[Current use of sedation and analgesia: 218 resuscitations in France services practices survey].
OBJECTIVE
To assess the current use of sedation and analgesia in a large sample of French intensive care units (ICUs) and to define structural characteristics of the units that use a written procedure.


METHODS
Self-reported survey.


METHODS
Three hundred and sixty French ICUs were presented the questionnaire in September 2007.


RESULTS
Surveys were received from 228 (60.6%) ICUs. Midazolam was used in more than 50% of the patients in 79.2% of the ICUs and propofol in 22.2% of the ICUs. Sufentanil was the most frequently used morphinic. A sedation-scale was used in 68.8% of the units (80.3% Ramsay score). Sedation was assessed at least every 4hours in 61% of ICUs. A pain-scale was used in 88.9% of the ICUs, but only 12.5% in the non-communicant patients. A written procedure was used in 29.4% of the units only. In multivariate analysis, use in the ICU of a written procedure for the early management of patients with septic shock and/or intensive insulin therapy was the single variable significantly associated with presence of a written procedure for sedation and analgesia (respectively OR 4.37; p<0.0001 and OR 5.64; p=0.032).


CONCLUSIONS
Although more than two-third of the responding ICUs reported the use of sedation-and-pain-scales, frequency of assessment was low, and objective assessment of pain in the non-communicating patients was extremely uncommon. Similarly, the use of written procedure was low. The use of sedation-analgesia written procedure in an ICU seems strongly influenced by a more global involvement of the ICU in the protocolisation of complex care. These findings support the reinforcement of educational programs.
Constantin
J-M
JM
Service de réanimation adulte, département d'anesthésie-réanimation, Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand cedex 1, France. jmconstantin@chu-clermontferrrand.fr
Chanques
G
G
De Jonghe
B
B
Sanchez
P
P
Mantz
J
J
Payen
J-F
JF
Sztark
F
F
Richebé
P
P
Lagneau
F
F
Capdevila
X
X
Bazin
J-E
JE
Lefrant
J-Y
JY
D000698:Analgesia / Q000592:standards*; D016292:Procedural Sedation / Q000592:standards*; D054810:Deep Sedation / Q000592:standards*; D005602:France; D006801:Humans; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires