Sedative and analgesic practice in the intensive care unit: the results ofa European survey

Sedation and analgesia are important aspects of patient care on the intensi ve care unit (ICU), yet relatively little information is available on commo n sedative and analgesic practice. We sought to assess international differ ences in the prescription of sedative and analgesic drugs in western Europe an ICUs by means of a short, self-administered questionnaire. Six hundred a nd forty-seven intensive care physicians from 16 western European countries replied to the questionnaire. Midazolam was used as a sedative often or al ways by 63% of respondents and propofol by 35%. There were considerable int ernational variations, with midazolam being preferred over propofol in Fran ce, Germany, the Netherlands, Norway and Austria. For analgesia, the drugs most commonly used were morphine (33%), fentanyl (33%) and sufentanil (24%) . Morphine was preferred over fentanyl and sufentanil in Norway, UK and Ire land, Sweden, Switzerland, the Netherlands, and Spain and Portugal. Fentany l was preferred in France, Germany and Italy. Sufentanil was preferred in B elgium and Luxemburg and in Austria. Multivariate analysis showed that the combination of midazolam with fentanyl was most often used in France; propo fol with morphine in Sweden, the UK and Ireland, and Switzerland; midazolam with morphine in Norway; and propofol with sufentanil in Belgium and Luxem burg, Germany and Italy. The use of a sedation scale varied from 72% in the UK and Ireland to 18% in Austria. When used, the most common sedation scal e was the Ramsay scale. This study demonstrates substantial international d ifferences in sedative and analgesic practices in western European ICUs.