Current sedation practices: lessons learned from international surveys.

Patient outcomes are significantly influenced by the choice of sedative and analgesic agents, the presence of over- or undersedation, poor pain control, and delirium. Individualized sedation management using sedation assessment tools, sedation protocols, and daily sedative interruption can improve clinical outcomes. Despite the publication of randomized trials and numerous guidelines, the uptake of proven strategies into routine practice can be slow. Surveys of clinicians' self-reported practice and prospective practice audits characterize sedation and analgesia practices and provide directions for education and future research. The objective of this review is to present the findings of surveys and practice audits, evaluating the management of sedation and analgesia in mechanically ventilated adults in the intensive care unit, and to summarize international critical care sedation practices.

[1]  D. Rhoney,et al.  National Survey of the Use of Sedating Drugs, Neuromuscular Blocking Agents, and Reversal Agents in the Intensive Care Unit , 2003, Journal of intensive care medicine.

[2]  Kathleen Puntillo,et al.  A review of objective pain measures for use with critical care adult patients unable to self-report. , 2008, The journal of pain : official journal of the American Pain Society.

[3]  M. Fischer,et al.  Practice of sedation and analgesia in German intensive care units: results of a national survey , 2005, Critical care.

[4]  Intensive care sedation of mechanically ventilated patients: a national Swedish survey. , 2003, Intensive & critical care nursing.

[5]  Theodore Speroff,et al.  Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. , 2004, JAMA.

[6]  J. Hansen-Flaschen,et al.  Use of Sedating Drugs and Neuromuscular Blocking Agents in Patients Requiring Mechanical Ventilation for Respiratory Failure. A National Survey , 1992 .

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

[8]  C. Gélinas,et al.  Validation of the critical-care pain observation tool in adult patients. , 2006, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[9]  G. Brattebø,et al.  Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit , 2002, BMJ : British Medical Journal.

[10]  M. Levy,et al.  Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 , 2007, Intensive Care Medicine.

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

[12]  D. Chittock,et al.  Measuring quality of sedation in adult mechanically ventilated critically ill patients. the Vancouver Interaction and Calmness Scale. Sedation Focus Group. , 2000, Journal of clinical epidemiology.

[13]  D. Hendrick,et al.  Budgerigar-fancier's lung: the commonest variety of allergic alveolitis in Britain. , 1978, British medical journal.

[14]  L. Aitken,et al.  The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit , 2006, Intensive Care Medicine.

[15]  Jesse B. Hall,et al.  A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients* , 2006, Critical care medicine.

[16]  C. Sessler,et al.  The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. , 2002, American journal of respiratory and critical care medicine.

[17]  J. Dasta,et al.  Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit , 1994, Critical care medicine.

[18]  The current practice of sedation and analgesia in intensive care units in Malaysian public hospitals. , 2007, The Medical journal of Malaysia.

[19]  G. Brattebø,et al.  Effect of a scoring system and protocol for sedation on duration of patients’ need for ventilator support in a surgical intensive care unit* , 2004, Quality & safety in health care.

[20]  G. Bernard,et al.  Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial , 2008, The Lancet.

[21]  G Sherman,et al.  Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. , 1999, Critical care medicine.

[22]  C. Gennings,et al.  Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients , 2008, Critical care.

[23]  M. Levy,et al.  Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 , 2007, Intensive Care Medicine.

[24]  P. Glass,et al.  Sedation during mechanical ventilation: A trial of benzodiazepine and opiate in combination* , 2006, Critical care medicine.

[25]  P. Kam,et al.  Propofol infusion syndrome , 2007, Anaesthesia.

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

[27]  T J Gallagher,et al.  Comparison of propofol and midazolam for sedation in intensive care unit patients. , 1995, Critical care medicine.

[28]  H. Merriman,et al.  The techniques used to sedate ventilated patients , 1981, Intensive Care Medicine.

[29]  G. Fraser,et al.  Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. , 1999, Critical care medicine.

[30]  M. Barrios,et al.  Comparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial. , 1996, Critical care medicine.

[31]  W J Sibbald,et al.  Sedation in the intensive care unit: a systematic review. , 2000, JAMA.

[32]  J. Kress,et al.  Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation* , 2008, Critical care medicine.

[33]  C. Weinert,et al.  The state of intubated ICU patients: development of a two-dimensional sedation rating scale for critically ill adults. , 2004, Chest.

