Analgesic, sedative, antipsychotic, and neuromuscular blocker use in Canadian intensive care units: a prospective, multicentre, observational study.

Abstract

PURPOSE:

Our aim was to describe analgo-sedation and antipsychotic and neuromuscular blocking drug (NMBD) use in critically ill patients, management strategies, and variables associated with these practice patterns.

METHODS:

This prospective observational study in 51 intensive care units (ICUs) included all patients who underwent invasive mechanical ventilation (MV) over a two-week period during 2008-2009.

RESULTS:

We included 712 patients representing 3,620 patient-days. Median MV duration was 3.0 days (interquartile range 2-6). During MV, 92% of patients received analgo-sedation, 32% an adjunct agent (e.g., acetaminophen), 18% NMBDs, and 10% antipsychotics. Opioids were used more frequently than benzodiazepines or propofol (84.8% vs 62.2% vs 10.1% patients, respectively, P < 0.0001). Independent predictors of opioid and benzodiazepine use were a longer MV duration, assessment scales, physical restraints, and university-affiliated hospital. Although more than 50% of ICUs reported that assessment tools, protocols, and daily sedation interruption (DSI) were available for use, application was modest: sedation scale 53.0%, pain scale 19.1%, delirium scale 5.2%, protocol 25.0%, DSI 42.1%. Accidental device removal occurred in 4.6% of patients, with 75.8% of events during DSI. Daily sedation interruption was associated with protocol use, physical restraints, university-affiliated hospital, and short-duration MV. Variables associated with protocol use included assessment scales, longer MV duration, lack of physical restraints, and admission to a community hospital.

CONCLUSION:

Nearly all MV patients received analgo-sedation. Opioids were used more often than sedatives despite infrequent use of pain scales. Few patients received antipsychotic therapy, but physical restraint was common. Protocol use was poor compared to DSI. Duration of MV predicted the use of either.

• Authors: Lisa D Burry, David R Williamson, Marc M Perreault, Louise Rose, Deborah J Cook, Niall D Ferguson, Stephanie C Lapinsky, Sangheeta Mehta
• Journal: Canadian journal of anaesthesia = Journal canadien d'anesthesie (Can J Anaesth) Vol. 61 Issue 7 Pg. 619-30 (Jul 2014) ISSN: 1496-8975 [Electronic] United States
• PMID: 24788564 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics
• Analgesics, Opioid
• Antipsychotic Agents
• Hypnotics and Sedatives
• Neuromuscular Blocking Agents

Topics

• Adult
• Aged
• Analgesics (therapeutic use)
• Analgesics, Opioid (therapeutic use)
• Antipsychotic Agents (therapeutic use)
• Canada
• Critical Illness
• Female
• Humans
• Hypnotics and Sedatives (therapeutic use)
• Intensive Care Units (statistics & numerical data)
• Male
• Middle Aged
• Neuromuscular Blocking Agents (therapeutic use)
• Prospective Studies
• Respiration, Artificial
• Restraint, Physical (statistics & numerical data)