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A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial.

Identifieur interne : 000D12 ( Main/Exploration ); précédent : 000D11; suivant : 000D13

A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial.

Auteurs : Pierre Kalfon [France] ; Karine Baumstarck [France] ; Philippe Estagnasie [France] ; Marie-Agnès Geantot [France] ; Audrey Berric [France] ; Georges Simon [France] ; Bernard Floccard [France] ; Thomas Signouret [France] ; Mohamed Boucekine [France] ; Mélanie Fromentin [France] ; Martine Nyunga [France] ; Achille Sossou [France] ; Marion Venot [France] ; René Robert [France] ; Arnaud Follin [France] ; Juliette Audibert [France] ; Anne Renault [France] ; Maïté Garrouste-Orgeas [France] ; Olivier Collange [France] ; Quentin Levrat [France] ; Isabelle Villard [France] ; Didier Thevenin [France] ; Julien Pottecher [France] ; René-Gilles Patrigeon [France] ; Nathalie Revel [France] ; Coralie Vigne [France] ; Elie Azoulay [France] ; Olivier Mimoz [France] ; Pascal Auquier [France]

Source :

RBID : pubmed:29181557

Descripteurs français

English descriptors

Abstract

PURPOSE

Critically ill patients are exposed to stressful conditions and experience several discomforts. The primary objective was to assess whether a tailored multicomponent program is effective for reducing self-perceived discomfort.

METHODS

In a cluster-randomized two-arm parallel trial, 34 French adult intensive care units (ICUs) without planned interventions to reduce discomfort were randomized, 17 to the arm including a 6-month period of program implementation followed by a 6-month period without the program (experimental group), and 17 to the arm with an inversed sequence (control group). The tailored multicomponent program consisted of assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to healthcare teams, and site-specific tailored interventions. The primary outcome was the overall discomfort score derived from the 16-item IPREA questionnaire (0, minimal, 100, maximal overall discomfort) and the secondary outcomes were the discomfort scores of each IPREA item. IPREA was administered on the day of ICU discharge with a considered timeframe from the ICU admission until ICU discharge.

RESULTS

During a 1-month assessment period, 398 and 360 patients were included in the experimental group and the control group, respectively. The difference (experimental minus control) of the overall discomfort score between groups was - 7.00 (95% CI - 9.89 to - 4.11, p < 0.001). After adjustment (age, gender, ICU duration, mechanical ventilation duration, and type of admission), the program effect was still positive for the overall discomfort score (difference - 6.35, SE 1.23, p < 0.001) and for 12 out of 16 items.

CONCLUSIONS

This tailored multicomponent program decreased self-perceived discomfort in adult critically ill patients.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier NCT02442934.


DOI: 10.1007/s00134-017-4991-x
PubMed: 29181557


Affiliations:

