title: Perceived versus actual sedation practices in adult intensive care unit patients receiving mechanical ventilation.
abstract: BACKGROUND
  With drug shortages, newer sedative medications, and updates in research, management of sedation and delirium in patients receiving mechanical ventilation continues to evolve.
  
  
  OBJECTIVE
  To compare perceived and actual sedation practices for adults receiving mechanical ventilation in intensive care units (ICUs).
  
  
  METHODS
  This was a multicenter, 2-part study conducted in adult ICUs in US hospitals. It included a sedation practice survey completed by ICU pharmacists and an observational study evaluating actual sedation practices over a 24-hour period.
  
  
  RESULTS
  Surveys were completed for 85 ICUs; observational data for 496 patients were collected. Preferred sedatives from the survey data were propofol (short-term); propofol, midazolam, or lorazepam (intermediate); and lorazepam (long-term). Propofol was the most commonly used agent overall during the observational period (primarily for short-term and intermediate-length sedation); midazolam was the most commonly used for long-term sedation. Fentanyl was the preferred analgesic, and haloperidol and quetiapine were the preferred antipsychotics. Sedation treatment algorithms were used in only 50% of observed ICUs. Use of daily interruption of sedation was perceived to be 66% but was only observed in 36% of patients. Monitoring for delirium was reported among 25% of those surveyed but was observed in only 10% of patients. Targeted sedation goals were most frequently achieved when a treatment algorithm was used or when an opiate infusion was the single agent used for sedative management.
  
  
  CONCLUSIONS
  These data suggest differences in perceived and actual sedation practice in the US, as well as underutilization of evidence-based interventions. Most notable was the limited use of sedation treatment algorithms, daily interruption of sedation, and monitoring for delirium. Individual sedation and delirium protocols should be evaluated and updated based on evidence-based recommendations.
authors.affiliation: Virginia Commonwealth University Health System, Department of Pharmacy, Department of Pulmonary and Critical Care Medicine, Richmond, USA. kvarney@mcvh-vcu.edu
authors.forename: Kimberly Varney
authors.initials: KV
authors.lastname: Gill
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Voils
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Chenault
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Brophy
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003625:Data Collection; D003693:Delirium / Q000139:chemically induced; D016903:Drug Monitoring; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010465:Perception; D010595:Pharmacists; D012121:Respiration, Artificial
chemical_list: D000700:Analgesics; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives