A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic
IMPORTANCE:. Recent studies have found an association between COVID-19 infection and deeper sedation in mechanically ventilated patients, raising concerns about the impact of the COVID-19 pandemic on pain, agitation, and delirium (PAD) management practices overall. OBJECTIVES:. This study aimed to a...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-01-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001202 |
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| author | Rachel L. Winner, PharmD, BCCCP Lydia R. Ware, PharmD, BCPS, BCCCP Kevin M. Dube, PharmD, BCPS, BCCCP Mary P. Kovacevic, PharmD, BCPS, BCCCP Kenneth E. Lupi, PharmD, BCPS, BCCCP Paul M. Szumita, PharmD, FCCM, FASHP, BCCCP, BCPS Jeremy R. DeGrado, PharmD, BCCCP |
| author_facet | Rachel L. Winner, PharmD, BCCCP Lydia R. Ware, PharmD, BCPS, BCCCP Kevin M. Dube, PharmD, BCPS, BCCCP Mary P. Kovacevic, PharmD, BCPS, BCCCP Kenneth E. Lupi, PharmD, BCPS, BCCCP Paul M. Szumita, PharmD, FCCM, FASHP, BCCCP, BCPS Jeremy R. DeGrado, PharmD, BCCCP |
| author_sort | Rachel L. Winner, PharmD, BCCCP |
| collection | DOAJ |
| description | IMPORTANCE:. Recent studies have found an association between COVID-19 infection and deeper sedation in mechanically ventilated patients, raising concerns about the impact of the COVID-19 pandemic on pain, agitation, and delirium (PAD) management practices overall.
OBJECTIVES:. This study aimed to assess differences in PAD management in patients without COVID-19 infection in pre- and peri-COVID-19 pandemic timeframes.
DESIGN, SETTING, AND PARTICIPANTS:. This was a single-center, retrospective, pre-/post-cohort analysis of mechanically ventilated adult patients without COVID-19 infection admitted to an ICU in Boston, MA. The “pre” and “post” groups enrolled patients in 2019 and 2021, respectively. All PAD data during the first 7 days of mechanical ventilation (MV) were collected.
MAIN OUTCOMES AND MEASURES:. The primary outcome was ventilator-free days (VFDs) during the first 28 days. A multivariable linear regression analysis was performed to assess VFD while controlling for confounders. Secondary outcomes included depth of sedation, total dose of sedatives, and in-hospital mortality.
RESULTS:. There were 339 patients included in the final analysis. There was no difference in VFD between the pre- and post-groups (22.2 vs. 22.6 d; p = 0.92); this was confirmed by multivariable linear regression (p = 0.91). Patients in the post-group experienced significantly deeper levels of sedation compared with the pre-group (58% vs. 53%; p < 0.01) within the first 48 hours of MV. The median number of Richmond Agitation-Sedation Scale assessments per 24-hour period was greater in the pre-group (13 vs. 12 assessments; p = 0.02) within the first 48 hours of MV. There were no significant differences in total cumulative dose of sedatives or in-hospital mortality between the two groups.
CONCLUSIONS AND RELEVANCE:. This study suggests that PAD practices, including depth of sedation and frequency of assessment, differed between pre- and post-COVID-19 groups in patients without COVID-19. Outcomes including VFD, mortality, and hospital length of stay were not affected. Further studies are needed to understand the broader impact of the COVID-19 pandemic on PAD management practices. |
| format | Article |
| id | doaj-art-add86e4565704ff7b57d2cd095a3d2f5 |
| institution | Kabale University |
| issn | 2639-8028 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj-art-add86e4565704ff7b57d2cd095a3d2f52025-01-24T09:19:27ZengWolters KluwerCritical Care Explorations2639-80282025-01-0171e120210.1097/CCE.0000000000001202202501000-00007A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 PandemicRachel L. Winner, PharmD, BCCCP0Lydia R. Ware, PharmD, BCPS, BCCCP1Kevin M. Dube, PharmD, BCPS, BCCCP2Mary P. Kovacevic, PharmD, BCPS, BCCCP3Kenneth E. Lupi, PharmD, BCPS, BCCCP4Paul M. Szumita, PharmD, FCCM, FASHP, BCCCP, BCPS5Jeremy R. DeGrado, PharmD, BCCCP6All authors: Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA.All authors: Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA.All authors: Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA.All authors: Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA.All authors: Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA.All authors: Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA.All authors: Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA.IMPORTANCE:. Recent studies have found an association between COVID-19 infection and deeper sedation in mechanically ventilated patients, raising concerns about the impact of the COVID-19 pandemic on pain, agitation, and delirium (PAD) management practices overall. OBJECTIVES:. This study aimed to assess differences in PAD management in patients without COVID-19 infection in pre- and peri-COVID-19 pandemic timeframes. DESIGN, SETTING, AND PARTICIPANTS:. This was a single-center, retrospective, pre-/post-cohort analysis of mechanically ventilated adult patients without COVID-19 infection admitted to an ICU in Boston, MA. The “pre” and “post” groups enrolled patients in 2019 and 2021, respectively. All PAD data during the first 7 days of mechanical ventilation (MV) were collected. MAIN OUTCOMES AND MEASURES:. The primary outcome was ventilator-free days (VFDs) during the first 28 days. A multivariable linear regression analysis was performed to assess VFD while controlling for confounders. Secondary outcomes included depth of sedation, total dose of sedatives, and in-hospital mortality. RESULTS:. There were 339 patients included in the final analysis. There was no difference in VFD between the pre- and post-groups (22.2 vs. 22.6 d; p = 0.92); this was confirmed by multivariable linear regression (p = 0.91). Patients in the post-group experienced significantly deeper levels of sedation compared with the pre-group (58% vs. 53%; p < 0.01) within the first 48 hours of MV. The median number of Richmond Agitation-Sedation Scale assessments per 24-hour period was greater in the pre-group (13 vs. 12 assessments; p = 0.02) within the first 48 hours of MV. There were no significant differences in total cumulative dose of sedatives or in-hospital mortality between the two groups. CONCLUSIONS AND RELEVANCE:. This study suggests that PAD practices, including depth of sedation and frequency of assessment, differed between pre- and post-COVID-19 groups in patients without COVID-19. Outcomes including VFD, mortality, and hospital length of stay were not affected. Further studies are needed to understand the broader impact of the COVID-19 pandemic on PAD management practices.http://journals.lww.com/10.1097/CCE.0000000000001202 |
| spellingShingle | Rachel L. Winner, PharmD, BCCCP Lydia R. Ware, PharmD, BCPS, BCCCP Kevin M. Dube, PharmD, BCPS, BCCCP Mary P. Kovacevic, PharmD, BCPS, BCCCP Kenneth E. Lupi, PharmD, BCPS, BCCCP Paul M. Szumita, PharmD, FCCM, FASHP, BCCCP, BCPS Jeremy R. DeGrado, PharmD, BCCCP A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic Critical Care Explorations |
| title | A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic |
| title_full | A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic |
| title_fullStr | A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic |
| title_full_unstemmed | A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic |
| title_short | A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic |
| title_sort | retrospective single center assessment of changes in pain agitation and delirium management before and during the covid 19 pandemic |
| url | http://journals.lww.com/10.1097/CCE.0000000000001202 |
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