Tags

Type your tag names separated by a space and hit enter

Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study.
Anesthesiology. 2007 Apr; 106(4):687-95; quiz 891-2.A

Abstract

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.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care, Albert Michallon Hospital, Grenoble, France. jfpayen@ujf-grenoble.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17413906

Citation

Payen, Jean-Francois, et al. "Current Practices in Sedation and Analgesia for Mechanically Ventilated Critically Ill Patients: a Prospective Multicenter Patient-based Study." Anesthesiology, vol. 106, no. 4, 2007, pp. 687-95; quiz 891-2.
Payen JF, Chanques G, Mantz J, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007;106(4):687-95; quiz 891-2.
Payen, J. F., Chanques, G., Mantz, J., Hercule, C., Auriant, I., Leguillou, J. L., Binhas, M., Genty, C., Rolland, C., & Bosson, J. L. (2007). Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology, 106(4), 687-95; quiz 891-2.
Payen JF, et al. Current Practices in Sedation and Analgesia for Mechanically Ventilated Critically Ill Patients: a Prospective Multicenter Patient-based Study. Anesthesiology. 2007;106(4):687-95; quiz 891-2. PubMed PMID: 17413906.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. AU - Payen,Jean-Francois, AU - Chanques,Gérald, AU - Mantz,Jean, AU - Hercule,Christiane, AU - Auriant,Igor, AU - Leguillou,Jean-Luc, AU - Binhas,Michèle, AU - Genty,Céline, AU - Rolland,Carole, AU - Bosson,Jean-Luc, PY - 2007/4/7/pubmed PY - 2007/5/12/medline PY - 2007/4/7/entrez SP - 687-95; quiz 891-2 JF - Anesthesiology JO - Anesthesiology VL - 106 IS - 4 N2 - 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. SN - 0003-3022 UR - https://www.unboundmedicine.com/medline/citation/17413906/Current_practices_in_sedation_and_analgesia_for_mechanically_ventilated_critically_ill_patients:_a_prospective_multicenter_patient_based_study_ L2 - https://pubs.asahq.org/anesthesiology/article-lookup/doi/10.1097/01.anes.0000264747.09017.da DB - PRIME DP - Unbound Medicine ER -