Changes in sedation management in German intensive care units between 2002 and 2006: a national follow up survey

Abstract

BackgroundThe aim of this study, conducted in 2006, was to find out whether changes in sedation management in German intensive care units took place in comparison with our survey from 2002.MethodsWe conducted a follow-up survey with a descriptive and comparative cross-sectional multi-center design. A postal survey was sent between January and May 2006, up to four times, to the same 269 hospitals that participated in our first survey in 2002. The same questionnaire as in 2002 was used with a few additional questions.ResultsTwo hundred fourteen (82%) hospitals replied. Sixty-seven percent of the hospitals carried out changes in sedation management since the 2002 survey. Reasons for changes were published literature (46%), national guidelines (29%), and scientific lectures (32%). Sedation protocols (8% versus 52%) and a sedation scale (21% versus 46%) were used significantly more frequently. During sedation periods of up to 24 hours, significantly less midazolam was used (46% versus 35%). In comparison to 2002, sufentanil and epidural analgesia were used much more frequently in all phases of sedation, and fentanyl more rarely. For periods of greater than 72 hours, remifentanil was used more often. A daily sedation break was introduced by 34% of the hospitals, and a pain scale by 21%.ConclusionThe increased implementation of protocols and scoring systems for the measurement of sedation depth and analgesia, a daily sedation break, and the use of more short-acting analgesics and sedatives account for more patient-oriented analgesia and sedation in 2006 compared with 2002.

Sedation Management in Australian and New Zealand Intensive Care Units: Doctors’ and Nurses’ Practices and Opinions

“…Compared with findings in early survey-based studies [8][9][10] that ICU patients were heavily sedated, the latest reports [11][12][13][14][15][16] of sedation management in North American and European ICUs have revealed an increasing use of sedation protocols, tools for scoring the level of sedation, and a target end point of light sedation that enables patients to interact with health care personnel and others. Previous Australian surveys on sedation also indicated a trend toward more alert and interactive patients, but these surveys requested opinions from ICU doctors 17 or nurses only.…”

Influence of clinical practice guidelines on pain management in german intenive care units – A state wide survey

“…Recently, national and international clinical practice guidelines have been developed whose implementation might ensure evidence-based care for mechanically ventilated ICU patients with sedation and analgesia therapy [13][14][15] . German guidelines recommend the use of reliable and valid instruments for the assessment of pain [16] .…”

“…These data are necessary for the identification of pain and the achievement of the therapy goal, documented in a patient-orientated treatment protocol [16,17] . Little is known whether these guideline recommendations have an influence on clinical practice in ICUs [15] .…”

Sedation in Intensive Care: A review of the State-of-the-Art

“…Для его более адекватной оценки во многих ОРИТ используют паузу седации в следующем режиме: 20 часов седации, далее перерыв до полного выхода на уровень сознания вне седации, оценка уровня сознания, неврологическо го статуса и решение о целесообразности дальнейшей седации, ее целевого уровня, затем продолжение седа ции, если это необходимо. Применение паузы седации является дискутабельным вопросом, в настоящее вре мя в свои протоколы применение паузы включили 40 50% отделений интенсивной терапии Европы, США и Канады [38][39][40]. Противники ее применения ссылают ся на возможность резко выраженного возбуждения, увеличения АД, ВЧД, ЧСС, риске дислокации эндотра хеальной трубки, катетеров и других осложнений, рез ком возрастании нагрузки на персонал ОРИТ.…”

“…Каждая клиника прини мает свой протокол, не противоречащий национально му, но учитывающий местные особенности. Введение такого протокола снижает время, проведенное пациен том на ИВЛ, реанимационный койко день, госпиталь ную летальность и общие затраты на лечение [4,5,8,20,21,33,34,36,38,39,40,41,45,72].…”