Sedation practice in Nordic and non-Nordic ICUs: a European survey.

BACKGROUND AND AIMS A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries. DESIGN AND METHODS A cross-sectional survey of ICU nurses attending the fourth European federation of Critical Care Nursing associations (EfCCNa) in Denmark, 2011. Data included use of protocols; sedation, pain and delirium assessment tools; collaborative decision-making; sedation and analgesic medications; and educational preparation related to sedation. RESULTS Response rate was 42% (n = 291) from 22 countries where 53% (n = 148) used sedation protocols. Nordic nurses reported greater use of sedation (91% versus 67%, p < 0·01) and pain (91% versus 69%, p < 0·01) assessment tools than non-Nordic nurses. Decision-making on sedation was more inter-professionally collaborative in Nordic ICUs (83% versus 61%, p < 0·01), units were smaller (10 versus 15 beds, p < 0·01) and nurse-patient ratio was higher (1:1, 75% versus 26%, p < 0·01). Nordic nurses reported greater consistency in maintaining circadian rhythm (66% versus 49%, p < 0·01), less use of physical restraints (14% versus 36%, p < 0·01), less use of neuromuscular blocking agents (3% versus 16%, p < 0·01), and received more sedation education (92% versus 76%, p < 0·01). Delirium assessment was not performed systematically in most settings. CONCLUSIONS Organizational and contextual factors, such as ICU size, staffing ratio and inter-professional collaboration, are contributing factors to sedation management in European ICUs. The Nordic context might be more germane to the goal of lighter sedation and better pain management. RELEVANCE TO CLINICAL PRACTICE Our study raises awareness of current sedation practice, paving the way towards optimized ICU sedation management.

[1]  D. Needham,et al.  Long-term complications of critical care , 2011, Critical care medicine.

[2]  S. Kane-Gill,et al.  Pharmacoeconomics of sedation in the ICU. , 2011, Anesthesiology clinics.

[3]  A. Esteban,et al.  Effect of a nursing-implemented sedation protocol on weaning outcome* , 2008, Critical care medicine.

[4]  R. Spirig,et al.  Diaries Written for ICU Patients , 2007, Qualitative health research.

[5]  J. Hollands,et al.  Optimizing sustained use of sedation in mechanically ventilated patients: focus on safety. , 2010, Current drug safety.

[6]  Torben Martinussen,et al.  A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial , 2010, The Lancet.

[7]  G. Bernard,et al.  Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). , 2001, JAMA.

[8]  R. Balk.  Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial , 2010 .

[9]  H. M. Soliman,et al.  Sedative and analgesic practice in the intensive care unit: the results of a European survey. , 2001, British journal of anaesthesia.

[10]  R. Hopkins,et al.  Cognitive functioning, mental health, and quality of life in ICU survivors: an overview. , 2009, Critical care clinics.

[11]  J. Devlin,et al.  Assessment of delirium in the intensive care unit: nursing practices and perceptions. , 2008, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[12]  J. Magarey,et al.  Sedation of adult critically ill ventilated patients in intensive care units: a national survey. , 1997, Australian critical care : official journal of the Confederation of Australian Critical Care Nurses.

[13]  Stephanie M. Mazerolle,et al.  Survey Instrument Validity Part I: Principles of Survey Instrument Development and Validation in Athletic Training Education Research. , 2011 .

[14]  D. McAuley,et al.  Decisional responsibility for mechanical ventilation and weaning: an international survey , 2011, Critical care.

[15]  E. Vasilevskis,et al.  Delirium and Sedation Recognition Using Validated Instruments: Reliability of Bedside Intensive Care Unit Nursing Assessments from 2007 to 2010 , 2011, Journal of the American Geriatrics Society.

[16]  M. Fischer,et al.  Sedation and analgesia in German intensive care units: how is it done in reality? Results of a patient-based survey of analgesia and sedation , 2006, Intensive Care Medicine.

[17]  A. Modrykamien.  The ICU Follow-Up Clinic: A New Paradigm for Intensivists , 2012, Respiratory Care.

[18]  Matthew J. Maiden,et al.  Sedation practice in the intensive care unit: a UK national survey , 2008, Critical care.