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<author>
<name sortKey="Kalfon, Pierre" sort="Kalfon, Pierre" uniqKey="Kalfon P" first="Pierre" last="Kalfon">Pierre Kalfon</name>
<affiliation wicri:level="1">
<nlm:affiliation>Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Le Coudray, France. pkalfon@ch-chartres.fr.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Le Coudray</wicri:regionArea>
<wicri:noRegion>Le Coudray</wicri:noRegion>
<wicri:noRegion>Le Coudray</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Baumstarck, Karine" sort="Baumstarck, Karine" uniqKey="Baumstarck K" first="Karine" last="Baumstarck">Karine Baumstarck</name>
<affiliation wicri:level="4">
<nlm:affiliation>Unité de Recherche EA3279, Aix-Marseille Université, Marseille, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Unité de Recherche EA3279, Aix-Marseille Université, Marseille</wicri:regionArea>
<placeName>
<region type="region">Provence-Alpes-Côte d'Azur</region>
<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Marseille</settlement>
</placeName>
<orgName type="university">Université d'Aix-Marseille</orgName>
</affiliation>
</author>
<author>
<name sortKey="Estagnasie, Philippe" sort="Estagnasie, Philippe" uniqKey="Estagnasie P" first="Philippe" last="Estagnasie">Philippe Estagnasie</name>
<affiliation wicri:level="1">
<nlm:affiliation>Réanimation, Clinique Ambroise Paré, Neuilly/Seine, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation, Clinique Ambroise Paré, Neuilly/Seine</wicri:regionArea>
<wicri:noRegion>Neuilly/Seine</wicri:noRegion>
<wicri:noRegion>Neuilly/Seine</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Geantot, Marie Agnes" sort="Geantot, Marie Agnes" uniqKey="Geantot M" first="Marie-Agnès" last="Geantot">Marie-Agnès Geantot</name>
<affiliation wicri:level="3">
<nlm:affiliation>Département d'Anesthésie Réanimation, CHU Dijon Bourgogne, Dijon, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Département d'Anesthésie Réanimation, CHU Dijon Bourgogne, Dijon</wicri:regionArea>
<placeName>
<region type="region">Bourgogne-Franche-Comté</region>
<region type="old region">Bourgogne</region>
<settlement type="city">Dijon</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Berric, Audrey" sort="Berric, Audrey" uniqKey="Berric A" first="Audrey" last="Berric">Audrey Berric</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Polyvalente, Centre Hospitalier Intercommunal Toulon/La Seyne Sur Mer, Toulon, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Polyvalente, Centre Hospitalier Intercommunal Toulon/La Seyne Sur Mer, Toulon</wicri:regionArea>
<placeName>
<region type="region">Provence-Alpes-Côte d'Azur</region>
<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Toulon</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Simon, Georges" sort="Simon, Georges" uniqKey="Simon G" first="Georges" last="Simon">Georges Simon</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation, CH Troyes, Troyes, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation, CH Troyes, Troyes</wicri:regionArea>
<placeName>
<region type="region">Grand Est</region>
<region type="old region">Champagne-Ardenne</region>
<settlement type="city">Troyes</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Floccard, Bernard" sort="Floccard, Bernard" uniqKey="Floccard B" first="Bernard" last="Floccard">Bernard Floccard</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Polyvalente, CHU Edouard Herriot, Hospices Civils de Lyon, Lyon, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Polyvalente, CHU Edouard Herriot, Hospices Civils de Lyon, Lyon</wicri:regionArea>
<placeName>
<region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Lyon</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Signouret, Thomas" sort="Signouret, Thomas" uniqKey="Signouret T" first="Thomas" last="Signouret">Thomas Signouret</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation, Hôpital Européen de Marseille, Marseille, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation, Hôpital Européen de Marseille, Marseille</wicri:regionArea>
<placeName>
<region type="region">Provence-Alpes-Côte d'Azur</region>
<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Marseille</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Boucekine, Mohamed" sort="Boucekine, Mohamed" uniqKey="Boucekine M" first="Mohamed" last="Boucekine">Mohamed Boucekine</name>
<affiliation wicri:level="4">
<nlm:affiliation>Unité de Recherche EA3279, Aix-Marseille Université, Marseille, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Unité de Recherche EA3279, Aix-Marseille Université, Marseille</wicri:regionArea>
<placeName>
<region type="region">Provence-Alpes-Côte d'Azur</region>
<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Marseille</settlement>
</placeName>
<orgName type="university">Université d'Aix-Marseille</orgName>
