title: Analgesia and sedation of mechanically ventilated patients - a national survey of clinical practice.
abstract: BACKGROUND
  The importance of balanced sedation and pain treatment in intensive care units (ICUs) is evident, but regimes and use of medication differ widely. Previous surveys have focused on the use of various medications and regimes. What has not been explored is the process by which nurses and physicians assess patients' needs and work together toward a defined level of sedation and pain for the ICU patient. The purpose of the study was to determine the use of protocols and medications for sedation and analgesia in Norwegian ICUs and the degree of cooperation between nurses and physicians in using them.
  
  
  METHODS
  A national survey was conducted in autumn 2007, using postal self-administered questionnaires.
  
  
  RESULTS
  Written pain treatment and sedation protocols were not routinely used in Norwegian ICUs; however, half of the departments titrated sedation according to a scoring system, most commonly the Motor Activity Assessment Score. The most commonly used sedatives were propofol and midazolam, while fentanyl and morphine were the most used analgesics. The majority of respondents were concerned about the side effects of sedation and analgesics, leading to circulatory instability and delayed awakening. Nurses and physicians agreed upon the main indications for sedation: patient tolerance for ventilation, tolerance for medical and nursing interventions, and patient symptoms.
  
  
  CONCLUSIONS
  Potential factors which may improve sedation and pain management of mechanically ventilated patients in Norwegian ICUs are more systematic assessments of pain and sedation, and the use of written protocols. Strategies which reduce side effects should be addressed.
authors.affiliation: Rikshospitalet Medical Centre, Oslo University Hospital, Norway. hilde.woien@ous-hf.no
authors.forename: H
authors.initials: H
authors.lastname: Wøien
authors.forename: A
authors.initials: A
authors.lastname: Stubhaug
authors.forename: I T
authors.initials: IT
authors.lastname: Bjørk
mesh_terms: D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D003625:Data Collection; D003627:Data Interpretation, Statistical; D015600:Glasgow Coma Scale; D019538:Health Care Surveys; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D009043:Motor Activity / Q000187:drug effects; D009664:Norway; D009726:Nurses; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement; D010820:Physicians; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012890:Sleep / Q000187:drug effects; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014140:Tracheotomy
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives