National survey and point prevalence study of sedation practice in UK critical care

Abstract

BackgroundThe present study was designed to (1) establish current sedation practice in UK critical care to inform evidence synthesis and potential future primary research and (2) to compare practice reported via a survey with actual practice assessed in a point prevalence study (PPS).MethodsUK adult general critical care units were invited to participate in a survey of current sedation practice, and a representative sample of units was invited to participate in a PPS of sedation practice at the patient level. Survey responses were compared with PPS data where both were available.ResultsSurvey responses were received from 214 (91 %) of 235 eligible critical care units. Of these respondents, 57 % reported having a written sedation protocol, 94 % having a policy of daily sedation holds and 94 % using a sedation scale to assess depth of sedation. In the PPS, across units reporting a policy of daily sedation holds, a median of 50 % (IQR 33–75 %) of sedated patients were considered for a sedation hold. A median of 88 % (IQR 63–100 %) of patients were assessed using the same sedation scale as reported in the survey. Both the survey and the PPS indicated propofol as the preferred sedative and alfentanil, fentanyl and morphine as the preferred analgesics. In most of the PPS units, all patients had received the unit’s reported first-choice sedative (median across units 100 %, IQR 64–100 %), and a median of 80 % (IQR 67–100 %) of patients had received the unit’s reported first-choice analgesic. Most units (83 %) reported in the survey that sedatives are usually administered in combination with analgesics. Across units that participated in the PPS, 69 % of patients had received a combination of agents – most frequently propofol combined with either alfentanil or fentanyl.ConclusionsClinical practice reported in the national survey did not accurately reflect actual clinical practice at the patient level observed in the PPS. Employing a mixed methods approach provided a more complete picture of sedation practice in terms of breadth and depth of information.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1532-x) contains supplementary material, which is available to authorized users.

Multicenter assessment of sedation and delirium practices in the intensive care units in Poland - is this common practice in Eastern Europe?

“…A definite weakness of this study is a low participant response rate – 37.8%. The response rate in similar studies in other parts of Europe or world was much higher - Richard-Belle et al showed a 91.1% response rate, Reschreiter et al reported a total of 192 responses out of 302 addressed units (63.5%) [ 12 , 13 ]. This phenomenon can be discussed in a variety of ways, as lack of interest, lack of time or work overload, therefore care must be taken in encouraging intensivists in Poland to participate in practice assessment and monitoring in the future in order to improve quality of care over most dependent patients.…”

“…It must be underlined that we cannot provide information about the actual practices in Poland as this was a study based on a survey and not a point prevalence study. A way of overcoming this issue may be a point prevalence study as performed by Richards-Belle et al [ 12 ] and shall be undertaken in the future by the authors.…”

“…Our data shows that benzodiazepines are the mainstay of sedation in Poland, thus there is much room for improvement. Previous surveys conducted in different parts of the world (USA, UK, Australia/New Zealand, Europe) indicate a shift in sedating patients in critical care away from benzodiazepines and towards propofol [ 12 , 15 – 22 ].…”

Sedation Practices and Preferences of Turkish Intensive Care Physicians: A National Survey

“…The survey showed that midazolam was the most commonly chosen agent, and this was followed by propofol and dexmedetomidine. Several surveys performed in different countries showed the same preference towards midazolam, especially if it is performed for >24 h (9)(10)(11)(12)(13)(14)(15)(16). Most of these surveys were conducted before the release of the ACCM pain, agitation and delirium (PAD) guideline, which suggests the use of non-benzodiazepine sedatives (5).…”

“…Most of these surveys were conducted before the release of the ACCM pain, agitation and delirium (PAD) guideline, which suggests the use of non-benzodiazepine sedatives (5). Indeed, survey studies from the United Kingdom performed from 2006 to 2015 showed an increase in the preference of propofol over midazolam (10,17,18). However, recent surveys conducted by Chawla et al (15) and Kotfis et al (16) from Poland and India, respectively, show that midazolam is still the most chosen sedative agent.…”