Practices in sedation, analgesia, mobilization, delirium, and sleep deprivation in adult intensive care units (SAMDS-ICU): an international survey before and during the COVID-19 pandemic

• Published in: Annals of intensive care 2022-02, Vol.12 (1), p.9-9, Article 9
• Main Authors: Luz, Mariana, Brandão Barreto, Bruna, de Castro, Roberta Esteves Vieira, Salluh, Jorge, Dal-Pizzol, Felipe, Araujo, Caio, De Jong, Audrey, Chanques, Gérald, Myatra, Sheila Nainan, Tobar, Eduardo, Gimenez-Esparza Vich, Carolina, Carini, Federico, Ely, Eugene Wesley, Stollings, Joanna L., Drumright, Kelly, Kress, John, Povoa, Pedro, Shehabi, Yahya, Mphandi, Wilson, Gusmao-Flores, Dimitri
• Format: Article
• Language: English
• Subjects: Analgesia; Anesthesia; Anesthesiology; Clinical practice guidelines; Coronaviruses; COVID-19; Critical Care Medicine; Delirium; Emergency Medicine; Intensive; Intensive care; Ketamine; Life Sciences; Medicine; Medicine & Public Health; Mobilization; Pain; Pandemics; Prescription drugs; Questionnaires; Sedation; Sleep deprivation; Ventilators
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-022-00985-y

Background Since the publication of the 2018 Clinical Guidelines about sedation, analgesia, delirium, mobilization, and sleep deprivation in critically ill patients, no evaluation and adequacy assessment of these recommendations were studied in an international context. This survey aimed to investigate these current practices and if the COVID-19 pandemic has changed them. Methods This study was an open multinational electronic survey directed to physicians working in adult intensive care units (ICUs), which was performed in two steps: before and during the COVID-19 pandemic. Results We analyzed 1768 questionnaires and 1539 (87%) were complete. Before the COVID-19 pandemic, we received 1476 questionnaires and 292 were submitted later. The following practices were observed before the pandemic: the Visual Analog Scale (VAS) (61.5%), the Behavioral Pain Scale (BPS) (48.2%), the Richmond Agitation Sedation Scale (RASS) (76.6%), and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (66.6%) were the most frequently tools used to assess pain, sedation level, and delirium, respectively; midazolam and fentanyl were the most frequently used drugs for inducing sedation and analgesia (84.8% and 78.3%, respectively), whereas haloperidol (68.8%) and atypical antipsychotics (69.4%) were the most prescribed drugs for delirium treatment; some physicians regularly prescribed drugs to induce sleep (19.1%) or ordered mechanical restraints as part of their routine (6.2%) for patients on mechanical ventilation; non-pharmacological strategies were frequently applied for pain, delirium, and sleep deprivation management. During the COVID-19 pandemic, the intensive care specialty was independently associated with best practices. Moreover, the mechanical ventilation rate was higher, patients received sedation more often (94% versus 86.1%, p