</affiliation>
</author>
<author>
<name sortKey="Fromentin, Melanie" sort="Fromentin, Melanie" uniqKey="Fromentin M" first="Mélanie" last="Fromentin">Mélanie Fromentin</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Chirurgicale, CHU Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Chirurgicale, CHU Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris</wicri:regionArea>
<placeName>
<region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Nyunga, Martine" sort="Nyunga, Martine" uniqKey="Nyunga M" first="Martine" last="Nyunga">Martine Nyunga</name>
<affiliation wicri:level="1">
<nlm:affiliation>Réanimation Polyvalente, CH Victor Provo, Roubaix, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Polyvalente, CH Victor Provo, Roubaix</wicri:regionArea>
<wicri:noRegion>Roubaix</wicri:noRegion>
<wicri:noRegion>Roubaix</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Sossou, Achille" sort="Sossou, Achille" uniqKey="Sossou A" first="Achille" last="Sossou">Achille Sossou</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation, CH Emile Roux, Le Puy-En-Velay, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation, CH Emile Roux, Le Puy-En-Velay</wicri:regionArea>
<placeName>
<region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Auvergne (région administrative)</region>
<settlement type="city">Le Puy-en-Velay</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Venot, Marion" sort="Venot, Marion" uniqKey="Venot M" first="Marion" last="Venot">Marion Venot</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris</wicri:regionArea>
<placeName>
<region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Robert, Rene" sort="Robert, Rene" uniqKey="Robert R" first="René" last="Robert">René Robert</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Médicale, CHU La Milétrie, Poitiers, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Médicale, CHU La Milétrie, Poitiers</wicri:regionArea>
<placeName>
<region type="region">Nouvelle-Aquitaine</region>
<region type="old region">Poitou-Charentes</region>
<settlement type="city">Poitiers</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Follin, Arnaud" sort="Follin, Arnaud" uniqKey="Follin A" first="Arnaud" last="Follin">Arnaud Follin</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, AP-HP, Paris</wicri:regionArea>
<placeName>
<region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Audibert, Juliette" sort="Audibert, Juliette" uniqKey="Audibert J" first="Juliette" last="Audibert">Juliette Audibert</name>
<affiliation wicri:level="1">
<nlm:affiliation>Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Le Coudray, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Le Coudray</wicri:regionArea>
<wicri:noRegion>Le Coudray</wicri:noRegion>
<wicri:noRegion>Le Coudray</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Renault, Anne" sort="Renault, Anne" uniqKey="Renault A" first="Anne" last="Renault">Anne Renault</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Médicale, CHU Brest, Brest, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Médicale, CHU Brest, Brest</wicri:regionArea>
<placeName>
<region type="region">Région Bretagne</region>
<region type="old region">Région Bretagne</region>
<settlement type="city">Brest</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Garrouste Orgeas, Maite" sort="Garrouste Orgeas, Maite" uniqKey="Garrouste Orgeas M" first="Maïté" last="Garrouste-Orgeas">Maïté Garrouste-Orgeas</name>
<affiliation wicri:level="3">
<nlm:affiliation>Médecine Intensive et Réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Médecine Intensive et Réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris</wicri:regionArea>
<placeName>
<region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Collange, Olivier" sort="Collange, Olivier" uniqKey="Collange O" first="Olivier" last="Collange">Olivier Collange</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Chirurgicale Polyvalente, Hôpital Civil, CHU Strasbourg, Strasbourg, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Chirurgicale Polyvalente, Hôpital Civil, CHU Strasbourg, Strasbourg</wicri:regionArea>
<placeName>
<region type="region">Grand Est</region>
<region type="old region">Alsace (région administrative)</region>
<settlement type="city">Strasbourg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Levrat, Quentin" sort="Levrat, Quentin" uniqKey="Levrat Q" first="Quentin" last="Levrat">Quentin Levrat</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation, Groupe Hospitalier de La Rochelle-Ré-Aunis, La Rochelle, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation, Groupe Hospitalier de La Rochelle-Ré-Aunis, La Rochelle</wicri:regionArea>
<placeName>
<region type="region">Nouvelle-Aquitaine</region>
<region type="old region">Poitou-Charentes</region>
