Intensive care sedation: a review of current British practice

Objective:Sedation is central to the management of intensive care patients. Many different techniques have been tried, all have potential side effects , and some have been associated with serious adverse effects. The aim of th is work is to establish current sedation practice in British ICUs; the use of neuromuscular blocking drugs and the indications for their use, the use of sedation policies and scoring systems, the influence of cost on drug cho ice, and the use of propofol for sedation in paediatric patients. Design: A postal survey sent to all units identified in the Directory of Emergency S ervices. Results: Two hundred and fifty-five replies were received from 323 questionnaires (79 % response rate). The replies show that alfentanil, mor phine, midazolam, and propofol are the most widely used drugs for sedation, and that changes occur in sedation policy with the time a patient spends i n intensive care. Atracurium is the most widely used neuromuscular blocking drug, but the number of patients who receive therapeutic paralysis is rela tively small and the indications for its use in different units is consiste nt. Propofol is used by many ICUs for the sedation of children despite repo rts linking its use to mortality in children and the advice of the regulato ry authorities, Conclusions: Drugs used for the sedation of patients in int ensive care have changed since previous surveys. The sedation policy of mos t units relies on the combination of small numbers of drugs. Sedation polic ies now seem to concentrate on achieving a lightly sedated co-operative pat ient.