Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study.
BACKGROUND
The authors conducted a patient-based survey of practices to fully describe the assessment and the management of pain and sedation of a large cohort of mechanically ventilated patients during their first week of intensive care unit (ICU) stay.


METHODS
A total of 1,381 adult patients were included in a prospective, observational study in 44 ICUs in France. Pain and sedation assessment, analgesic and sedative use, and analgesic management during procedural pain were collected on days 2, 4, and 6 of the ICU stay.


RESULTS
The observed rates of assessment on day 2 for sedation (43%) and analgesia (42%) were significantly smaller than that of use of sedatives (72%) and opioids (90%), also noted on days 4 and 6. The use of protocols/guidelines for sedation/analgesia in the ICU reduced the proportion of patients who were treated, although not evaluated. A large proportion of assessed patients were in a deep state of sedation (40-50%). Minor changes in the dosages of the main prescribed agents for sedation (midazolam, propofol) and analgesia (sufentanil, fentanyl, morphine, remifentanil) were found across 6 days of the patient's ICU stay. Procedural pain was specifically managed for less than 25% of patients; during those procedures, the proportion of patients with pain significantly increased from the baseline pain evaluation.


CONCLUSIONS
Excessively deep states of sedation and a lack of analgesia during painful procedures must be prevented. To facilitate systematic pain and sedation assessment and to adjust daily drug dosages accordingly, it seems crucial to promote educational programs and elaboration of protocols/guidelines in the ICU.
Payen
Jean-Francois
JF
Department of Anesthesiology and Critical Care, Albert Michallon Hospital, Grenoble, France. jfpayen@ujf-grenoble.fr
Chanques
Gérald
G
Mantz
Jean
J
Hercule
Christiane
C
Auriant
Igor
I
Leguillou
Jean-Luc
JL
Binhas
Michèle
M
Genty
Céline
C
Rolland
Carole
C
Bosson
Jean-Luc
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D000700:Analgesics / Q000627:therapeutic use*; D016638:Critical Illness; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012121:Respiration, Artificial
D000700:Analgesics; D006993:Hypnotics and Sedatives