[34]  G. Guyatt,et al.  Adaptation to the Intensive Care Environment (ATICE): Development and validation of a new sedation assessment instrument , 2003, Critical care medicine.

[35]  P. Marik Propofol: An Immunomodulating Agent , 2005, Pharmacotherapy.

[36]  Jesse B. Hall,et al.  Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients* , 2004, Critical care medicine.

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

[38]  P. Tonner,et al.  Analgesie und Sedierung in der Intensivmedizin , 2004, Der Anaesthesist.

[39]  C. Spies,et al.  Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey , 2007, Critical care.

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

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

[42]  A. Pohlman,et al.  Continuous intravenous infusions of lorazepam versus midazolam for sedation during mechanical ventilatory support: A prospective, randomized study , 1994, Critical care medicine.

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

[44]  P. Pandharipande,et al.  Sedative and analgesic medications: risk factors for delirium and sleep disturbances in the critically ill. , 2006, Critical care clinics.

[45]  J. Bion,et al.  Sedation in intensive care--a postal survey. , 1987, Intensive care medicine.

[46]  C. Weinert,et al.  Epidemiology of sedation and sedation adequacy for mechanically ventilated patients in a medical and surgical intensive care unit* , 2007, Critical care medicine.

[47]  Analgesia and Sedation in Intensive Care , 2011 .

[48]  A. Arroliga,et al.  Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults* , 2004, Critical care medicine.

[49]  L. Berggren,et al.  Survey of routines for sedation of patients on controlled ventilation in Nordic intensive care units , 2004, Acta anaesthesiologica Scandinavica.

[50]  A. Cohen,et al.  Intensive care sedation: a review of current British practice , 2000, Intensive Care Medicine.

[51]  Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease , 2008 .

[52]  E. Ely,et al.  Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. , 2009, JAMA.

[53]  D. Cook,et al.  A Prospective Evaluation of Sedative, Analgesic, Anti-Psychotic and Paralytic Practices in Canadian Mechanically Ventilated Adults. , 2009, ATS 2009.

[54]  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.

[55]  G. Fraser,et al.  Adverse Events Associated with Sedatives, Analgesics, and Other Drugs That Provide Patient Comfort in the Intensive Care Unit , 2005, Pharmacotherapy.

[56]  Jesse B. Hall,et al.  The long-term psychological effects of daily sedative interruption on critically ill patients. , 2003, American journal of respiratory and critical care medicine.

[57]  Andres Esteban,et al.  Use of sedatives and neuromuscular blockers in a cohort of patients receiving mechanical ventilation. , 2005, Chest.

[58]  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.

[59]  J. Kress,et al.  Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. , 2000, The New England journal of medicine.

[60]  E. Manias,et al.  Sedation management in Australian and New Zealand intensive care units: doctors' and nurses' practices and opinions. , 2010, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[61]  G. Bernard,et al.  Delirium and sedation in the intensive care unit: Survey of behaviors and attitudes of 1384 healthcare professionals* , 2009, Critical care medicine.

[62]  A. Muijtjens,et al.  Fellows’ in intensive care medicine views on professionalism and how they learn it , 2009, Intensive Care Medicine.

[63]  J. Devlin,et al.  Predictors of mortality in patients with suspected propofol infusion syndrome , 2008, Critical care medicine.

[64]  Philip D Lumb,et al.  Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. , 2002, Critical care medicine.

[65]  M. H. Ensom,et al.  Clinical Pharmacokinetic Monitoring of Midazolam in Critically Ill Patients , 2007, Pharmacotherapy.

[66]  C. Gross,et al.  Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy. , 2001, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[67]  F. Paoletti,et al.  SIAARTI recommendations for analgo-sedation in intensive care unit. , 2006, Minerva anestesiologica.

[68]  Jean-Luc Bosson,et al.  Assessing pain in critically ill sedated patients by using a behavioral pain scale , 2001, Critical care medicine.

[69]  R. Barrientos-Vega,et al.  Prolonged sedation of critically ill patients with midazolam or propofol: impact on weaning and costs. , 1997, Critical care medicine.

[70]  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.

[71]  Sangeeta Mehta,et al.  Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically ill patients* , 2006, Critical care medicine.

[72]  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.

[73]  T. Shaw,et al.  Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients. , 2006, Intensive & critical care nursing.

[74]  B. de Jonghe,et al.  Sedation algorithm in critically ill patients without acute brain injury , 2005, Critical care medicine.

[75]  G Sherman,et al.  The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. , 1998, Chest.