Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: A randomized clinical trial
Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: A randomized clinical trial
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DOI：
10.1016/j.jcrc.2013.06.019
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发表时间：
2013-12-01
影响因子：
3.7
通讯作者：
Tabatabaee, Hamid Reza
中科院分区：
文献类型：
--
作者：
Mansouri, Parisa;Javadpour, Shohreh;Tabatabaee, Hamid Reza
背景：在重症监护环境中，对疼痛、激越和谵妄（PAD）的诊断和治疗不当会导致患者预后不良。我们设计和使用的系统评估和管理PAD的护士，以提高临床重症监护病房（ICU）outcomes.Materials and Methods：共201例患者入住2个混合内科手术ICU随机分配到协议和对照组。一个多学科小组批准了该方案。疼痛采用数字评定量表和行为疼痛量表评定，躁动采用里士满躁动镇静量表评定，谵妄采用ICU意识模糊评定法评定。波斯语版本的量表编制和测试的有效性，可靠性和可行性的初步研究。结果：两组患者机械通气时间的中位数（四分位距）分别为19（9.3-67.8）和40（0-217）h（P= 0.038）。ICU住院时间的中位数（四分位距）方案组为97（54.5-189）小时，对照组为170（80-408）小时（P
Background: Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes.Materials and Methods: A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine.Results: The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P=.038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P