Background and Objective: Sedation and analgesia are crucial
therapies in ICU but few guidelines for their use are available. A
recent retrospective local study showed that the drugs and doses used
in the local adult ICU are similar to reports in the literature. Propofol,
morphine, fentanyl and midazolam are the most prescribed drugs.
This study aimed at measuring the nurses' and physicians' global
assessment of the patient sedation and at comparing the results with
those of the retrospective study. The final aim was to evaluate the
need for local guidelines on ICU sedation.
Design: Two anonymous 10-item questionnaires were developed for
this protocol. The first one, sent to the 36 physicians of the ICU,
included also 4 additional clinical cases to discuss. The second one
was send to the 207 nurses. 6 questions were the same in both
questionnaires.
Setting: 34-bed adult ICU of a university hospital
Main Outcome Measures: Physicians' and nurses' perception of
sedation.
Results: 47 percent of physicians and 15% of nurses returned the
questionnaire despite 3 reminders. 47% physicians and 50% nurses
considered the sedation adequate in 50-75% cases and 47% and 27%
respectively considered it adequate in 75-90% cases. When the
sedation was rated as inadequate, 80% of the nurses thought that
patients were under-sedated while over-sedation was mentioned by
65% of the physicians. The vast majority of physicians (76%) and
nurses (93%) mentioned using the sedation agitation scale (SAS) on a
regular basis and 87% of physicians said that they prescribed a daily
interruption of sedation. However, a daily interruption was observed
in only 20% of cases during the retrospective study. This discrepancy
could partly be explained by the lack of response from medical residents.
Moreover, in practice, the sedation level is sometimes just
decreased to allow a clinical evaluation of the patient without a formal
interruption of the administration of esdatives. This could also
explain the very low percentage observed. The discussion of the 4
clinical cases showed a large variability in the choice of sedative
drugs. This demonstrated a lack of consensus among the prescribers.
The implementation of local guidelines for the sedation was requested
by nurses and physicians.
Conclusions: This study demonstrated a large diversity among prescribers
in the management of sedation. Hence, the need for
guidelines exists. Such a document also requested by nurses and
physicians. Once the new guidelines will be available, teaching to the
nurses and to the medical residents has to be provided. The
enhancement of the communication between physicians and nurses
about the level of sedation and its goal has to be promoted. The
pharmacist will contribute to the elaboration and implementation of
the guidelines.