Reducing Discomforts in Critically Ill Patients: the IPREA3 Study

NCT ID: NCT02442934

Last Updated: 2016-03-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

5411 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-10-31

Study Completion Date

2015-10-31

Brief Summary

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Since critically ill patients are exposed to stressful conditions, the investigators evaluated the effectiveness of a multicomponent program to reduce perceived discomforts in the Intensive Care Unit (ICU) .

Detailed Description

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The investigators conducted a cluster-randomized trial randomizing 34 ICUs. The program targeted staff members with 3 components : web-based systematic measurement of discomforts on the day of ICU discharge by institutional caregivers (nurses and assistant nurses of the participating ICU), immediate feedback through electronic reminder messages intended to caregivers, and targeted interventions in each ICU based on comparative discomfort scores monthly reported to local champions who were also responsible for staff education.

The measurement of discomforts perceived by critically ill patients at the end of the ICU stay, related to the whole stay in the ICU, was performed by the bedside nurse using a specific questionnaire, the IPREA questionnaire whose construct validity, external validity, reliability, reproducibility and acceptability have been already demonstrated (Development and validation of a questionnaire for quantitative assessment of perceived discomforts in critically ill patients. Kalfon P et al, Intensive care Med 2010, 36:1751-58). The version of the IPREA questionnaire used in the study was a 18-item questionnaire : noise ; excessive light ; discomfort related to sleeping in a different bed from home ; sleep deprivation ; thirst ; hunger ; feeling of cold ; feeling of heat ; pain ; being tied down by perfusion lines, tubes or as a result of connections due to monitoring devices ; no respect for intimacy ; anxiety ; isolation ; limited visiting hours ; absence of phone ; lack of information ; shortness of breath ; and depression.

The duration of the program is 6 months in each arm. Potential participants in the study were consecutive patients admitted in all the participating ICU that are divided in two groups of 17 ICUs.

During October 2014, the IPREA questionnaire is administered to all potentially eligible patients hospitalized in the 34 participating ICUs without applying the program (period P1). The 17 ICUs of the group 1 do not apply the multicomponent program during 5 months (until March 2015), while the 17 ICUs of the group 2 apply the program (period P2). During April 2015, the questionnaire IPREA is administered again in both groups (period P3). From May 2015 until September 2015, the multicomponent program is only applied in the group 1 and no longer in the group 2 (period P4) in order to achieve the crossover of the intervention. During October 2015, the questionnaire IPREA is administered again in both groups (period P5).

The overall score of discomfort and the scores for each item will be compared in the control arm and in the interventional arm.

The control arm consists in the patients included in the group 2 during October 2014 and the patients included in the group 1 during April 2015, i.e. patients included during the month preceding the implementation of the multicomponent program.

The interventional arm consists in the patients included in the group 2 during April 2015 and the patients included in the group 1 during October 2015, i.e. patients included during the last month of the period of application of the multicomponent program.

Conditions

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Critical Illness

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Participants

Study Groups

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Multicomponent program

Multicomponent intervention to reduce perceived discomforts in critically ill patients : the IPREA3 program

Group Type EXPERIMENTAL

Administration of the IPREA3 questionnaire

Intervention Type OTHER

On the day of the ICU discharge, the bedside nurse administers to the patient the 18-item IPREA questionnaire i.e the nurse asks the patient to rate the severity of each discomfort source contained in the IPREA3 questionnaire experienced during the entire stay in the ICU

Immediate feedback through electronic reminder messages

Intervention Type OTHER

After the nurse had administered the questionnaire, warning messages are displayed on the screen corresponding to the key points to prevent the three discomforts reported with the highest scores

Targeted interventions in each ICU to reduce discomforts

Intervention Type OTHER

These targeted interventions are implemented through the coordination of two local champions.

The central coordination IPREA3 team sends each month to the local champions monthly and cumulative discomfort scores of their unit (overall score of discomfort and scores for each item) and their ranking relative to other units assigned to the interventional arm i.e applying the IPREA3 program.

The local champions organize monthly meetings with the unit staff to present the results in terms of perceived discomforts measured by the IPREA questionnaire, identify main discomfort sources and actions to be conducted to reduce the discomforts reported with the highest scores in the unit and those that are most easily preventable, and assess the efficacy of already applied measures.

Standard Care

Standard care

Group Type ACTIVE_COMPARATOR

Administration of the IPREA3 questionnaire

Intervention Type OTHER

On the day of the ICU discharge, the bedside nurse administers to the patient the 18-item IPREA questionnaire i.e the nurse asks the patient to rate the severity of each discomfort source contained in the IPREA3 questionnaire experienced during the entire stay in the ICU

Interventions

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Administration of the IPREA3 questionnaire

On the day of the ICU discharge, the bedside nurse administers to the patient the 18-item IPREA questionnaire i.e the nurse asks the patient to rate the severity of each discomfort source contained in the IPREA3 questionnaire experienced during the entire stay in the ICU

Intervention Type OTHER

Immediate feedback through electronic reminder messages

After the nurse had administered the questionnaire, warning messages are displayed on the screen corresponding to the key points to prevent the three discomforts reported with the highest scores

Intervention Type OTHER

Targeted interventions in each ICU to reduce discomforts

These targeted interventions are implemented through the coordination of two local champions.

The central coordination IPREA3 team sends each month to the local champions monthly and cumulative discomfort scores of their unit (overall score of discomfort and scores for each item) and their ranking relative to other units assigned to the interventional arm i.e applying the IPREA3 program.

