Cargando…

Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT)

BACKGROUND: Agitated behaviors are problematic in intensive care unit (ICU) patients recovering from traumatic brain injury (TBI) as they create substantial risks and challenges for healthcare providers. To date, there have been no studies evaluating their epidemiology and impact in the ICU. Prior t...

Descripción completa

Detalles Bibliográficos
Autores principales: Williamson, David R., Cherifa, Sofia Ihsenne, Frenette, Anne Julie, Saavedra Mitjans, Mar, Charbonney, Emmanuel, Cataford, Gabrielle, Williams, Virginie, Lainer Palacios, Julia, Burry, Lisa, Mehta, Sangeeta, Arbour, Caroline, Bernard, Francis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729148/
https://www.ncbi.nlm.nih.gov/pubmed/33308318
http://dx.doi.org/10.1186/s40814-020-00736-5
_version_ 1783621395613220864
author Williamson, David R.
Cherifa, Sofia Ihsenne
Frenette, Anne Julie
Saavedra Mitjans, Mar
Charbonney, Emmanuel
Cataford, Gabrielle
Williams, Virginie
Lainer Palacios, Julia
Burry, Lisa
Mehta, Sangeeta
Arbour, Caroline
Bernard, Francis
author_facet Williamson, David R.
Cherifa, Sofia Ihsenne
Frenette, Anne Julie
Saavedra Mitjans, Mar
Charbonney, Emmanuel
Cataford, Gabrielle
Williams, Virginie
Lainer Palacios, Julia
Burry, Lisa
Mehta, Sangeeta
Arbour, Caroline
Bernard, Francis
author_sort Williamson, David R.
collection PubMed
description BACKGROUND: Agitated behaviors are problematic in intensive care unit (ICU) patients recovering from traumatic brain injury (TBI) as they create substantial risks and challenges for healthcare providers. To date, there have been no studies evaluating their epidemiology and impact in the ICU. Prior to planning a multicenter study, assessment of recruitment, feasibility, and pilot study procedures is needed. In this pilot study, we aimed to evaluate the feasibility of conducting a large multicenter prospective cohort study. METHODS: This feasibility study recruited adult patients admitted to the ICU with TBI and an abnormal cerebral CT scan. In all patients, we documented Richmond Agitation Sedation Score (RASS) and agitated behaviors every 8-h nursing shift using a dedicated tool documenting 14 behaviors. Our feasibility objectives were to obtain consent from at least 2 patients per month; completion of screening logs for agitated behaviors by bedside nurses for more than 90% of 8-h shifts; completion of data collection in an average of 6 h or less; and obtain 6-month follow-up for surviving patients. The main clinical outcome was the incidence of agitation and individual agitated behaviors. RESULTS: In total, 47 eligible patients were approached for inclusion and 30 (64% consent rate) were recruited over a 10-month period (3 patients/month). In total, 794 out of 827 (96%) possible 8-h periods of agitated behavior logs were completed by bedside nurses, with a median of 24 observations (IQR 28.0) per patient. During the ICU stay, 17 of 30 patients developed agitation (56.7%; 95% CI 0.37–0.75) defined as RASS ≥ 2 during at least one observation period and for a median of 4 days (IQR 5.5). At 6 months post-TBI, among the 24 available patients, an unfavorable score (GOS-E < 5 including death) was reported in 12 patients (50%). In the 14 patients who were alive and available at 6 months, the median QOLIBRI score was 74.5 (IQR 18.5). CONCLUSIONS: This study demonstrates the feasibility of conducting a larger cohort study to evaluate the epidemiology and impact of agitated behaviors in critically ill TBI patients. This study also shows that agitated behaviors are frequent and are associated with adverse events. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40814-020-00736-5.
format Online
Article
Text
id pubmed-7729148
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-77291482020-12-11 Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT) Williamson, David R. Cherifa, Sofia Ihsenne Frenette, Anne Julie Saavedra Mitjans, Mar Charbonney, Emmanuel Cataford, Gabrielle Williams, Virginie Lainer Palacios, Julia Burry, Lisa Mehta, Sangeeta Arbour, Caroline Bernard, Francis Pilot Feasibility Stud Research BACKGROUND: Agitated behaviors are problematic in intensive care unit (ICU) patients recovering from traumatic brain injury (TBI) as they create substantial risks and challenges for healthcare providers. To date, there have been no studies evaluating their epidemiology and impact in the ICU. Prior to planning a multicenter study, assessment of recruitment, feasibility, and pilot study procedures is needed. In this pilot study, we aimed to evaluate the feasibility of conducting a large multicenter prospective cohort study. METHODS: This feasibility study recruited adult patients admitted to the ICU with TBI and an abnormal cerebral CT scan. In all patients, we documented Richmond Agitation Sedation Score (RASS) and agitated behaviors every 8-h nursing shift using a dedicated tool documenting 14 behaviors. Our feasibility objectives were to obtain consent from at least 2 patients per month; completion of screening logs for agitated behaviors by bedside nurses for more than 90% of 8-h shifts; completion of data collection in an average of 6 h or less; and obtain 6-month follow-up for surviving patients. The main clinical outcome was the incidence of agitation and individual agitated behaviors. RESULTS: In total, 47 eligible patients were approached for inclusion and 30 (64% consent rate) were recruited over a 10-month period (3 patients/month). In total, 794 out of 827 (96%) possible 8-h periods of agitated behavior logs were completed by bedside nurses, with a median of 24 observations (IQR 28.0) per patient. During the ICU stay, 17 of 30 patients developed agitation (56.7%; 95% CI 0.37–0.75) defined as RASS ≥ 2 during at least one observation period and for a median of 4 days (IQR 5.5). At 6 months post-TBI, among the 24 available patients, an unfavorable score (GOS-E < 5 including death) was reported in 12 patients (50%). In the 14 patients who were alive and available at 6 months, the median QOLIBRI score was 74.5 (IQR 18.5). CONCLUSIONS: This study demonstrates the feasibility of conducting a larger cohort study to evaluate the epidemiology and impact of agitated behaviors in critically ill TBI patients. This study also shows that agitated behaviors are frequent and are associated with adverse events. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40814-020-00736-5. BioMed Central 2020-12-11 /pmc/articles/PMC7729148/ /pubmed/33308318 http://dx.doi.org/10.1186/s40814-020-00736-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Williamson, David R.
Cherifa, Sofia Ihsenne
Frenette, Anne Julie
Saavedra Mitjans, Mar
Charbonney, Emmanuel
Cataford, Gabrielle
Williams, Virginie
Lainer Palacios, Julia
Burry, Lisa
Mehta, Sangeeta
Arbour, Caroline
Bernard, Francis
Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT)
title Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT)
title_full Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT)
title_fullStr Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT)
title_full_unstemmed Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT)
title_short Agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (ACACIA-PILOT)
title_sort agitation, confusion, and aggression in critically ill traumatic brain injury-a pilot cohort study (acacia-pilot)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729148/
https://www.ncbi.nlm.nih.gov/pubmed/33308318
http://dx.doi.org/10.1186/s40814-020-00736-5
work_keys_str_mv AT williamsondavidr agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT cherifasofiaihsenne agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT frenetteannejulie agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT saavedramitjansmar agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT charbonneyemmanuel agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT catafordgabrielle agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT williamsvirginie agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT lainerpalaciosjulia agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT burrylisa agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT mehtasangeeta agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT arbourcaroline agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT bernardfrancis agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot
AT agitationconfusionandaggressionincriticallyilltraumaticbraininjuryapilotcohortstudyacaciapilot