Skip to main content
Top
Published in: Critical Care 2/2005

Open Access 01-04-2005 | Research

Practice of sedation and analgesia in German intensive care units: results of a national survey

Authors: Jörg Martin, Axel Parsch, Martin Franck, Klaus D Wernecke, Matthias Fischer, Claudia Spies

Published in: Critical Care | Issue 2/2005

Login to get access

Abstract

Introduction

Sedation and analgesia are provided by using different agents and techniques in different countries. The goal is to achieve early spontaneous breathing and to obtain an awake and cooperative pain-free patient. It was the aim of this study to conduct a survey of the agents and techniques used for analgesia and sedation in intensive care units in Germany.

Methods

A survey was sent by mail to 261 hospitals in Germany. The anesthesiologists running the intensive care unit were asked to fill in the structured questionnaire about their use of sedation and analgesia.

Results

A total of 220 (84%) questionnaires were completed and returned. The RAMSAY sedation scale was used in 8% of the hospitals. A written policy was available in 21% of hospitals. For short-term sedation in most hospitals, propofol was used in combination with sufentanil or fentanyl. For long-term sedation, midazolam/fentanyl was preferred. Clonidine was a common part of up to two-thirds of the regimens. Epidural analgesia was used in up to 68%. Neuromuscular blocking agents were no longer used.

