LAUSR

Learning Objectives: The international extent to which the 2013 Pain, Agitation, and Delirium (PAD) guidelines have been implemented is unclear. The purpose of this study was to characterize changes in analgesia and sedation strategies over time and across world regions and to assess the prevalence of delirium. Methods: We performed a retrospective analysis of a multicenter, international, prospective cohort study. Mechanically ventilated adults in intensive care units were followed for up to 28 days in 2010 and 2016. Use of sedation and analgesia, performance of a spontaneous awakening trial (SAT), and occurrence of delirium were assessed on a daily basis. Results: A total of 14,281 patients from 6 different international regions were analyzed. Use of analgesia and sedation increased from 2010 to 2016. Use of benzodiazepines decreased in every region, accompanied by increased use of propofol and dexmedetomidine. In the U.S./Canada, Europe, and Australia/New Zealand regions, propofol supplanted benzodiazepines as most frequently used sedative in 2016, while benzodiazepines remained the most common sedative in Africa, Asia, and Latin America. Performance of SATs increased overall, driven mostly by the U.S./Canada region (24% to 35% of days with sedation, p<0.001). Any delirium during admission increased from 7.4% to 8.4% of patients overall and more than doubled in the U.S./Canada region (16.5% to 35.7%, p<0.001). Conclusions: Implementation of guideline recommendations for analgesia and sedation varied widely across international regions. Opportunities for improvement include increasing delirium monitoring and performance of SATs, and decreasing use of sedation, particularly benzodiazepines.