A web-based survey of United Kingdom sedation practice in the intensive care unit

Yassin, S.M., Terblanche, M., Yassin, J. and McKenzie, C.A. (2015) A web-based survey of United Kingdom sedation practice in the intensive care unit. Journal of Critical Care, 30 (2), 436.e1-436.e6. (doi:10.1016/j.jcrc.2014.11.006).

Abstract

Purpose
The purpose of this work was to obtain a detailed perspective of sedation practice. Sedation included sedative and opioid choice, presence of local guidelines, and use of scoring systems.

Methods
A Web-based survey was designed. The aim was to gain sufficient detail of UK sedation while also being succinct enough to complete in 15 minutes. It was composed of relevant demographics, policy, sedative choice, and analgesia. The survey was piloted before launch. The investigators selected the intensive care unit (ICU) pharmacist as the respondent.

Results
One hundred fifty-seven ICUs responded. Eighty-nine (59%) reported use of sedation guidelines, 78% undertook sedation holds, and 87% use sedation scores. Only 42% used a daily sedation target. Seventy (43%) assess for delirium; 27 of those use a validated tool.

Propofol (89%) use was common, followed by midazolam (49%). Morphine (49%), fentanyl (34%), and alfentanil (34%) were the most frequently used opioids.

Conclusion
This survey confirmed expected variation in UK sedation practice. Recognized strategies such as target sedation score and sedation policy are underused. A 43% uptake in delirium screening suggests that larger engagement is required to meet national standards.

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Contributors

Author: C.A. McKenzie

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