Sedation and Delirium in the Intensive Care Unit: An Australian and New Zealand Perspective

Abstract

A survey was conducted to determine sedation and delirium practices in Australian and New Zealand intensive care units. The survey was in two parts, comprising an online survey of reported sedation and delirium management (unit survey) and a collection of de-identified data about each patient in a unit at a given time on a specified day (patient snapshot survey). All intensive care units throughout Australia and New Zealand were invited by email to participate in the survey. Twenty-three predominantly metropolitan, level III Australian and New Zealand intensive care units treating adult patients participated. Written sedation policies were in place in 48% of units, while an additional 44% of units reported having informal sedation policies. Seventy percent of units routinely used a sedation scale. In contrast, only 9% of units routinely used a delirium scale. Continuous intravenous infusion is the primary means of patient sedation (74% of units). While 30% of units reported routinely interrupting sedation, only 10% of sedated patients in the snapshot survey had had their sedation interrupted in the preceding 12 hours. Oversedation appears to be common (46% of patients with completed sedation scales). Use of neuromuscular blockade is low (10%) compared to other published studies. Midazolam and propofol were the most frequently used sedatives. The proportion of patients developing delirium was 21% of assessable patients. Failed and self-extubation rates were low: 3.2% and 0.5% respectively. In Australian and New Zealand intensive care units, routine use of sedation scales is common but not universal, while routine delirium assessment is rare. The use of a sedation protocol is valuable and should be encouraged.

Validation of the Greek version of confusion assessment method for the intensive care unit (CAM-ICU)

“…In a recent study (Mac Sweeney et al, 2010), it was found that delirium in critical care is routinely screened by only 25% of clinicians in the United Kingdom (UK), while only 14% of them use a validated tool. Similar findings are reported from intensive care settings in other countries as well (Ely et al, 2004;Mehta et al, 2006;Shehabi et al, 2008;Van Eijk et al, 2008).…”

Trajectory of sedation assessment and sedative use in intubated and ventilated patients in intensive care: A clinical audit

“…were very sedated (Martin, Franck, Fischer, & Spies, 2006;Shehabi et al, 2012;Shehabi et al, 2008). Sedation scores were monitored at inconsistent intervals and at irregular frequencies.…”

“…Relatively extensive work has been conducted in Australia describing sedation practices in ICUs using survey approaches (Knowles, Rolls, Elliot, Hardy, & Middleton, 2009;O' Connor, Bucknall, & Manias, 2010;Shehabi et al, 2008). O'Connor, Bucknall, and Manias (2010) undertook a cross-sectional internet-based survey in 2006 and 2007 with members of the Australian College of Critical Care Nurses (ACCCN) and Australian and New Zealand Intensive Care Society (ANZICS) (N = 2146, 11.5% response rate).…”

“…Only 18 (45%) nurses were satisfied with how sedation practices were managed in their unit. Between 2005and 2006, Shehabi et al (2008 conducted an online survey with ANZICS members, seeking out their experiences about sedation practices based on patient snapshot data for a particular ICU day. Members from 23 metropolitan ICUs participated.…”

Neuromuscular Blockade in the Optimal Management of Mechanical Ventilation of Patients with Respiratory Distress

“…Their routine use in the ICU in the 21st century appears to be low [7]. The immediate consequences of undetected circuit disconnection and the reduced ability to monitor neurological signs are self-evident examples of immediate dangers.…”