title: Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: A survey conducted by the Indian Society of Critical Care Medicine.
abstract: OBJECTIVE
  Use of sedation, analgesia and neuromuscular blocking agents is widely practiced in Intensive Care Units (ICUs). Our aim is to study the current practice patterns related to mobilization, analgesia, relaxants and sedation (MARS) to help in standardizing best practices in these areas in the ICU.
  
  
  METHODS
  A web-based nationwide survey involving physicians of the Indian Society of Critical Care Medicine (ISCCM) and the Indian Society of Anesthesiologists (ISA) was carried out. A questionnaire included questions on demographics, assessment scales for delirium, sedation and pain, as also the pharmacological agents and the practice methods.
  
  
  RESULTS
  Most ICUs function in a semi-closed model. Midazolam (94.99%) and Fentanyl (47.04%) were the most common sedative and analgesic agents used, respectively. Vecuronium was the preferred neuromuscular agent. Monitoring of sedation, analgesia and delirium in the ICU. Ramsay's Sedation Scale (56.1%) and Visual Analogue Scale (48.07%) were the preferred sedation and pain scales, respectively. CAM (Confusion Assessment Method)-ICU was the most preferred method of delirium assessment. Haloperidol was the most commonly used agent for delirium. Majority of the respondents were aware of the benefit of early mobilization, but lack of support staff and safety concerns were the main obstacles to its implementation.
  
  
  CONCLUSIONS
  The results of the survey suggest that compliance with existing guidelines is low. Benzodiazepines still remain the predominant ICU sedative. The recommended practice of giving analgesia before sedation is almost non-existent. Delirium remains an underrecognized entity. Monitoring of sedation levels, analgesia and delirium is low and validated and recommended scales for the same are rarely used. Although awareness of the benefits of early mobilization are high, the implementation is low.
authors.affiliation: Department of Critical Care Medicine, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chawla
authors.affiliation: Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India.
authors.forename: Sheila Nainan
authors.initials: SN
authors.lastname: Myatra
authors.affiliation: Department of Critical Care Services, Apollo Hospitals, Chennai, India.
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Ramakrishnan
authors.affiliation: Department of Critical Care Medicine, Vision Care Hospital, Mukundpur, Kolkata, India.
authors.forename: Subhash
authors.initials: S
authors.lastname: Todi
authors.affiliation: Department of Critical Care Medicine, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Sudha
authors.initials: S
authors.lastname: Kansal
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Citizens Hospitals and American Oncology Hospitals, Hyderabad, India.
authors.forename: Sananta Kumar
authors.initials: SK
authors.lastname: Dash
keywords: Analgesia; early mobilization; muscle relaxants; sedation