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Published on: September 24, 2020
Severe agitation among ventilated medical intensive care unit patients: frequency, characteristics and outcomes
Jeffery C Woods1, Lorraine C Mion, Jason T Connor
1Critical Care and Step-down Nursing, Huron Hospital, Cleveland, Ohio, USA.
Objective:
To determine the frequency, characteristics and outcomes of severe agitation among ventilated medical intensive care unit (MICU) patients.
Design:
Prospective cohort study.
Setting:
Eighteen-bed MICU in 964-bed tertiary care center.
Patients:
All ventilated patients, aged 18 years or older and admitted for more than 24 h between January 1, 2001 and May 8, 2001.
Interventions:
None.
Measurements:
Data were collected daily by concurrent chart abstractions. Variables included sociodemographic, clinical, laboratory, pharmacologic and non-pharmacologic interventions, ventilator settings and adverse events. Severe agitation, the main outcome variable, was defined as two or more Motor Activity Assessment Scale (MAAS) scores above 4 in a 24-h period and sedative and/or narcotic doses above the established sedation and analgesia protocol or a combination of two or more sedatives.
Results:
Twenty-three (16.1%) of 143 enrolled patients exhibited severe agitation. Agitated patients were younger (hazard ratio [HR] 1.32), more likely to be admitted from an outside hospital ICU (HR 2.48), had lower pH (HR 1.55) and PaO(2)/FIO(2) less than 200 mmHg (HR 2.59). Agitated patients had longer MICU stays (median 12 versus 5 days, p<0.0001) and more ventilator days (median 14 versus 6, p<0.0001). Agitated patients were more likely to self-extubate (26% versus 6%, p=0.002). Benzodiazepines, narcotics and neuromuscular blocking agents were administered more frequently and at higher doses, but haloperidol was not.
Conclusion:
Severe agitation occurs commonly in critically ill patients and is associated with adverse events including longer ICU stays, duration of mechanical ventilation and self-extubation.
Insights
Severe agitation is common in ventilated ICU patients, leading to longer hospital stays and more complications like self-extubation. Understanding agitation risk factors is crucial for critical care management.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Patient Outcomes
Background:
- Severe agitation is a frequent challenge in medical intensive care units (MICUs).
- Identifying factors associated with agitation is vital for improving patient care and outcomes.
Purpose of the Study:
- To investigate the incidence, characteristics, and consequences of severe agitation in mechanically ventilated patients within a MICU.
- To identify patient demographics and clinical factors associated with severe agitation.
Main Methods:
- A prospective cohort study was conducted in an 18-bed MICU.
- 143 ventilated adult patients admitted for over 24 hours were monitored.
- Severe agitation was defined using the Motor Activity Assessment Scale (MAAS) and medication protocols.
Main Results:
- 16.1% of patients experienced severe agitation.
- Agitated patients were younger, more likely to be transferred from outside ICUs, and had poorer respiratory parameters (lower pH, PaO2/FiO2).
- Severe agitation correlated with longer MICU stays, increased ventilator days, and higher rates of self-extubation.
Conclusions:
- Severe agitation is a prevalent issue in critically ill patients.
- Agitation is linked to adverse outcomes, including prolonged mechanical ventilation and ICU length of stay.
- Increased use of sedatives and analgesics was noted in agitated patients.
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