The local champions organize monthly meetings with the unit staff to present the results in terms of perceived discomforts measured by the IPREA questionnaire, identify main discomfort sources and actions to be conducted to reduce the discomforts reported with the highest scores in the unit and those that are most easily preventable, and assess the efficacy of already applied measures.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* adult critically ill patients
* ICU stay of three calendar days or more

Exclusion Criteria

* deceased patient in the ICU
* ICU stay of two calendar days or less
* patient younger than 18
* patient under trusteeship
* patient refusing to participate to the study
* patient with diminished mental capacity
* patient not understanding French sufficiently to be questioned (language barrier)
* transfer to another ICU while mechanically ventilated
* emergency discharge
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Dr Pierre KALFON

OTHER

Sponsor Role lead

Responsible Party

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Dr Pierre KALFON

MD, PhD

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Pierre KALFON, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

CH CHARTRES

Locations

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CH Auxerre

Auxerre, , France

Site Status

Hôpital de la Cavale Blanche

Brest, , France

Site Status

CH Louis Pasteur

Chartres, , France

Site Status

CHU Beaujon APHP

Clichy, , France

Site Status

CHU Hôpital Bocage

Dijon, , France

Site Status

CH Douai

Douai, , France

Site Status

CHU Raymond Poincaré APHP

Garches, , France

Site Status

CH La Rochelle

La Rochelle, , France

Site Status

CH Le Puy en Velay

Le Puy-en-Velay, , France

Site Status

CH Lens

Lens, , France

Site Status

CHU Edouard Herriot

Lyon, , France

Site Status

Hôpital Européen

Marseille, , France

Site Status

CHU Hôpital Nord

Marseille, , France

Site Status

Clinique Ambroise Paré

Neuilly-sur-Seine, , France

Site Status

CHU Hôpital Pasteur2

Nice, , France

Site Status

CHU Saint Louis APHP

Paris, , France

Site Status

CHU La Pitié Salpétrière APHP

Paris, , France

Site Status

CHU Cochin APHP

Paris, , France

Site Status

Hôpital Saint Joseph

Paris, , France

Site Status

CHU Hôpital Européen Georges Pompidou APHP

Paris, , France

Site Status

CHU La Milétrie

Poitiers, , France

Site Status

CH Victor Provo

Roubaix, , France

Site Status

CHU NHC

Strasbourg, , France

Site Status

CHU Hautepierre

Strasbourg, , France

Site Status

Hôpital Saint Musse

Toulon, , France

Site Status

CH Troyes

Troyes, , France

Site Status

Countries

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France

References

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Kalfon P, Mimoz O, Auquier P, Loundou A, Gauzit R, Lepape A, Laurens J, Garrigues B, Pottecher T, Malledant Y. Development and validation of a questionnaire for quantitative assessment of perceived discomforts in critically ill patients. Intensive Care Med. 2010 Oct;36(10):1751-1758. doi: 10.1007/s00134-010-1902-9. Epub 2010 May 26.

Reference Type BACKGROUND
PMID: 20502874 (View on PubMed)

Kalfon P, Boucekine M, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Fromentin M, Nyunga M, Audibert J, Ben Salah A, Mauchien B, Sossou A, Venot M, Robert R, Follin A, Renault A, Garrouste-Orgeas M, Collange O, Levrat Q, Villard I, Thevenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Azoulay E, Mimoz O, Auquier P, Baumstarck K; IPREA Study Group. Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay. Crit Care. 2020 Dec 7;24(1):685. doi: 10.1186/s13054-020-03396-2.

Reference Type DERIVED
PMID: 33287910 (View on PubMed)

Baumstarck K, Boucekine M, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Fromentin M, Nyunga M, Sossou A, Venot M, Robert R, Follin A, Audibert J, Renault A, Garrouste-Orgeas M, Collange O, Levrat Q, Villard I, Thevenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Azoulay E, Mimoz O, Auquier P, Kalfon P; IPREA Study group. Assessment of patients' self-perceived intensive care unit discomforts: Validation of the 18-item version of the IPREA. Health Qual Life Outcomes. 2019 Feb 7;17(1):29. doi: 10.1186/s12955-019-1101-5.

Reference Type DERIVED
PMID: 30732654 (View on PubMed)

Kalfon P, Baumstarck K, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Boucekine M, Fromentin M, Nyunga M, Sossou A, Venot M, Robert R, Follin A, Audibert J, Renault A, Garrouste-Orgeas M, Collange O, Levrat Q, Villard I, Thevenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Azoulay E, Mimoz O, Auquier P; IPREA Study group. A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial. Intensive Care Med. 2017 Dec;43(12):1829-1840. doi: 10.1007/s00134-017-4991-x. Epub 2017 Nov 27.

Reference Type DERIVED
PMID: 29181557 (View on PubMed)

Kalfon P, Mimoz O, Loundou A, Geantot MA, Revel N, Villard I, Amour J, Azoulay E, Garrouste-Orgeas M, Martin C, Sharshar T, Baumstarck K, Auquier P. Reduction of self-perceived discomforts in critically ill patients in French intensive care units: study protocol for a cluster-randomized controlled trial. Trials. 2016 Feb 16;17:87. doi: 10.1186/s13063-016-1211-x.

Reference Type DERIVED
PMID: 26880373 (View on PubMed)

Other Identifiers

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2012-AO1696-37

Identifier Type: -

Identifier Source: org_study_id

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