Agitation in the critically ill is a frequent complication of hospitalization - up to 71% of ICU patients have some degree of agitation during their ICU stay. Agitation can result in life-threatening complications related to hemodynamic instability, unplanned extubation and hypoxia as well as injury to the patient or care providers. Agitation has been found to extend the hospital length of stay from 5 to 12 days, increasing patient morbidity and mortality, and adding to the cost of hospitalization. Despite the obvious need for more information in this area, a consensus has yet to be reached for almost any aspect of agitation including identified indicators, assessment approach, or treatment plan. Agitation is often identified after overtly agitated behavior is observed. Use of empirically based information would assist care providers to identify those at risk as well as predict agitation. Identification of patients at particularly high risk for developing agitation provides an opportunity to implement preventative strategies to protect patients from self- and iatrogenic-induced injury. In addition, the management of agitation usually involves patient restraints or increasing sedative load - both considered detrimental to the patient. The Agency for Healthcare Research and Quality (AHRQ), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and Centers for Medicare &Medicaid Services (CMS), support measures to reduce patient physical restraints. The use of restraints poses an inherent risk to the physical safety and psychological well-being of the individual and staff, and is to be used only in an emergency with an imminent risk of individual harm. These conditions are often present during agitation. Early identification and optimal management of agitation may improve patient safety, which is an important target of national health care programs. A critical barrier to progress in the field has been the lack of identification of the precursors of agitation which, with the appropriate intervention, could reduce the need to treat the agitated patient. The purpose of the proposed research is to examine the relationship of clinical and interventional characteristics of critically ill patients to the development and severity of agitated behavior. Thus, the specific aim of the fellowship is to identify predictors of agitation related to pre-existing conditions, ICU therapies, and ICU patient status in the critically ill adult. This study will use prospective chart review to identify clinical characteristics associated with development of agitated behavior in ICU patients. After identification of the risk factors and predictors of agitation, an evaluative tool can be developed to alert caretakers to the possibility of agitation, and interventions can be implemented before agitation occurs.
| Burk, Ruth S; Grap, Mary Jo; Munro, Cindy L et al. (2014) Agitation onset, frequency, and associated temporal factors in critically ill adults. Am J Crit Care 23:296-304 |
| Burk, Ruth S; Grap, Mary Jo; Munro, Cindy L et al. (2014) Predictors of agitation in critically ill adults. Am J Crit Care 23:414-23 |