Conclusion

In contrast to the US 'Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult', our survey showed that in Germany different agents, and frequently neuroaxial techniques, were used.
Appendix
Available only for authorised users
Literature
1.
go back to reference Koepke JP: Effect of environmental stress on neural control of renal function. Miner Electrolyte Metab. 1989, 15: 83-87.PubMed Koepke JP: Effect of environmental stress on neural control of renal function. Miner Electrolyte Metab. 1989, 15: 83-87.PubMed
2.
3.
go back to reference Lewis KS, Whipple JK, Michael KA, Quebbeman EJ: Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Pharm. 1994, 51: 1539-1554.PubMed Lewis KS, Whipple JK, Michael KA, Quebbeman EJ: Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Pharm. 1994, 51: 1539-1554.PubMed
4.
go back to reference Whipple JK, Lewis KS, Quebbeman EJ, Wolff M, Gottlieb MS, Medicus-Bringa M, Hartnett KR, Graf M, Ausman RK: Analysis of pain management in critically ill patients. Pharmacotherapy. 1995, 15: 592-599.CrossRefPubMed Whipple JK, Lewis KS, Quebbeman EJ, Wolff M, Gottlieb MS, Medicus-Bringa M, Hartnett KR, Graf M, Ausman RK: Analysis of pain management in critically ill patients. Pharmacotherapy. 1995, 15: 592-599.CrossRefPubMed
5.
go back to reference Merriman HM: The techniques used to sedate ventilated patients. A survey of methods used in 34 ICUs in Great Britain. Intensive Care Med. 1981, 7: 217-224.CrossRefPubMed Merriman HM: The techniques used to sedate ventilated patients. A survey of methods used in 34 ICUs in Great Britain. Intensive Care Med. 1981, 7: 217-224.CrossRefPubMed
6.
go back to reference Gast PH, Fisher A, Sear JW: Intensive care sedation now. Lancet. 1984, 2: 863-864. 10.1016/S0140-6736(84)90892-4.CrossRefPubMed Gast PH, Fisher A, Sear JW: Intensive care sedation now. Lancet. 1984, 2: 863-864. 10.1016/S0140-6736(84)90892-4.CrossRefPubMed
7.
go back to reference Miller-Jones CMH, Williams JH: Sedation for ventilation. A retrospective study to ventilated patients. Anaesthesia. 1980, 35: 1104-1106.CrossRefPubMed Miller-Jones CMH, Williams JH: Sedation for ventilation. A retrospective study to ventilated patients. Anaesthesia. 1980, 35: 1104-1106.CrossRefPubMed
8.
go back to reference Burns AM, Shelly MP, Park GR: The use of sedative agents in critically ill patients. Drugs. 1992, 43: 507-515.CrossRefPubMed Burns AM, Shelly MP, Park GR: The use of sedative agents in critically ill patients. Drugs. 1992, 43: 507-515.CrossRefPubMed
9.
go back to reference Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G: The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest. 1998, 114: 541-548.CrossRefPubMed Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G: The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest. 1998, 114: 541-548.CrossRefPubMed
10.
go back to reference Durbin CG: Sedation in the critically ill patient. New Horiz. 1994, 2: 64-74.PubMed Durbin CG: Sedation in the critically ill patient. New Horiz. 1994, 2: 64-74.PubMed
11.
go back to reference Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ: Sedation in the intensive care unit: a systematic review. JAMA. 2000, 283: 1451-1459. 10.1001/jama.283.11.1451.CrossRefPubMed Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ: Sedation in the intensive care unit: a systematic review. JAMA. 2000, 283: 1451-1459. 10.1001/jama.283.11.1451.CrossRefPubMed
12.
go back to reference Tonner PH, Weiler N, Paris A, Scholz J: Sedation and analgesia in the intensive care unit. Curr Opin Anaesthesiol. 2003, 16: 113-121. 10.1097/00001503-200304000-00003.CrossRefPubMed Tonner PH, Weiler N, Paris A, Scholz J: Sedation and analgesia in the intensive care unit. Curr Opin Anaesthesiol. 2003, 16: 113-121. 10.1097/00001503-200304000-00003.CrossRefPubMed
13.
go back to reference Tung A, Rosenthal M: Patients requiring sedation. Crit Care Clin. 1995, 11: 791-802.PubMed Tung A, Rosenthal M: Patients requiring sedation. Crit Care Clin. 1995, 11: 791-802.PubMed
14.
go back to reference Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, Von Spiegel T, Mutz N: Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med. 2001, 164: 43-49.CrossRefPubMed Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, Von Spiegel T, Mutz N: Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med. 2001, 164: 43-49.CrossRefPubMed
15.
go back to reference Murdoch S, Cohen A: Intensive care sedation: a review of current British practice. Intensive Care Med. 2000, 26: 922-928. 10.1007/s001340051282.CrossRefPubMed Murdoch S, Cohen A: Intensive care sedation: a review of current British practice. Intensive Care Med. 2000, 26: 922-928. 10.1007/s001340051282.CrossRefPubMed
16.
