Sedatives, analgesics, and paralytics in the ICU.
OBJECTIVE
To solicit practitioner-perceived opinions regarding current sedative/analgesic/paralytic practice including drug selection, admixture methods, and methods of assessing patient response to therapy via surgery tool; and to assess sedative/pain/paralytic drug use patterns including dosage, route selection, and combination therapy by collecting actual drug administration data from multiple centers.


METHODS
Respondents completed a survey and collected drug administration data for 5 consecutive days in the intensive care unit (ICU) in which they practiced.


METHODS
One hundred thirty-eight members of the Society of Critical Care Medicine Clinical Pharmacology and Pharmacy section and the Critical Care Practice Research Network of the American College of Clinical Pharmacy agreed to participate in the study.


RESULTS
Fifty-one percent of the participants completed surveys, and 45% returned drug administration data collection forms. Patients received sedative/pain/paralytic therapy 62% of the 5 days studied. The most frequently received drugs were opiates, followed by benzodiazepines. Intermittent intravenous injection, oral/enteral, and continuous infusion methods were used in most patients. Combination therapy was used 25% of the time, with benzodiazepine/opiate combinations used most often (46%). Administration protocols were rarely used. Paralytic agents were occasionally administered without sedative/pain therapy.


CONCLUSIONS
Patients received these agents during the majority of their ICU stay. Multicenter drug use data suggested a preference for opiate and benzodiazepine therapy. Many centers used continuous infusion therapy despite minimal pharmacokinetic/pharmacodynamic information on ICU patients. Further studies are needed to standardize end points, as well as obtain both pharmacokinetic/pharmacodynamic and stability data in ICU patients.
Watling
S M
SM
Critical Care Department of Pharmacy, University of Missouri, Columbia 65212, USA.
Dasta
J F
JF
Seidl
E C
EC
D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016292:Procedural Sedation / Q000379:methods; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007263:Infusions, Parenteral; D007362:Intensive Care Units; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014481:United States
D000700:Analgesics; D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents