Survey of routines for sedation of patients on controlled ventilation in Nordic intensive care units

Background: Sedation strategies and practice for patients on controlled ventilation is variable from place to place as well as over time. Less sedation results in shorter ventilation time and new ventilatory modes permit more awake patients. Previous works estimated sedative and analgesic use in Nordic ICUs some years ago, but current practice is not known. We therefore designed this study to describe pharmacological and practical routines for sedation of patients on controlled ventilation. Material and methods: We used an electronic questionnaire about characteristics of the participating ICUs and the routines for sedation of ventilator-treated patients, and secondly, an Internet-based 5-day registration on the use of drugs for sedation and analgesia. Results: Eighty-eight of 220 ICUs (36%) responded to the questionnaire and 47 out of these 88 units (53%) used a sedation scale. Written guidelines for sedation were used in 41% of the units. Both daily interruption of sedation infusions and guidelines for weaning from the ventilator were used in 15% of the units. Data on 202 patients (633 patient days) from 55 ICUs were reported. Among analgesics, fentanyl predominated (240/633 days), followed by ketobemidon (160/633 days) and morphine (115/633 days). Propofol and midazolam were the most commonly used agents for sedation (345 and 238/633 days, respectively). Conclusion: Most units used a sedation scale, although other strategies to reduce the sedation level had not yet been fully introduced. Differences in pharmacological strategies were found between the Nordic countries, and some favourite drugs could be identified.