Current practices in sedation and analgesia for mechanically ventilated critically ill patients

A prospective multicenter patient-based study

Jean Francois Payen, Gérald Chanques, Jean Mantz, Christiane Hercule, Igor Auriant, Jean Luc Leguillou, Michèle Binhas, Céline Genty, Carole Rolland, Jean Luc Bosson

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)687-695
Number of pages9
JournalAnesthesiology
Volume106
Issue number4
DOIs
StatePublished - Apr 2007
Externally publishedYes

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Critical Illness
Analgesia
Intensive Care Units
Pain Measurement
Deep Sedation
Pain
Hypnotics and Sedatives
Analgesics
Guidelines
Sufentanil
Midazolam
Fentanyl
Propofol
Pain Management
Morphine
Opioid Analgesics
France
Observational Studies
Patient Care
Prospective Studies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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Current practices in sedation and analgesia for mechanically ventilated critically ill patients : A prospective multicenter patient-based study. / Payen, Jean Francois; Chanques, Gérald; Mantz, Jean; Hercule, Christiane; Auriant, Igor; Leguillou, Jean Luc; Binhas, Michèle; Genty, Céline; Rolland, Carole; Bosson, Jean Luc.

In: Anesthesiology, Vol. 106, No. 4, 04.2007, p. 687-695.

Research output: Contribution to journalArticle

Payen, JF, Chanques, G, Mantz, J, Hercule, C, Auriant, I, Leguillou, JL, Binhas, M, Genty, C, Rolland, C & Bosson, JL 2007, 'Current practices in sedation and analgesia for mechanically ventilated critically ill patients: A prospective multicenter patient-based study', Anesthesiology, vol. 106, no. 4, pp. 687-695. https://doi.org/10.1097/01.anes.0000264747.09017.da
Payen, Jean Francois ; Chanques, Gérald ; Mantz, Jean ; Hercule, Christiane ; Auriant, Igor ; Leguillou, Jean Luc ; Binhas, Michèle ; Genty, Céline ; Rolland, Carole ; Bosson, Jean Luc. / Current practices in sedation and analgesia for mechanically ventilated critically ill patients : A prospective multicenter patient-based study. In: Anesthesiology. 2007 ; Vol. 106, No. 4. pp. 687-695.
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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

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