[19]  A. Stubhaug,et al.  Analgesia and sedation of mechanically ventilated patients – a national survey of clinical practice , 2012, Acta anaesthesiologica Scandinavica.

[20]  J. Payen,et al.  Current Practices in Sedation and Analgesia for Mechanically Ventilated Critically Ill Patients: A Prospective Multicenter Patient-based Study , 2007, Anesthesiology.

[21]  J. Devlin,et al.  Perceived barriers to the use of sedation protocols and daily sedation interruption: a multidisciplinary survey. , 2009, Journal of critical care.

[22]  M. Ringdal,et al.  Patients' participation in and evaluation of a follow‐up program following intensive care , 2011, Acta anaesthesiologica Scandinavica.

[23]  I. Egerod,et al.  Intensive Care Patient Diaries in Scandinavia: a Comparative Study of Emergence and Evolution , 2010 .

[24]  M. Mirski,et al.  'Cooperative sedation': optimizing comfort while maximizing systemic and neurological function , 2012, Critical Care.

[25]  E. Ely,et al.  Sedation, delirium and mechanical ventilation: the ‘ABCDE’ approach , 2011, Current opinion in critical care.

[26]  I. Lat,et al.  Sedation, Analgesia, and Delirium in the Critically Ill Patient , 2011, Journal of pharmacy practice.

[27]  B. V. Christensen,et al.  Use of sedatives, analgesics and neuromuscular blocking agents in Danish ICUs 1996/97 , 1999, Intensive Care Medicine.

[28]  J. Vincent,et al.  Toward less sedation in the intensive care unit: a prospective observational study. , 2011, Journal of critical care.

[29]  M. Meade,et al.  A multicenter survey of Ontario intensive care unit nurses regarding the use of sedatives and analgesics for adults receiving mechanical ventilation. , 2007, Journal of critical care.

[30]  C. Sessler,et al.  Protocolized and target-based sedation and analgesia in the ICU. , 2009, Critical care clinics.

[31]  R. Griffiths,et al.  Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial , 2010, Critical care.

[32]  K. Samuelson,et al.  A nurse-led intensive care after-care programme - development, experiences and preliminary evaluation. , 2009, Nursing in critical care.

[33]  Daniel L Jackson,et al.  The incidence of sub-optimal sedation in the ICU: a systematic review , 2009, Critical care.

[34]  G. Martin,et al.  Protocols in the management of critical illness , 2011, Critical Care.

[35]  S. Pocock,et al.  Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. , 2012, JAMA.

[36]  M. Eriksson,et al.  Delirium--awareness, observation and interventions in intensive care units: a national survey of Swedish ICU head nurses. , 2010, Intensive & critical care nursing.

[37]  J. Devlin,et al.  Impact of a delirium screening tool and multifaceted education on nurses' knowledge of delirium and ability to evaluate it correctly. , 2012, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[38]  M. Ramsay,et al.  Controlled Sedation with Alphaxalone-Alphadolone , 1974, British medical journal.

[39]  B. Fridlund,et al.  Stressful experiences in relation to depth of sedation in mechanically ventilated patients. , 2007, Nursing in critical care.

[40]  Theodore Speroff,et al.  Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). , 2003, JAMA.

[41]  Laalitha Surapaneni,et al.  Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation , 2015 .

[42]  I. Egerod,et al.  Trends in sedation practices in Danish intensive care units in 2003: a national survey , 2005, Intensive Care Medicine.

[43]  Y. Skrobik,et al.  Intensive Care Delirium Screening Checklist: evaluation of a new screening tool , 2001, Intensive Care Medicine.

[44]  Kathryn A. Lee,et al.  Sleep and delirium in ICU patients: a review of mechanisms and manifestations , 2009, Intensive Care Medicine.

[45]  D R Nerenz,et al.  Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. , 1999, Critical care medicine.

[46]  C. Sessler,et al.  Protocolized and target-based sedation and analgesia in the ICU. , 2011, Anesthesiology Clinics.

[47]  C. Mora.  Cultures and Organizations: Software of the Mind Intercultural Cooperation and Its Importance for Survival , 2013 .

[48]  A. Rhodes,et al.  Standardised drug labelling in intensive care: results of an international survey among ESICM members , 2012, Intensive Care Medicine.