<settlement type="city">La Rochelle</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Villard, Isabelle" sort="Villard, Isabelle" uniqKey="Villard I" first="Isabelle" last="Villard">Isabelle Villard</name>
<affiliation wicri:level="1">
<nlm:affiliation>Anesthésie Réanimation, CHU Beaujon, AP-HP, Clichy, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Anesthésie Réanimation, CHU Beaujon, AP-HP, Clichy</wicri:regionArea>
<wicri:noRegion>Clichy</wicri:noRegion>
<wicri:noRegion>Clichy</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Thevenin, Didier" sort="Thevenin, Didier" uniqKey="Thevenin D" first="Didier" last="Thevenin">Didier Thevenin</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation, CH Lens, Lens, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation, CH Lens, Lens</wicri:regionArea>
<placeName>
<region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lens (Pas-de-Calais)</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Pottecher, Julien" sort="Pottecher, Julien" uniqKey="Pottecher J" first="Julien" last="Pottecher">Julien Pottecher</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Chirurgicale, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Chirurgicale, Hôpital Hautepierre, CHU Strasbourg, Strasbourg</wicri:regionArea>
<placeName>
<region type="region">Grand Est</region>
<region type="old region">Alsace (région administrative)</region>
<settlement type="city">Strasbourg</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Patrigeon, Rene Gilles" sort="Patrigeon, Rene Gilles" uniqKey="Patrigeon R" first="René-Gilles" last="Patrigeon">René-Gilles Patrigeon</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation, CH Auxerre, Auxerre, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation, CH Auxerre, Auxerre</wicri:regionArea>
<placeName>
<region type="region">Bourgogne-Franche-Comté</region>
<region type="old region">Bourgogne</region>
<settlement type="city">Auxerre</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Revel, Nathalie" sort="Revel, Nathalie" uniqKey="Revel N" first="Nathalie" last="Revel">Nathalie Revel</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Médico-chirurgicale, Hôpital Pasteur, CHU Nice, Nice, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Médico-chirurgicale, Hôpital Pasteur, CHU Nice, Nice</wicri:regionArea>
<placeName>
<region type="region">Provence-Alpes-Côte d'Azur</region>
<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Nice</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Vigne, Coralie" sort="Vigne, Coralie" uniqKey="Vigne C" first="Coralie" last="Vigne">Coralie Vigne</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Chirurgicale, CHU Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Chirurgicale, CHU Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille</wicri:regionArea>
<placeName>
<region type="region">Provence-Alpes-Côte d'Azur</region>
<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Marseille</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Azoulay, Elie" sort="Azoulay, Elie" uniqKey="Azoulay E" first="Elie" last="Azoulay">Elie Azoulay</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris</wicri:regionArea>
<placeName>
<region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Mimoz, Olivier" sort="Mimoz, Olivier" uniqKey="Mimoz O" first="Olivier" last="Mimoz">Olivier Mimoz</name>
<affiliation wicri:level="3">
<nlm:affiliation>Réanimation chirugicale, CHU La Milétrie, Poitiers, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Réanimation chirugicale, CHU La Milétrie, Poitiers</wicri:regionArea>
<placeName>
<region type="region">Nouvelle-Aquitaine</region>
<region type="old region">Poitou-Charentes</region>
<settlement type="city">Poitiers</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Auquier, Pascal" sort="Auquier, Pascal" uniqKey="Auquier P" first="Pascal" last="Auquier">Pascal Auquier</name>
<affiliation wicri:level="4">
<nlm:affiliation>Unité de Recherche EA3279, Aix-Marseille Université, Marseille, France.</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Unité de Recherche EA3279, Aix-Marseille Université, Marseille</wicri:regionArea>
<placeName>
<region type="region">Provence-Alpes-Côte d'Azur</region>
<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Marseille</settlement>
</placeName>
<orgName type="university">Université d'Aix-Marseille</orgName>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Intensive care medicine</title>
<idno type="eISSN">1432-1238</idno>
<imprint>
<date when="2017" type="published">2017</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass>
<keywords scheme="KwdEn" xml:lang="en">
<term>Aged (MeSH)</term>
<term>Aged, 80 and over (MeSH)</term>
<term>Critical Care (psychology)</term>
<term>Critical Illness (psychology)</term>
<term>Female (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Intensive Care Units (statistics & numerical data)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Pain Measurement (MeSH)</term>
