Sedation and Analgesia Bundled Strategies Among ICU Nurses

Since the development of critical care medicine, analgesia and sedation management strategies have occupied an increasingly crucial position in the treatment of critically ill patients. Previous studies indicate that the traditional notion that deep sedation allows patients to "rest" and avoid painful memories is misguided. Deep sedation not only fails to deliver the anticipated benefits but is highly likely to prolong the patient's recovery cycle and impede physical recuperation.In actual intensive care practice, precisely and meticulously controlling the depth of analgesia and sedation is fundamental to ensuring patient comfort and the safety of clinical procedures. If the patient is in a state of pain and agitation, it is highly probable to trigger a series of severe adverse consequences, such as chronic pain and post-traumatic stress symptoms. These symptoms may persist long after the patient is discharged from the ICU, causing sustained damage to their physical and mental health. Simultaneously, the pain response significantly increases the patient's oxygen demand and the release of endogenous catecholamines, subsequently leading to a hypermetabolic state. These physiological changes will undoubtedly markedly delay the patient's recovery process.

Current critical care practices commonly emphasize the use of multimodal analgesia regimens, frequent assessment of patients' pain and sedation levels, and the implementation of light sedation using short-acting agents whenever feasible. These scientifically validated measures collectively form the influential ABCDEF bundled strategy (namely: Assessment, prevention, and management of pain; Both Spontaneous Awakening Trials (SATs) and Spontaneous Breathing Trials (SBTs); Choice of analgesia and sedation; Delirium assessment, prevention, and management; Early mobilization and Exercise; Family engagement and empowerment) .However, despite the significant theoretical advantages of the ABCDEF bundled strategy, its progress in actual clinical implementation has been slow. The sudden outbreak of the COVID-19 pandemic, in particular, delivered a substantial blow to healthcare systems. Compounded by multiple challenges such as drug shortages, resource constraints, and insufficient staffing, it has led to some irrational shifts in clinical practice. For instance, the proportion of deep sedation strategies has increased, the use frequency of benzodiazepines has risen, and compliance with daily sedation interruption has significantly decreased. These adverse changes severely compromise patient monitoring quality, subsequently exerting an extremely detrimental impact on patient prognosis.

Therefore, this study aims to gain insights into the current implementation status of the analgesia and sedation bundled strategy for critically ill patients among ICU nurses in China, as well as the underlying barriers. Its goal is to provide a robust and reliable scientific basis for optimizing the management strategies for critically ill patients and enhancing treatment outcomes.

• Scale of barriers in the current practice of bundled strategies in ICU nurses [Time frame: Day 1]