Sedative, analgesic and neuromuscular blocker use in TBI patients admitted to Canadian ICUs: a multicenter, observational study
CCCF ePoster library. Williamson D. 11/13/19; 283409; EP114 Disclosure(s): This project was supported by a University of Toronto Respirology Pettit Block Term Grant and the Fonds de Recherche du Québec -Santé
Prof. David Williamson
Prof. David Williamson
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Abstract
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Williamson David1,2, Marc M. Perreault1,3, Louise Rose4, Jonathan Mailman5, Seungjoo Lee6, Robert MacLean7, Rabia Sadiq7, Aleesa Carter8, Frédérick D'Aragon9, Alexis Turgeon10, Marie-Elaine Blouin11, Victoria McCredie12, Sangeeta Mehta13, Christie Lee13, Lisa Burry6

1 Faculté de pharmacie, Université de Montéal, Montreal, Canada
2 Pharmacy department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
3 Pharmacy department, McGil University Health Center, Montreal, Canada
4 Research Center, Sunnybrook Health Sciences Center, Toronto, Canada
5 Pharmacy department, Saskatchewan Health Authority, Regina, Saskatchewan
6 Pharmacy department, Mount Sinai Hospital, Toronto, Canada
7 Pharmacy department, The Ottawa Hospital, Ottawa, Canada
8 Pharmacy department, Toronto Western Hospital, Toronto, Canada
9 Critical Care department, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
10 Critical Care department, CHU de Québec – Université Laval, Quebec, Canada
11 Pharmacy department, CHU de Québec – Université Laval, Quebec, Canada
12 Critical Care department, Toronto Western Hospital, Toronto, Canada
13 Critical Care department, Mount Sinai Hospital, Toronto, Canada


Introduction
TBI represents a significant health burden and is associated with a wide range of short- and long-term deficits. Analgesics, sedatives and neuromuscular blockers are commonly required to manage pain, sedation, anxiety, agitation, and intracranial hypertension. Pain, Agitation, Delirium (PAD) guidelines1 do not provide specific recommendations for TBI patients and it is unknown if  strategies promoted by the SCCM for critically ill patients are used for TBI patients in the ICU or what clinical benefits these strategies provide. Thus, significant heterogeneity likely exists in the prescribing of sedation/analgesia strategies for Canadian TBI patients.
 
Objectives
The objective was to describe sedation, analgesia, and neuromuscular blockers practices in critically ill TBI patients.   
 
Methods
A retrospective observational study of 9 adult trauma ICUs in Canada was conducted to describe the utilization of sedation/analgesia strategies during hospitalization. We included consecutive adult (18 years or older) patients with moderate (Glagow Coma Score 9-12) to severe (Glagow Coma Score of 8 or less) TBI admitted to ICU between Jan 2015 and Dec 2016. Data were collected using standardized forms for up to a maximum of 21 days in ICU or until transfer out of ICU or death. The primary outcome was the proportion of patients receiving propofol.
 
Results
We included 332 patients (3029 patient days) with a moderate (43.7%) or severe (56.3%) TBI. Etiologies included falls (47.6%), MVA (33.7%) and assaults (7.8%). The majority were male (71%), mean age was 53.6 (SD 21.9) and median SOFA score was 6 (IQR 4). A total of 32.7% of patients required invasive ICP monitoring. Sedation and pain scales were used in 86.8% and 39.3% of patients-days, respectively. Protocolized sedation, daily awakenings and interruptions for neurological evaluation for were used in 39.9%, 6.9% and 7.9% of patient-days, respectively. Propofol (42.1% of patient-days) was the most frequently used sedative followed by benzodiazepines (30.4% patient-days) and dexmedetomidine (3.9% of patient-days). Pentobarbital was used for 0.1% of patient-days. Analgesics were used 73.0% of patient-days whereas neuromuscular blockers were used 7.3% of patient-days.
 
