ 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) ≥ 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain. RESULTS Eight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 (± 17) years with a SAPS 2 score of 32 (± 16) (mean ± SD). The median ICU length of stay was 6 [4-12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1-5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1-2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3-4]), prone positioning (OR 3 95% CI [1.4-6.4]) and the presence of pain symptoms on ICU discharge (NRS ≥ 3) (OR 2.4 95% CI [1.7-3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1-6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months. CONCLUSIONS Persistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain. TRIAL REGISTRATION NCT04817696. Registered March 26, 2021.
Collapse
Affiliation(s)
- Alexandre Bourdiol
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Vincent Legros
- Service d'Anesthésie-Réanimation, Hôpital Maison Blanche, CHU de Reims, 51100, Reims, France
| | - Fanny Vardon-Bounes
- Service d'Anesthésie-Réanimation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Thomas Rimmele
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- EA7426 Pathophysiology of Injury-Induced Immunosuppression (Pi3), Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France
| | - Paul Abraham
- Service de médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Clément Hoffmann
- Burn Center, Percy Military Training Hospital, 101, Avenue Henri Barbusse - BP 406, 92141, Clamart, France
| | - Claire Dahyot-Fizelier
- Intensive Care and Anesthesia Department, University Hospital of Poitiers, University of Poitiers, Poitiers, France
- INSERM U1770, University of Poitiers, Poitiers, France
| | - Maud Jonas
- Service de Réanimation, Hôpital de Saint-Nazaire, Saint-Nazaire, France
| | - Pierre Bouju
- Service de Réanimation Polyvalente, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Cédric Cirenei
- Hôpital Claude Huriez, Pôle Anesthésie-Réanimation, médecine périopératoire et douleur, CHU Lille, 59000, Lille, France
| | - Yoann Launey
- Department of Anaesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Gregoire Le Gac
- Department of Anaesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
- UMR_S 1242, Chemistry Oncogenesis Stress Signaling, University of Rennes, 35000, Rennes, France
| | - Samia Boubeche
- Service d'Anesthésie-Réanimation, CHU de Rouen, Rouen, France
| | - Edouard Lamarche
- Department of Anaesthesia and Critical Care, University Hospital of Tours, 37000, Tours, France
| | - Olivier Huet
- Department of Anaesthesia and Critical Care, University Hospital of Brest, 29000, Brest, France
| | - Lucillia Bezu
- Service de Réanimation Polyvalente, Gustave Roussy, 94805, Villejuif, France
- Metabolomics and Cell Biology Platforms, Université Paris Saclay, Université de Paris, Sorbonne Université, Inserm UMR1138, Villejuif, France
| | - Julie Darrieussecq
- CH Aubagne, Pôle CARK, Service d'Anesthésie-Réanimation chirurgicale, Edmond Garcin, 179 Av. des soeurs Gastine, 13400, Aubagne, France
| | - Magdalena Szczot
- Service d'Anesthésie-Réanimation, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, CHBA Vannes, Vannes, France
| | - Johan Schmitt
- Hôpital d'Instruction des Armées Clermont Tonnerre, Rue Colonel Fonferrier, 29240, Brest, France
| | - Sigismond Lasocki
- Department of Anaesthesia and Critical Care, University Hospital of Tours, 49100, Angers, France
| | - Johann Auchabie
- Service de Réanimation, centre hospitalier de Cholet, Cholet, France
| | - Ludivine Petit
- CHU Saint-Etienne, Service d'Anesthésie-Réanimation, Saint-Étienne, France
| | - Emmanuelle Kuhn-Bougouin
- Centre d'Etude et de Traitement de la Douleur, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Karim Asehnoune
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Hugo Ingles
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Antoine Roquilly
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
- UMR 1064, Center for Research in Transplantation and Translational Immunology, INSERM, Nantes Université, 44000, Nantes, France
| | - Raphaël Cinotti
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France.
- MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, INSERM, Nantes Université, Univ Tours, CHU Nantes, CHU Tours, 44000, Nantes, France.
- Department of Anesthesia and Critical Care, Hôtel-Dieu, University Hospital of Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
| |
Collapse
|
3
|
Wang J, Lu C, Liu X, Zhang G, Zhang J, Gao M, Liu D, Zhang X, Liu Y. Histamine H1 receptor antagonist attenuates catecholamine surge and organ injury after severe burns. Front Endocrinol (Lausanne) 2023; 14:1068925. [PMID: 36843581 PMCID: PMC9946968 DOI: 10.3389/fendo.2023.1068925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Severe burns induce a catecholamine surge, causing severe damage to the organism and raising the possibility of multisystem organ failure. Few strategies are generally acceptable to reduce catecholamine surge and organ injury post-burn. We have previously shown that histamine can amplify the catecholamine surge. In addition, promethazine, a first-generation histamine H1 receptor antagonist, alleviates catecholamine surge and organ injury after severe burns in rats. However, evidence is lacking on whether promethazine benefits patients after severe burns. Currently, sedation and analgesia (such as midazolam and fentanyl) are commonly required for patients after severe burns. It remains unclear if patients after severe burns derive clinical benefit from histamine H1 receptor antagonists combined with sedation and analgesia. This study investigates the therapeutic effect of promethazine on patients after severe burns. Moreover, we test the therapeutic effect of cetirizine, a second-generation histamine H1 receptor antagonist, combined with sedation and analgesia in rats after severe burns. We find that promethazine-pethidine treatment shows a tendency for a lower level of total bilirubin than midazolam-fentanyl in patients 7-day after severe burn. Our study confirms that cetirizine combined with midazolam and fentanyl reduces catecholamine surge and liver and lung damage after severe burns in rats; the effects are better than midazolam and fentanyl treatment. In summary, for the first time, we suggest that histamine H1 receptor antagonist has the potential clinical value of reducing liver injury in patients after severe burns. In addition, we reveal that cetirizine combined with midazolam and fentanyl may be an ideal strategy for treating severe burns.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Yan Liu
- *Correspondence: Yan Liu, ; Xiong Zhang,
| |
Collapse
|
4
|
Roquilly A, Chanques G, Lasocki S, Foucrier A, Fermier B, De Courson H, Carrie C, Danguy des Deserts M, Gakuba C, Constantin JM, Lagarde K, Holleville M, Blidi S, Sossou A, Cailliez P, Monard C, Oudotte A, Mathieu C, Bourenne J, Isetta C, Perrigault PF, Lakhal K, Rouhani A, Asehnoune K, Guerci P, Tran Dinh A, Chousterman B, Cupaciu A, Dahyot-Fizelier C, Bellier R, Au Duong J, Mansour A, Morel J, Beauplet G, Vibet MA, Feuillet F, Sébille V, Leone M. Implementation of French recommendations for the prevention and the treatment of hospital-acquired pneumonia: a cluster-randomized trial. Clin Infect Dis 2020; 73:e1601-e1610. [PMID: 32970811 DOI: 10.1093/cid/ciaa1441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) for can improve the outcomes of patients in intensive care units (ICUs). METHODS This study was conducted at 35 ICUs in 30 hospitals. We included consecutive adult patients hospitalized in ICUs for three days or more. After a three-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a three-month cluster-randomized trial. We randomly assigned ICUs to either audit and feedback (intervention group) or participation to a national registry (control group). The primary outcome was the duration of ICU stay. RESULTS Among 1,856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measure of compliance was 47(38-56)% in the intervention group and 42(25-53)% in the control group (p=0.001). As compared to the baseline period, the ICU length of stay was reduced by 3.2 days in the intervention group (p=0.07) and by 2.8 days in the control group (p=0.02). The duration of ICU stay was 7 (5-14) in the control group and 9 (5-20) days in the intervention group (p=0.10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from ICU in the control group was 1.17 (95% CI, 0.69 to 2.01; p=0.10). CONCLUSIONS The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes.