go back to reference Christensen B, Thunedborg L: Use of sedatives, analgesics and neuromuscular blocking agents in Danish ICUs 1996/97. A national survey. Intensive Care Med. 1999, 25: 186-191. 10.1007/s001340050814.CrossRefPubMed Christensen B, Thunedborg L: Use of sedatives, analgesics and neuromuscular blocking agents in Danish ICUs 1996/97. A national survey. Intensive Care Med. 1999, 25: 186-191. 10.1007/s001340050814.CrossRefPubMed
17.
go back to reference Soliman H, Melot C, Vincent J: Sedative and analgesic practice in the intensive care unit: the results of a European survey. Br J Anaesth. 2001, 87: 186-192. 10.1093/bja/87.2.186.CrossRefPubMed Soliman H, Melot C, Vincent J: Sedative and analgesic practice in the intensive care unit: the results of a European survey. Br J Anaesth. 2001, 87: 186-192. 10.1093/bja/87.2.186.CrossRefPubMed
18.
go back to reference Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke HS, Coplin WM, et al: Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002, 30: 119-141. 10.1097/00003246-200201000-00020.CrossRefPubMed Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke HS, Coplin WM, et al: Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002, 30: 119-141. 10.1097/00003246-200201000-00020.CrossRefPubMed
20.
go back to reference Holm S: A simple sequentially rejective multiple test procedure. Scand J Stat. 1979, 6: 65-70. Holm S: A simple sequentially rejective multiple test procedure. Scand J Stat. 1979, 6: 65-70.
22.
go back to reference Breitfeld C, Peters J, Vockel T, Lorenz C, Eikermann M: Emetic effects of morphine and piritramide. Br J Anaesth. 2003, 91: 218-223. 10.1093/bja/aeg165.CrossRefPubMed Breitfeld C, Peters J, Vockel T, Lorenz C, Eikermann M: Emetic effects of morphine and piritramide. Br J Anaesth. 2003, 91: 218-223. 10.1093/bja/aeg165.CrossRefPubMed
23.
go back to reference Brodner G, Van Aken H, Hertle L, Fobker M, Von Eckardstein A, Goeters C, Buerkle H, Harks A, Kehlet H: Multimodal perioperative management – combining thoracic epidural analgesia, forced mobilization, and oral nutrition – reduces hormonal and metabolic stress and improves convalescence after major urologic surgery. Anesth Analg. 2001, 92: 1594-1600.CrossRefPubMed Brodner G, Van Aken H, Hertle L, Fobker M, Von Eckardstein A, Goeters C, Buerkle H, Harks A, Kehlet H: Multimodal perioperative management – combining thoracic epidural analgesia, forced mobilization, and oral nutrition – reduces hormonal and metabolic stress and improves convalescence after major urologic surgery. Anesth Analg. 2001, 92: 1594-1600.CrossRefPubMed
24.
go back to reference Beattie WS, Badner NH, Choi P: Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg. 2001, 93: 853-858. 10.1097/00000539-200110000-00010.CrossRefPubMed Beattie WS, Badner NH, Choi P: Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg. 2001, 93: 853-858. 10.1097/00000539-200110000-00010.CrossRefPubMed
25.
go back to reference Walz M, Mollenhoff G, Muhr G: Verkürzung der Weaningphase nach maschineller Beatmung durch kombinierte Gabe von Clonidin und Sufentanil. Chirurg. 1999, 70: 66-73. 10.1007/s001040050608.CrossRefPubMed Walz M, Mollenhoff G, Muhr G: Verkürzung der Weaningphase nach maschineller Beatmung durch kombinierte Gabe von Clonidin und Sufentanil. Chirurg. 1999, 70: 66-73. 10.1007/s001040050608.CrossRefPubMed
26.
go back to reference Bohrer H, Bach A, Layer M, Werning P: Clonidine as a sedative adjunct in intensive care. Intensive Care Med. 1990, 16: 265-266.CrossRefPubMed Bohrer H, Bach A, Layer M, Werning P: Clonidine as a sedative adjunct in intensive care. Intensive Care Med. 1990, 16: 265-266.CrossRefPubMed
27.
go back to reference Zielmann S, Grote R: Auswirkungen der Langzeitsedierung auf die intestinale Funktion. Anaesthesist. 1995, 44 (Suppl 3): S549-S558.PubMed Zielmann S, Grote R: Auswirkungen der Langzeitsedierung auf die intestinale Funktion. Anaesthesist. 1995, 44 (Suppl 3): S549-S558.PubMed
28.
go back to reference Bion JF, Ledingham IM: Sedation in intensive care – a postal survey. Intensive Care Med. 1987, 13: 215-216.PubMed Bion JF, Ledingham IM: Sedation in intensive care – a postal survey. Intensive Care Med. 1987, 13: 215-216.PubMed
29.
go back to reference Brattebo G, Hofoss D, Flaatten H, Muri AK, Gjerde S, Plsek PE: Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit. BMJ. 2002, 324: 1386-1389. 10.1136/bmj.324.7350.1386.PubMedCentralCrossRefPubMed Brattebo G, Hofoss D, Flaatten H, Muri AK, Gjerde S, Plsek PE: Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit. BMJ. 2002, 324: 1386-1389. 10.1136/bmj.324.7350.1386.PubMedCentralCrossRefPubMed
30.
