Use of Sedative and Analgesic Drugs in the First Week of ICU Stay in High-Level-of-Care.

Iapichino G, Bertolini G, Pezzi A, Rossi C, Melotti R, Valdambrini F, Albicini M, Di Mauro P.

Minerva Anestesiol. 2003;69(10):765-70, 771-4.

Aim: the aim of this study was to update the current practice of pharmacological sedation and analgesia in Italian intensive care units.

Methods: design: observational, prospective, cohort study involving consecutive patients admitted during 5 months in 1999. Patients were evaluated for the first 7 days of high-level-of care. Setting: 45 adult general intensive care units. Patients: 388 fulfilling enrollment criteria: admission diagnosis out of non-traumatic cerebral hemorrage, stroke, respiratory failure in chronic obstructive pulmonary disease (COPD), acute lung injury/distress syndrome (ALI/ARDS), polytrauma, head trauma, cardiac failure and major abdominal surgery; unit stay longer than 47 hours and high-level-of care treatment.

Results: sedation pattern was different among diagnosis-groups. No therapy was registered in 18.8% of overall days in polytrauma vs 67.6% of cardiac patients. Opioids supply ranged from 10.1% of overall days of acute on COPD patients vs 51.4% of polytrauma patients. Propofol was the more prescribed drug, followed by opioids and benzodiazepines. Propofol was at the top in cerebrovascular disease, ALI/ARDS and COPD; opioids in abdominal surgery and trauma, benzodiazepines in cardiac failure. The average number of prescribed drugs per day was 1.5 ranging from 1.2 on COPD to 1.7 in head trauma.

Conclusion: diagnosis influences the pattern of sedation-analgesia during high-level-of-care period. Sedation prevalence is reasonably prescribed in trauma groups while it remains low in ALI/ARDS, post-operative, cerebrovascular, COPD and hearth failure. Particularly opioid use remains limited in post-operative patients. This surveys shows a poorly standardised sedation approach to the different phases of the therapy: induction, short and long-term sedation phase.

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