Sedation of adult critically ill ventilated patients in intensive care units: a national survey.

The aim of this survey was to review the practice of sedation for adult artificially ventilated patients in Australian intensive care units. In particular, the survey sought to investigate the drugs used, how they were administered, who was responsible for the administration, how sedation was assessed, and if, in the opinion of charge nurses, complications were occurring as a result of their practice. Questionnaires were sent by post to the clinical nurse consultants (CNCs) in charge of 72 units containing five or more beds, as identified in the Hospital Health Services Yearbook. By June 1996, 65 questionnaires had been returned (a 90 per cent response rate). Results showed that the most common form of sedation is a combination of benzodiazepines and narcotics (88 per cent); in particular, morphia (92 per cent) and midazolam (94 per cent). In 79 per cent of units, these drugs are administered by continuous infusion. Neuromuscular blocking agents are no longer commonly used in conjunction with sedation, with the majority of units (88 per cent) indicating occasional use only. Also in the majority of units (94 per cent), nurses are responsible for titrating and administering sedation. The experience of these nurses varied; in 61 per cent of units it ranged from first year post-graduation to the holding of a critical care certificate. In most units (63 per cent), the aim is to lightly sedate patients. Methods of assessing sedation vary, with few units using sedation scales (17 per cent). Twenty six CNCs (40 per cent) reported that, in their opinion, there were no complications related to their practice of sedation. The most common complication reported (by 21 CNCs or 32 per cent) was over-sedation. It appears that there is no consistent method of assessing the level of sedation in critically ill ventilated patients and that over-sedation is common. Therefore, it is recommended that clinicians investigate the possibility of introducing sedation scales in their units. However, the efficacy of such scales in ensuring a more appropriate level of sedation needs to be researched.