Sedation practice in Nordic and non‐Nordic <scp>ICUs</scp>: a European survey

Egerod, Ingrid; Albarran, John; Ring, Mette; Blackwood, Bronagh

doi:10.1111/nicc.12003

Cited by 88 publications

(79 citation statements)

References 53 publications

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“…A review of previous surveys [2, 3, 6–10] informed development of the survey tool (Additional file 1: Figure S1), which captured information on management of sedation as well as the use of specific sedative and analgesic agents. With respect to analgesia, the focus was on analgesic agents with a sedative effect, such as intravenous opioids, rather than on oral or regional analgesia.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Methodsmentioning

confidence: 99%

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

et al. 2016

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“…Today's sedation practices have moved from a deeper towards a lighter sedation regimen. This is something to consider as patients are more awake and thus sensitive to the surrounding space (Egerod et al, 2013).…”

Section: Critical Reflectionsmentioning

confidence: 99%

Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit

Engwall

Fridh

Johansson

et al. 2015

Intensive and Critical Care Nursing

108

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Patients in an intensive care unit (ICU) may risk disruption of their circadian rhythm. In an intervention research project a cycled lighting system was set up in an ICU room to support patients' circadian rhythm. Part I aimed to compare experiences of the lighting environment in two rooms with different lighting environments by lighting experiences questionnaire. The results indicated differences in advantage for the patients in the intervention room (n=48), in perception of daytime brightness (p=0.004). In nighttime, greater lighting variation (p=0.005) was found in the ordinary room (n=52). Part II aimed to describe experiences of lighting in the room equipped with the cycled lighting environment. Patients (n=19) were interviewed and the results were presented in categories: "A dynamic lighting environment", "Impact of lighting on patients' sleep", "The impact of lighting/lights on circadian rhythm" and "The lighting calms". Most had experiences from sleep disorders and half had nightmares/sights and circadian rhythm disruption. Nearly all were pleased with the cycled lighting environment, which together with daylight supported their circadian rhythm. In night's actual lighting levels helped patients and staff to connect which engendered feelings of calm.

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“…[8] It needed eligible training that seemed generally scarce. Recently, some surveys showed that[91011] a number of patients in the ICUs still suffered from pain and inappropriate sedation treatment, and the rate of delirium assessment was still low. About 10 years ago, some surveys showed that[112] most of the patients did not get enough treatment for pain, agitation, and delirium (PAD) in China.…”

Section: Introductionmentioning

confidence: 99%

A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China

Wang

Peng

Zhou

et al. 2017

Chinese Medical Journal

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Background:The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China.Methods:A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016. The questionnaire focused on the assessment and management of PAD by the clinicians in ICUs. The practice of PAD was compared among the four regions of China (North, Southeast, Northwest, and Southwest). The data were expressed as percentage and frequency. The Chi-square test, Fisher's exact test, and line-row Chi-square test were used.Results:Of the 1011 valid questionnaire forms, the response rate was 80.37%. The clinicians came from 704 hospitals across 158 cities of China. The rate of PAD assessment was 75.77%, 90.21%, and 66.77%, respectively. The rates of PAD scores were 45.8%, 68.94%, and 34.03%, respectively. The visual analog scale, Richmond agitation-sedation scale, and confusion assessment method for the ICU were the first choices of scales for PAD assessment. Fentanyl, midazolam, and dexmedetomidine were the first choices of agents for analgesic, sedation, and delirium treatment. While choosing analgesics and sedatives, the clinicians put the pharmacological characteristics of drugs in the first place (66.07% and 76.36%). Daily interruption for sedation was carried out by 67.26% clinicians. Most of the clinicians (87.24%) used analgesics while using sedatives. Of the 738 (73%) clinicians titrating the sedatives on the basis of the proposed target sedation level, 268 (26.61%) clinicians just depended on their clinical experience. Totally, 519 (51.34%) clinicians never used other nondrug strategies for PAD. The working time of clinicians was an important factor in the management of analgesia and sedation rather than their titles and educational background. The ratios of pain score and sedation score in the Southwest China were the highest and the North China were the lowest. The ratios of delirium assessment and score were the same in the four regions of China. Moreover, the first choices of scales for PAD in the four regions were the same. However, the top three choices of agents in PAD treatment in the four regions were not the same.Conclusions:The practice of PAD in China follows the international guidelines; however, the pain assessment should be improved. The PAD practice is a little different across the four regions of China; however, the trend is consistent.Trial Registration:The study is registered at http://www.clinicaltrials.gov (No. ChiCTR-OOC-16009014, www.chictr.org.cn/index.aspx.).

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Sedation practice in Nordic and non‐Nordic ICUs: a European survey

Abstract: Our study raises awareness of current sedation practice, paving the way towards optimized ICU sedation management.

Cited by 88 publications

References 53 publications

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

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

Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit

A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China

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