go back to reference MacLaren R, Plamondon JM, Ramsay KB, Rocker GM, Patrick WD, Hall RI: A prospective evaluation of empiric versus protocol-based sedation and analgesia. Pharmacotherapy. 2000, 20: 662-672. 10.1592/phco.20.7.662.35172.CrossRefPubMed MacLaren R, Plamondon JM, Ramsay KB, Rocker GM, Patrick WD, Hall RI: A prospective evaluation of empiric versus protocol-based sedation and analgesia. Pharmacotherapy. 2000, 20: 662-672. 10.1592/phco.20.7.662.35172.CrossRefPubMed
31.
go back to reference Mascia MF, Koch M, Medicis JJ: Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care. Crit Care Med. 2000, 28: 2300-2306. 10.1097/00003246-200007000-00019.CrossRefPubMed Mascia MF, Koch M, Medicis JJ: Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care. Crit Care Med. 2000, 28: 2300-2306. 10.1097/00003246-200007000-00019.CrossRefPubMed
32.
go back to reference Kress JP, Pohlman AS, O'Connor M, Hall JB: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000, 342: 1471-1477. 10.1056/NEJM200005183422002.CrossRefPubMed Kress JP, Pohlman AS, O'Connor M, Hall JB: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000, 342: 1471-1477. 10.1056/NEJM200005183422002.CrossRefPubMed
33.
go back to reference Barrientos-Vega R, Sanchez-Soria MM, Morales-Garcia C, Cuena-Boy R, Castellano-Hernandez M: Pharmacoeconomic assessment of propofol 2% used for prolonged sedation. Crit Care Med. 2001, 29: 317-322. 10.1097/00003246-200102000-00018.CrossRefPubMed Barrientos-Vega R, Sanchez-Soria MM, Morales-Garcia C, Cuena-Boy R, Castellano-Hernandez M: Pharmacoeconomic assessment of propofol 2% used for prolonged sedation. Crit Care Med. 2001, 29: 317-322. 10.1097/00003246-200102000-00018.CrossRefPubMed
34.
go back to reference Dahaba AA, Grabner T, Rehak PH, List WF, Metzler H: Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients: a randomized double blind study. Anesthesiology. 2004, 101: 640-646. 10.1097/00000542-200409000-00012.CrossRefPubMed Dahaba AA, Grabner T, Rehak PH, List WF, Metzler H: Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients: a randomized double blind study. Anesthesiology. 2004, 101: 640-646. 10.1097/00000542-200409000-00012.CrossRefPubMed
35.
go back to reference Hughes MA, Glass PS, Jacobs JR: Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology. 1992, 76: 334-341.CrossRefPubMed Hughes MA, Glass PS, Jacobs JR: Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology. 1992, 76: 334-341.CrossRefPubMed
36.
go back to reference Meyer TJ, Eveloff SE, Bauer MS, Schwartz WA, Hill NS, Millman RP: Adverse environmental conditions in the respiratory and medical ICU settings. Chest. 1994, 105: 1211-1216.CrossRefPubMed Meyer TJ, Eveloff SE, Bauer MS, Schwartz WA, Hill NS, Millman RP: Adverse environmental conditions in the respiratory and medical ICU settings. Chest. 1994, 105: 1211-1216.CrossRefPubMed
37.
go back to reference Walder B, Francioli D, Meyer JJ, Lancon M, Romand JA: Effects of guidelines implementation in a surgical intensive care unit to control nighttime light and noise levels. Crit Care Med. 2000, 28: 2242-2247. 10.1097/00003246-200007000-00010.CrossRefPubMed Walder B, Francioli D, Meyer JJ, Lancon M, Romand JA: Effects of guidelines implementation in a surgical intensive care unit to control nighttime light and noise levels. Crit Care Med. 2000, 28: 2242-2247. 10.1097/00003246-200007000-00010.CrossRefPubMed
38.
go back to reference Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK: The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001, 27: 1892-1900. 10.1007/s00134-001-1132-2.CrossRefPubMed Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK: The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001, 27: 1892-1900. 10.1007/s00134-001-1132-2.CrossRefPubMed
39.
go back to reference Tobias JD: Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit. Crit Care Med. 2000, 28: 2122-2132. 10.1097/00003246-200006000-00079.CrossRefPubMed Tobias JD: Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit. Crit Care Med. 2000, 28: 2122-2132. 10.1097/00003246-200006000-00079.CrossRefPubMed
40.
go back to reference Hack G, Götz E, Sorgatz H, van Eimeren W, Wulff A: Umfrage zur Situation der Anästhesiologie in Deutschland. Anästh Intensivmed. 2000, 41: 535-541. Hack G, Götz E, Sorgatz H, van Eimeren W, Wulff A: Umfrage zur Situation der Anästhesiologie in Deutschland. Anästh Intensivmed. 2000, 41: 535-541.
Metadata
Title
Practice of sedation and analgesia in German intensive care units: results of a national survey
Authors
Jörg Martin
Axel Parsch
Martin Franck
Klaus D Wernecke
Matthias Fischer
Claudia Spies
Publication date
01-04-2005
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2005
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3035

Other articles of this Issue 2/2005

Critical Care 2/2005 Go to the issue