Practice of sedation and analgesia in German intensive care units: results of a national survey

Abstract

Introduction: Sedation and analgesia are provided by using different agents and techniques in different countries. The goal is to achieve early spontaneous breathing and to obtain an awake and cooperative pain-free patient. It was the aim of this study to conduct a survey of the agents and techniques used for analgesia and sedation in intensive care units in Germany.

Methods: A survey was sent by mail to 261 hospitals in Germany. The anesthesiologists running the intensive care unit were asked to fill in the structured questionnaire about their use of sedation and analgesia.

Results: A total of 220 (84%) questionnaires were completed and returned. The RAMSAY sedation scale was used in 8% of the hospitals. A written policy was available in 21% of hospitals. For short-term sedation in most hospitals, propofol was used in combination with sufentanil or fentanyl. For long-term sedation, midazolam/fentanyl was preferred. Clonidine was a common part of up to two-thirds of the regimens. Epidural analgesia was used in up to 68%. Neuromuscular blocking agents were no longer used.

Conclusion: In contrast to the US 'Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult', our survey showed that in Germany different agents, and frequently neuroaxial techniques, were used.

Figure 1

The most commonly used sedative agents for the different sedation periods. *Differences between midazolam and propofol in a phase (χ² test, P < 0.05). The values were tested with the χ² test (P < 0.05) and multiple differences with the Bonferroni–Holm multiple test procedure. (Propofol: less than 24 hours versus 24–72 hours versus more than 72 hours versus weaning, all P < 0.0001. Midazolam: less than 24 hours versus 24–72 hours versus more than 72 hours versus weaning, all P < 0.0001.)

Figure 2

The most commonly used analgesic agents during the different sedation periods. *Differences between fentanyl and sufentanil in a phase (χ² test, P < 0.05). The values were tested with the χ² test (P < 0.05) and multiple differences with the Bonferroni–Holm multiple test procedure. (Fentanyl: less than 24 hours versus 24–72 hours versus more than 72 hours versus weaning, all P < 0.01. Sufentanil: less than 24 hours versus 24–72 hours; less than 24 hours versus more than 72 hours; 24–72 hours versus more than 72 hours and 24–72 hours versus weaning, all P = 0.01; less than 24 hours versus weaning, P = 0.04; more than 72 hours versus weaning, P = 0.55.)

Figure 3

Epidural analgesia, piritramid and NSAIDs in the different phases of analgesia and sedation. The values were tested with the χ² test (P < 0.05) and multiple differences with the Bonferroni–Holm multiple test procedure. NSAIDs, non-steroidal anti-inflammatory drugs. (Epidural: less than 24 hours versus more than 72 hours; less than 24 hours versus weaning; 24–72 hours versus more than 72 hours and 24–72 hours versus weaning, all P < 0.01; less than 24 hours versus 24–72 hours, P = 0.015; more than 72 hours versus weaning, P = 0.37. Piritramid: less than 24 hours versus 24–72 hours versus more than 72 hours versus weaning, all P < 0.01. NSAIDs: less than 24 hours versus 24–72 hours, less than 24 hours versus more than 72 hours and less than 24 hours versus weaning, all P < 0.0001; 24–72 hours versus more than 72 hours, P = 0.14; 24–72 hours versus weaning, P = 0.67; more than 72 hours versus weaning, P = 0.087.)

Figure 4

The most commonly used adjunct techniques in the different phases of analgesia and sedation. The values were tested with the χ² test (P < 0.05) and multiple differences with the Bonferroni–Holm multiple test procedure. (Clonidine: less than 24 hours versus more than 72 hours, less than 24 hours versus weaning and 24–72 hours versus weaning, all P < 0.01; 24 hours versus 24–72 hours, P = 0.23; 24–72 hours versus more than 72 hours, P < 0.017; more than 72 hours versus weaning, P = 0.067. Ketamine (S): less than 24 hours versus 24–72 hours, less than 24 hours versus more than 72 hours, 24–72 hours versus weaning and more than 72 hours versus weaning, all P < 0.0001; less than 24 hours versus weaning, P = 0.22; 24–72 hours versus more than 72 hours, P = 0.087.)