Mechanical Ventilation Clinical Trial
Official title:
Evaluation of Decision Capacity of ICU Patients Under Sedatives. A Prospective Observational Multicenter Study.
This prospective observational multicenter study is intended to investigate the impact of sedatives on the decision capacity of intensive care units patients.
Medicine has recently turned from paternalism to patient-centered decisions giving them back
autonomy to determine their own treatments and end-of-life directives. Main prerequisite is
patient's competence to fully understand information given from medical staff, integrate it
and resituate comprehensive willing.
Informed decision-making necessitates patient's ability to appropriately communicate and
interact with its environment. Intensive care unit (ICU) patients are often intubated
-rendering oral communication impossible- and get sedated with various medications (hypnotics
and opioids). Despite an apparently appropriate communication, some of them are confused.
Confusion is regularly under diagnosed in ICU settings and necessitates specific tools to be
detected, such as CAM-ICU (Confusion Assessment Method in ICU). While not confused, a patient
might lack decision-making capacity, meaning that despite obvious communication, more
elaborated cognitive function remains uncertain and often inappropriate. Decision-making
capacity can be evaluated with dedicated scores such as the Johns Hopkins adapted cognitive
examination (ACE). This score has recently been formally translated into French.
The influence of sedatives on decision-making capacity remains unknown to date. This
prospective observational multicentre study is intended to investigate the impact of
sedatives on the decision-making capacity of ICU patients. Furthermore, each sub-score of the
ACE (orientation, language, registration, attention and calculation, and recall) will be
investigated according to sedatives types. Patients' decision-making capacity will be
clinically assessed by physician, resident and nurse in charge, blindly of ACE result.
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