<term>Perception (MeSH)</term>
<term>Quality of Life (MeSH)</term>
<term>Self Report (MeSH)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr">
<term>Adulte d'âge moyen (MeSH)</term>
<term>Autorapport (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Maladie grave (psychologie)</term>
<term>Mesure de la douleur (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Perception (MeSH)</term>
<term>Qualité de vie (MeSH)</term>
<term>Soins de réanimation (psychologie)</term>
<term>Sujet âgé (MeSH)</term>
<term>Sujet âgé de 80 ans ou plus (MeSH)</term>
<term>Unités de soins intensifs (statistiques et données numériques)</term>
</keywords>
<keywords scheme="MESH" qualifier="psychologie" xml:lang="fr">
<term>Maladie grave</term>
<term>Soins de réanimation</term>
</keywords>
<keywords scheme="MESH" qualifier="psychology" xml:lang="en">
<term>Critical Care</term>
<term>Critical Illness</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en">
<term>Intensive Care Units</term>
</keywords>
<keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr">
<term>Unités de soins intensifs</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Pain Measurement</term>
<term>Perception</term>
<term>Quality of Life</term>
<term>Self Report</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte d'âge moyen</term>
<term>Autorapport</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mesure de la douleur</term>
<term>Mâle</term>
<term>Perception</term>
<term>Qualité de vie</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
</keywords>
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<front>
<div type="abstract" xml:lang="en">
<p>
<b>PURPOSE</b>
</p>
<p>Critically ill patients are exposed to stressful conditions and experience several discomforts. The primary objective was to assess whether a tailored multicomponent program is effective for reducing self-perceived discomfort.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>METHODS</b>
</p>
<p>In a cluster-randomized two-arm parallel trial, 34 French adult intensive care units (ICUs) without planned interventions to reduce discomfort were randomized, 17 to the arm including a 6-month period of program implementation followed by a 6-month period without the program (experimental group), and 17 to the arm with an inversed sequence (control group). The tailored multicomponent program consisted of assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to healthcare teams, and site-specific tailored interventions. The primary outcome was the overall discomfort score derived from the 16-item IPREA questionnaire (0, minimal, 100, maximal overall discomfort) and the secondary outcomes were the discomfort scores of each IPREA item. IPREA was administered on the day of ICU discharge with a considered timeframe from the ICU admission until ICU discharge.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>During a 1-month assessment period, 398 and 360 patients were included in the experimental group and the control group, respectively. The difference (experimental minus control) of the overall discomfort score between groups was - 7.00 (95% CI - 9.89 to - 4.11, p < 0.001). After adjustment (age, gender, ICU duration, mechanical ventilation duration, and type of admission), the program effect was still positive for the overall discomfort score (difference - 6.35, SE 1.23, p < 0.001) and for 12 out of 16 items.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>This tailored multicomponent program decreased self-perceived discomfort in adult critically ill patients.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>TRIAL REGISTRATION</b>
</p>
<p>Clinicaltrials.gov Identifier NCT02442934.</p>
</div>
</front>
</TEI>
<pubmed>
<MedlineCitation Status="MEDLINE" Owner="NLM">
<PMID Version="1">29181557</PMID>
<DateCompleted>
<Year>2018</Year>
<Month>07</Month>
<Day>23</Day>
</DateCompleted>
<DateRevised>
<Year>2018</Year>
<Month>11</Month>
<Day>13</Day>
</DateRevised>
<Article PubModel="Print-Electronic">
<Journal>
<ISSN IssnType="Electronic">1432-1238</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>43</Volume>
<Issue>12</Issue>
<PubDate>
<Year>2017</Year>
<Month>Dec</Month>
</PubDate>
</JournalIssue>
<Title>Intensive care medicine</Title>
<ISOAbbreviation>Intensive Care Med</ISOAbbreviation>
</Journal>
<ArticleTitle>A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial.</ArticleTitle>
<Pagination>
<MedlinePgn>1829-1840</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1007/s00134-017-4991-x</ELocationID>
<Abstract>
