Current Practices in Sedation and Analgesia for Mechanically Ventilated Critically Ill Patients.A Prospective Multicenter Patient-based Study
Jean-Francois Payen, Gèrald Chanques, Jean Mantz, Christiane Hercule,
Igor Auriant, M.D., Michèle Binhas, Cèline Genty, Carole Rolland, Jean-Luc Bosson
Anesthesiology 2007, 106
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.
A new frontier in critical care: saving the injuried brain.
Link veloci
Gestire il dolore
Flowchart doloreVNR
BPS
Gestire la sedazione
Flowchart sedaz/agitazRASS
Gestire il delirium
Flowchart DeliriumManuale CAM-ICU
Scheda di lavoro CAM-ICU
ICDSC
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