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Critical Care
Published in: Critical Care 6/2008

Open Access 01-12-2008 | Research

Sedation practice in the intensive care unit: a UK national survey

Authors: Henrik Reschreiter, Matt Maiden, Atul Kapila

Published in: Critical Care | Issue 6/2008

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Abstract

Introduction

The purpose of this study was to evaluate sedation practice in UK intensive care units (ICUs), particularly the implementation of daily sedation holding, written sedation guidelines, sedation scoring tools and choice of agents.

Methods

A national postal survey was conducted in all UK ICUs.

Results

A total of 192 responses out of 302 addressed units were received (63.5%). Of the responding ICUs, 88% used a sedation scoring tool, most frequently the Ramsey Sedation Scale score (66.4%). The majority of units have a written sedation guideline (80%), and 78% state that daily sedation holding is practiced. A wide variety of sedating agents is used, with the choice of agent largely determined by the duration of action rather than cost. The most frequently used agents were propofol and alfentanil for short-term sedation; propofol, midazolam and morphine for longer sedation; and propofol for weaning purposes.

Conclusions

Most UK ICUs use a sedation guideline and sedation scoring tool. The concept of sedation holding has been implemented in the majority of units, and most ICUs have a written sedation guideline.
Appendix
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Literature
1.
Hansen-Flaschen JH, Brazinsky S, Basile C, Lanken PN: Use of sedating drugs and neuromuscular blocking agents in patients requiring mechanical ventilation for respiratory failure. A national survey. Jama 1991, 266: 2870-2875.CrossRefPubMed
2.
Roth-Isigkeit A, Brechmann J, Dibbelt L, Sievers HH, Raasch W, Schmucker P: Persistent endocrine stress response in patients undergoing cardiac surgery. J Endocrinol Invest 1998, 21: 12-19.CrossRefPubMed
3.
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.
Schelling G: Post-traumatic stress disorder in somatic disease: lessons from critically ill patients. Prog Brain Res 2008, 167: 229-237.CrossRefPubMed
5.
Burns AM, Shelly MP, Park GR: The use of sedative agents in critically ill patients. Drugs 1992, 43: 507-515.CrossRefPubMed
6.
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
7.
Kress JP, Pohlman AS, O'Connor MF, Hall JB: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000, 342: 1471-1477.CrossRefPubMed
8.
Elliott R, McKinley S, Aitken LM, Hendrikz J: The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit. Intensive Care Med 2006, 32: 1506-1514.CrossRefPubMed
9.
Hogarth DK, Hall J: Management of sedation in mechanically ventilated patients. Curr Opin Crit Care 2004, 10: 40-46.CrossRefPubMed
10.
Kress JP, Gehlbach B, Lacy M, Pliskin N, Pohlman AS, Hall JB: The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 2003, 168: 1457-1461.CrossRefPubMed
11.
Schweickert WD, Gehlbach BK, Pohlman AS, Hall JB, Kress JP: Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med 2004, 32: 1272-1276.CrossRefPubMed
12.
Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke HS, Coplin WM, Crippen DW, Fuchs BD, Kelleher RM, Marik PE, Nasraway SA Jr, Murray MJ, Peruzzi WT, Lumb PD: Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002, 30: 119-141.CrossRefPubMed
13.
Mattia C, Savoia G, Paoletti F, Piazza O, Albanese D, Amantea B, Ambrosio F, Belfiore B, Berti M, Bertini L, Bruno F, Carassiti M, Celleno D, Coluzzi F, Consales G, Costantini A, Cuppini F, De Gaudio RA, Farnia A, Finco G, Gravino E, Guberti A, Laurenzi L, Mangione S, Marano M, Mariconda G, Martorano PP, Mediati R, Mercieri M, Mondello E, et al.: SIAARTI recommendations for analgo-sedation in intensive care unit. Minerva Anestesiol 2006, 72: 769-805.PubMed
14.
Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ: Sedation in the intensive care unit: a systematic review. JAMA 2000, 283: 1451-1459.CrossRefPubMed
15.
Izurieta R, Rabatin JT: Sedation during mechanical ventilation: a systematic review. Crit Care Med 2002, 30: 2644-2648.CrossRefPubMed
16.
Murray MJ, Cowen J, DeBlock H, Erstad B, Gray AW Jr, Tescher AN, McGee WT, Prielipp RC, Susla G, Jacobi J, Nasraway SA Jr, Lumb PD: Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med 2002, 30: 142-156.CrossRefPubMed
17.