<AbstractText Label="PURPOSE" NlmCategory="OBJECTIVE">Critically ill patients are exposed to stressful conditions and experience several discomforts. The primary objective was to assess whether a tailored multicomponent program is effective for reducing self-perceived discomfort.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">In a cluster-randomized two-arm parallel trial, 34 French adult intensive care units (ICUs) without planned interventions to reduce discomfort were randomized, 17 to the arm including a 6-month period of program implementation followed by a 6-month period without the program (experimental group), and 17 to the arm with an inversed sequence (control group). The tailored multicomponent program consisted of assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to healthcare teams, and site-specific tailored interventions. The primary outcome was the overall discomfort score derived from the 16-item IPREA questionnaire (0, minimal, 100, maximal overall discomfort) and the secondary outcomes were the discomfort scores of each IPREA item. IPREA was administered on the day of ICU discharge with a considered timeframe from the ICU admission until ICU discharge.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">During a 1-month assessment period, 398 and 360 patients were included in the experimental group and the control group, respectively. The difference (experimental minus control) of the overall discomfort score between groups was - 7.00 (95% CI - 9.89 to - 4.11, p < 0.001). After adjustment (age, gender, ICU duration, mechanical ventilation duration, and type of admission), the program effect was still positive for the overall discomfort score (difference - 6.35, SE 1.23, p < 0.001) and for 12 out of 16 items.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">This tailored multicomponent program decreased self-perceived discomfort in adult critically ill patients.</AbstractText>
<AbstractText Label="TRIAL REGISTRATION" NlmCategory="BACKGROUND">Clinicaltrials.gov Identifier NCT02442934.</AbstractText>
</Abstract>
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<LastName>Kalfon</LastName>
<ForeName>Pierre</ForeName>
<Initials>P</Initials>
<Identifier Source="ORCID">http://orcid.org/0000-0002-0095-8759</Identifier>
<AffiliationInfo>
<Affiliation>Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Le Coudray, France. pkalfon@ch-chartres.fr.</Affiliation>
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<ForeName>Karine</ForeName>
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<AffiliationInfo>
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<ForeName>Philippe</ForeName>
<Initials>P</Initials>
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<Affiliation>Réanimation, Clinique Ambroise Paré, Neuilly/Seine, France.</Affiliation>
</AffiliationInfo>
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<LastName>Geantot</LastName>
<ForeName>Marie-Agnès</ForeName>
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<Affiliation>Département d'Anesthésie Réanimation, CHU Dijon Bourgogne, Dijon, France.</Affiliation>
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<ForeName>Audrey</ForeName>
<Initials>A</Initials>
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<Affiliation>Réanimation Polyvalente, Centre Hospitalier Intercommunal Toulon/La Seyne Sur Mer, Toulon, France.</Affiliation>
</AffiliationInfo>
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<LastName>Simon</LastName>
<ForeName>Georges</ForeName>
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</AffiliationInfo>
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<LastName>Floccard</LastName>
<ForeName>Bernard</ForeName>
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<Affiliation>Réanimation Polyvalente, CHU Edouard Herriot, Hospices Civils de Lyon, Lyon, France.</Affiliation>
</AffiliationInfo>
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</AffiliationInfo>
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</AffiliationInfo>
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</AffiliationInfo>
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<ForeName>Achille</ForeName>
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</AffiliationInfo>
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<ForeName>René</ForeName>
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<AffiliationInfo>
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<ForeName>Arnaud</ForeName>
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</AffiliationInfo>
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</AffiliationInfo>
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<ForeName>Olivier</ForeName>
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</AffiliationInfo>
</Author>
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<LastName>Levrat</LastName>
<ForeName>Quentin</ForeName>
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<Affiliation>Réanimation, Groupe Hospitalier de La Rochelle-Ré-Aunis, La Rochelle, France.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Villard</LastName>
