Abstract
Objective: To evaluate current practices and problems with analgesia and sedation in Japanese ICUs using a questionnaire survey. Methods: Doctors, nurses, and pharmacists working in ICUs at board-certified training facilities for intensive care specialists were asked to fill out the form detailing the generic names and administration methods of analgesics, sedatives, and neuromuscular blocking agents and the assessment methods of analgesia and sedation that were used for adult patients admitted to the ICU between June 1 and 30, 2009 who received mechanical ventilation with tracheal intubation or tracheostomy, noninvasive ventilation (NIV), or no ventilatory support. Results: We received replies to the questionnaire from 97 ICUs (response rate: 44%). In mechanical ventilated patients with tracheal intubation or tracheostomy, the continuous intravenous administrations of fentanyl and propofol were the most frequently used analgesic and sedative, respectively, and neuromuscular blocking agents were used in about 10% of the patients. In patients with NIV, the continuous intravenous administration of dexmedetomidine was used most frequently. Thirty-eight and 64% of the patients without any ventilatory support were not administered any analgesics or sedatives, respectively. Although it was subjective, pain was mainly assessed by ICU nurses. Sedation level was mainly assessed by the Richmond Agitation-Sedation Scale. The use of analgesics, the practice of daily interruption of sedatives, and the assessment of delirium using the confusion assessment method for the ICU were unsatisfactory. Conclusion: Although there were some problems, the practice of analgesia and sedation in Japanese ICUs was generally acceptable.