Martin J, Parsch A, Franck M, Wernecke KD, Fischer M, Spies C: Practice of sedation and analgesia in German intensive care units: results of a national survey. Crit Care 2005, 9: R117-R123.PubMedCentralCrossRefPubMed
18.
Mehta S, Burry L, Fischer S, Martinez-Motta JC, Hallett D, Bowman D, Wong C, Meade MO, Stewart TE, Cook DJ: Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically ill patients. Crit Care Med 2006, 34: 374-380.CrossRefPubMed
19.
Egerod I, Christensen BV, Johansen L: Trends in sedation practices in Danish intensive care units in 2003: a national survey. Intensive Care Med 2006, 32: 60-66.CrossRefPubMed
20.
Martin J, Franck M, Sigel S, Weiss M, Spies C: Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey. Crit Care 2007, 11: R124.PubMedCentralCrossRefPubMed
21.
Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, Binhas M, Genty C, Rolland C, Bosson JL: Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology 2007, 106: 687-695. quiz 891-682.CrossRefPubMed
22.
Murdoch S, Cohen A: Intensive care sedation: a review of current British practice. Intensive Care Med 2000, 26: 922-928.CrossRefPubMed
23.
24.
Riker RR, Fraser GL, Cox PM: Continuous infusion of haloperidol controls agitation in critically ill patients. Crit Care Med 1994, 22: 433-440.CrossRefPubMed
25.
Riker RR, Picard JT, Fraser GL: Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999, 27: 1325-1329.CrossRefPubMed
26.
Devlin JW, Boleski G, Mlynarek M, Nerenz DR, Peterson E, Jankowski M, Horst HM, Zarowitz BJ: Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med 1999, 27: 1271-1275.CrossRefPubMed
27.
de Lemos J, Tweeddale M, Chittock D: Measuring quality of sedation in adult mechanically ventilated critically ill patients. The Vancouver Interaction and Calmness Scale. Sedation Focus Group. J Clin Epidemiol 2000, 53: 908-919.CrossRefPubMed
28.
Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK: The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002, 166: 1338-1344.CrossRefPubMed
29.
Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR: Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003, 289: 2983-2991.CrossRefPubMed
30.
De Jonghe B, Cook D, Appere-De-Vecchi C, Guyatt G, Meade M, Outin H: Using and understanding sedation scoring systems: a systematic review. Intensive Care Med 2000, 26: 275-285.CrossRefPubMed
31.
Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH: Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 1999, 27: 2609-2615.CrossRefPubMed
32.
Duane TM, Riblet JL, Golay D, Cole FJ Jr, Weireter LJ Jr, Britt LD: Protocol-driven ventilator management in a trauma intensive care unit population. Arch Surg 2002, 137: 1223-1227.CrossRefPubMed
33.
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.PubMedCentralCrossRefPubMed
34.
Adam C, Rosser D, Manji M: Impact of introducing a sedation management guideline in intensive care. Anaesthesia 2006, 61: 260-263.CrossRefPubMed
35.
Marshall J, Finn CA, Theodore AC: Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay. Crit Care Med 2008, 36: 427-433.CrossRefPubMed
36.
Bucknall TK, Manias E, Presneill JJ: A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit. Crit Care Med 2008, 36: 1444-1450.CrossRefPubMed
37.
Krishnan JA, Moore D, Robeson C, Rand CS, Fessler HE: A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation. Am J Respir Crit Care Med 2004, 169: 673-678.CrossRefPubMed
38.
Kress JP, Vinayak AG, Levitt J, Schweickert WD, Gehlbach BK, Zimmerman F, Pohlman AS, Hall JB: Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease. Crit Care Med 2007, 35: 365-371.CrossRefPubMed
39.
de Wit M, Gennings C, Jenvey WI, Epstein SK: Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients. Crit Care 2008, 12: R70.PubMedCentralCrossRefPubMed
40.
Mehta S, Burry L, Martinez-Motta JC, Stewart TE, Hallett D, McDonald E, Clarke F, Macdonald R, Granton J, Matte A, Wong C, Suri A, Cook DJ: A randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial. Crit Care Med 2008, 36: 2092-2099.CrossRefPubMed
41.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008, 34: 17-60.PubMedCentralCrossRefPubMed
42.
Devlin JW, Tanios MA, Epstein SK: Intensive care unit sedation: waking up clinicians to the gap between research and practice. Crit Care Med 2006, 34: 556-557.CrossRefPubMed
43.
Metadata
Title
Sedation practice in the intensive care unit: a UK national survey
Authors
Henrik Reschreiter
Matt Maiden
Atul Kapila
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2008
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc7141

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