Conclusion
Propofol remains the most frequently used sedative in TBI patients but benzodiazepines use remains significant. Sedation scales are commonly used whereas protocolized sedation is much less common and pain is less well documented.


  1. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility and sleep disruption in adult patients. Crit Care Med 2018; 46: e825-e875.
ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Williamson David1,2, Marc M. Perreault1,3, Louise Rose4, Jonathan Mailman5, Seungjoo Lee6, Robert MacLean7, Rabia Sadiq7, Aleesa Carter8, Frédérick D'Aragon9, Alexis Turgeon10, Marie-Elaine Blouin11, Victoria McCredie12, Sangeeta Mehta13, Christie Lee13, Lisa Burry6

1 Faculté de pharmacie, Université de Montéal, Montreal, Canada
2 Pharmacy department, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
3 Pharmacy department, McGil University Health Center, Montreal, Canada
4 Research Center, Sunnybrook Health Sciences Center, Toronto, Canada
5 Pharmacy department, Saskatchewan Health Authority, Regina, Saskatchewan
6 Pharmacy department, Mount Sinai Hospital, Toronto, Canada
7 Pharmacy department, The Ottawa Hospital, Ottawa, Canada
8 Pharmacy department, Toronto Western Hospital, Toronto, Canada
9 Critical Care department, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
10 Critical Care department, CHU de Québec – Université Laval, Quebec, Canada
11 Pharmacy department, CHU de Québec – Université Laval, Quebec, Canada
12 Critical Care department, Toronto Western Hospital, Toronto, Canada
13 Critical Care department, Mount Sinai Hospital, Toronto, Canada


Introduction
TBI represents a significant health burden and is associated with a wide range of short- and long-term deficits. Analgesics, sedatives and neuromuscular blockers are commonly required to manage pain, sedation, anxiety, agitation, and intracranial hypertension. Pain, Agitation, Delirium (PAD) guidelines1 do not provide specific recommendations for TBI patients and it is unknown if  strategies promoted by the SCCM for critically ill patients are used for TBI patients in the ICU or what clinical benefits these strategies provide. Thus, significant heterogeneity likely exists in the prescribing of sedation/analgesia strategies for Canadian TBI patients.
 
Objectives
The objective was to describe sedation, analgesia, and neuromuscular blockers practices in critically ill TBI patients.   
 
Methods
A retrospective observational study of 9 adult trauma ICUs in Canada was conducted to describe the utilization of sedation/analgesia strategies during hospitalization. We included consecutive adult (18 years or older) patients with moderate (Glagow Coma Score 9-12) to severe (Glagow Coma Score of 8 or less) TBI admitted to ICU between Jan 2015 and Dec 2016. Data were collected using standardized forms for up to a maximum of 21 days in ICU or until transfer out of ICU or death. The primary outcome was the proportion of patients receiving propofol.
 
Results
We included 332 patients (3029 patient days) with a moderate (43.7%) or severe (56.3%) TBI. Etiologies included falls (47.6%), MVA (33.7%) and assaults (7.8%). The majority were male (71%), mean age was 53.6 (SD 21.9) and median SOFA score was 6 (IQR 4). A total of 32.7% of patients required invasive ICP monitoring. Sedation and pain scales were used in 86.8% and 39.3% of patients-days, respectively. Protocolized sedation, daily awakenings and interruptions for neurological evaluation for were used in 39.9%, 6.9% and 7.9% of patient-days, respectively. Propofol (42.1% of patient-days) was the most frequently used sedative followed by benzodiazepines (30.4% patient-days) and dexmedetomidine (3.9% of patient-days). Pentobarbital was used for 0.1% of patient-days. Analgesics were used 73.0% of patient-days whereas neuromuscular blockers were used 7.3% of patient-days.
 
Conclusion
Propofol remains the most frequently used sedative in TBI patients but benzodiazepines use remains significant. Sedation scales are commonly used whereas protocolized sedation is much less common and pain is less well documented.


  1. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility and sleep disruption in adult patients. Crit Care Med 2018; 46: e825-e875.
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