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<AffiliationInfo>
<Affiliation>Anesthésie Réanimation, CHU Beaujon, AP-HP, Clichy, France.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Thevenin</LastName>
<ForeName>Didier</ForeName>
<Initials>D</Initials>
<AffiliationInfo>
<Affiliation>Réanimation, CH Lens, Lens, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Pottecher</LastName>
<ForeName>Julien</ForeName>
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<AffiliationInfo>
<Affiliation>Réanimation Chirurgicale, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France.</Affiliation>
</AffiliationInfo>
</Author>
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<ForeName>René-Gilles</ForeName>
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</AffiliationInfo>
</Author>
<Author ValidYN="Y">
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<ForeName>Nathalie</ForeName>
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</AffiliationInfo>
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<LastName>Vigne</LastName>
<ForeName>Coralie</ForeName>
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</AffiliationInfo>
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<Author ValidYN="Y">
<LastName>Azoulay</LastName>
<ForeName>Elie</ForeName>
<Initials>E</Initials>
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<Affiliation>Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Mimoz</LastName>
<ForeName>Olivier</ForeName>
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<Affiliation>Réanimation chirugicale, CHU La Milétrie, Poitiers, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Auquier</LastName>
<ForeName>Pascal</ForeName>
<Initials>P</Initials>
<AffiliationInfo>
<Affiliation>Unité de Recherche EA3279, Aix-Marseille Université, Marseille, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<CollectiveName>IPREA Study group</CollectiveName>
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<AccessionNumber>NCT02442934</AccessionNumber>
</AccessionNumberList>
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<GrantList CompleteYN="Y">
<Grant>
<GrantID>12-010-0554</GrantID>
<Agency>French Ministry of Health, Programme Hospitalier de Recherche Clinique National</Agency>
<Country></Country>
</Grant>
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<Year>2017</Year>
<Month>11</Month>
<Day>27</Day>
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<Country>United States</Country>
<MedlineTA>Intensive Care Med</MedlineTA>
<NlmUniqueID>7704851</NlmUniqueID>
<ISSNLinking>0342-4642</ISSNLinking>
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<MeshHeading>
<DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D003422" MajorTopicYN="N">Critical Care</DescriptorName>
<QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName>
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<MeshHeading>
<DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D007362" MajorTopicYN="N">Intensive Care Units</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
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<DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D010147" MajorTopicYN="Y">Pain Measurement</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D010465" MajorTopicYN="N">Perception</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D011788" MajorTopicYN="Y">Quality of Life</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D057566" MajorTopicYN="N">Self Report</DescriptorName>
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<Keyword MajorTopicYN="N">Cluster-randomized controlled trial</Keyword>
<Keyword MajorTopicYN="N">Critical care</Keyword>
<Keyword MajorTopicYN="N">Discomfort</Keyword>
<Keyword MajorTopicYN="N">ICU</Keyword>
<Keyword MajorTopicYN="N">Patient-reported outcome</Keyword>
<Keyword MajorTopicYN="N">Tailored program</Keyword>
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<LastName>Vie</LastName>
<ForeName>Karine</ForeName>
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<ForeName>Gwenaëlle</ForeName>
<Initials>G</Initials>
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<ForeName>Hélène</ForeName>
<Initials>H</Initials>
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<LastName>Parthiot</LastName>
<ForeName>Jean-Philippe</ForeName>
<Initials>JP</Initials>
</Investigator>
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<LastName>Parthiot</LastName>
<ForeName>Jean-Philippe</ForeName>
<Initials>JP</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Chazal</LastName>
<ForeName>Isabelle</ForeName>
<Initials>I</Initials>
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<LastName>Charve</LastName>
<ForeName>Philippe</ForeName>
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<ForeName>Jean-Pierre</ForeName>
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