Collapse
Affiliation(s)
- Antoine Roquilly
- Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, France.,Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, France
| | - Gérald Chanques
- Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Montpellier, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU d'Angers, Université d'Angers, Angers, France
| | - Arnaud Foucrier
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Beaujon (AP/HP), Beaujon, France
| | - Brice Fermier
- Intensive Care Unit, Simone Veil Hospital, Blois, France
| | - Hugues De Courson
- Department of Neuro-Critical Care, Pellegrin Hospital, Bordeaux, France
| | - Cedric Carrie
- Surgical and trauma Intensive Care, Pellegrin Hospital, Bordeaux, France
| | - Marc Danguy des Deserts
- Department of Anesthesiology and Critical Care, Hospital Inter-Armée Clermont Tonnerre, Brest, France
| | - Clément Gakuba
- Department of Anesthesiology and Critical Care, CHU Caen, Caen, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, Hôpital Gabriel Montpied, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Kevin Lagarde
- Neuroréanimation-Anesthésie Neuroradiologie Interventionnelle, Hôpital Gabriel Montpied, CHU Clermont Ferrand, Clermont-Ferrand, France
| | | | - Sami Blidi
- Intensive Care Unit, Eaubonne Hospital, Eaubonne, France
| | - Achille Sossou
- Department of Anesthesiology and Critical Care, Emile Roux Hospital, Le Puy en Velay, France
| | | | - Celine Monard
- Department of Anesthesiology and Critical Care, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Adrien Oudotte
- Department of Neuro-Critical Care, Hospices Civils de Lyon, Lyon, France
| | - Calypso Mathieu
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, France
| | - Jeremy Bourenne
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Emergency Intensive Care Unit, Hopital la Timone, Marseille, France
| | - Christian Isetta
- Department of Anesthesiology and Cardiothoracic Intensive Care, Pierre Zobda-Quitman, Martinique, France
| | | | - Karim Lakhal
- Department of Anesthesiology and Critical Care, Guillaume and Rene Laennec Hospital, CHU Nantes, Nantes, France
| | - Armine Rouhani
- Severe Burn Intensive Care Unit, Hotel Dieu, CHU Nantes, Nantes, France
| | - Karim Asehnoune
- Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, France.,Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, France
| | - Philippe Guerci
- Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Nancy, France
| | - Alexy Tran Dinh
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Bichat (AP/ HP), Paris, France
| | - Benjamin Chousterman
- Department of Anesthesiology and Critical Care, Severe Burn Unit, Centre Hospitalier Universitaire de Lariboisiere (AP/HP), Paris, France
| | - Alexandru Cupaciu
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Saint Louis (AP/ HP), Paris, France
| | | | - Remy Bellier
- Neuro-Intensive Care Unit, Centre Hospitalier Universitaire, Poitiers, France
| | - Jonathan Au Duong
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Rangueil Hospital, Centre Hospitalier Universitaire, Toulouse, France
| | - Alexandre Mansour
- Department of Anesthesiology and Critical Care, Pontchaillou Hospital, CHU Rennes, Rennes, France
| | - Jérome Morel
- Department of Anesthesiology and Critical Care, CHU Saint Etienne, Saint Etienne, France
| | - Ghilain Beauplet
- Department of Anesthesiology, Intensive care and Perioperative medicine - Hautepierre Hospital, Strasbourg, France
| | - Marie-Anne Vibet
- Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Université de Nantes, Nantes, France.,DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France
| | - Fanny Feuillet
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France.,UMR INSERM U1246 - SPHERE "methodS in Patient-centered outcomes & HEalth ResEarch" Université de Nantes, Université de Tours, France
| | - Véronique Sébille
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France.,UMR INSERM U1246 - SPHERE "methodS in Patient-centered outcomes & HEalth ResEarch" Université de Nantes, Université de Tours, France
| | - Marc Leone
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, France
| | | |
Collapse
|