Category: Professional Posters
Purpose: A significant number of critically ill patients have agitation during their intensive care unit (ICU) stay, and may develop delirium as a result of inadequate detection or treatment. In such cases, sedatives are frequently used to alleviate anxiety, reduce the stress of being mechanically ventilated, and avoid agitation-related complications. However, guidelines implementation rates in diagnosing and treating agitation and delirium among intensive care patients are sub-optimal. The aim of this study was to evaluate the pattern of drug utilization in intensive care departments in Lebanese hospitals to control agitation and delirium.
Methods: This study was a five months retrospective observational hospital-based study on drug utilization. Researchers obtained institutional review board approval from three Lebanese hospitals in Beirut. Hospital records were scanned from January 2018 till May 2019 to include patients, eighteen years and older, that have received treatment for agitation or delirium during their intensive care unit (ICU) stay. Patients presenting with a psychiatric illness, ongoing therapy with anti psychotics prior to hospitalization, migraine, agitation prior to intensive care unit (ICU) admission, as well as comatose patients were excluded. A comprehensive data collection sheet was used to assess the most commonly prescribed sedative, its administration, reason for admission, and the need for adjunctive drugs; it was composed of four fields including patient demographics, admission data, medication prescribing patterns, and other administered drugs, and filled by the researchers on site. Data was analyzed using statistical package for social science (SPSS) version 22. Means, standard deviations, and percentages were used.
Results: Among three hundred scanned files, sixty patients with mean age 69.1 ±19.19 years were eligible for the study. Regarding psychiatric illness history, 70.2 percent reported no previous episode, and 98.2 percent had no drug abuse. The mean length of stay of patients in the intensive care unit (ICU) was 14.28 ±12.69 days. Sepsis and respiratory distress were the main reasons for intensive care unit (ICU) admission with equal percentages (15.7 percent), followed by post-surgical care (9.8 percent), and stroke (3.9 percent). Thirty percent of the patients received midazolam as primary care for agitation or delirium; haloperidol was used in 21.7 percent of the sample, and valproic acid in 11.7 percent. Alternative drugs such as propofol, quetiapine, fentanyl or other benzodiazepines or anticonvulsants were used to a lesser extent. Among the sample, 43.3 percent received monotherapy, whereas 56.7 percent received one adjunct to the main sedative, or a combination of adjunctive medications to treat agitation or delirium. The majority of the sample (81.7 percent) received the listed drugs through intravenous route.
Conclusion: The findings of this study revealed that midazolam is the most commonly prescribed drug for agitated and delirious patients in the intensive care unit (ICU) in Lebanese hospitals. Hence, adherence to international agitation and delirium guidelines in Lebanese hospitals must be highlighted. Educational efforts directed at the proper prevention, prompt recognition and adequate management of agitation and delirium in critically ill patients is fundamental.