Sedation practices in intensive care units at National Hospital of Sri Lanka

Abstract

There is a marked variation in the use of sedation practices in ICUs worldwide. There is no data on sedation practices in Sri Lankan ICUs. This study was conducted to evaluate sedation practices in intensive care units at National Hospital of Sri Lanka (NHSL) with special emphasis on the use of sedation guidelines, scoring systems, practice of sedation interval and the choice of pharmacological agents. A tick-box questionnaire was used to obtain data from the medical officers in-charge of seven intensive care units at National Hospital of Sri Lanka. Only 4 (57.1 %) ICUs at NHSL use a sedation scale. Ramsay sedation scale and Richmond Agitation Sedation Scale (RASS) is used equally by the ICUs. Only 2 (28%) ICUs had a written sedation guideline and 5 (71.6%) ICUs practice daily "sedation hold". None of the ICUs audit their sedation practices. Midazolam and morphine are the frequently used drugs for sedation and analgesia respectively. The choice of sedating agent was mainly influenced by the duration of action than the cost of the drug. Our survey revealed that the current sedation practices in the ICUs need improvement. Use of a written sedation guideline, use of a sedation scale and auditing of sedation practices should be encouraged to improve patient outcomes. We believe that there is an urgent need to implement a national guideline for sedation practices in ICUs in Sri Lanka.

What are the perceptions of intensive care staff about their sedation practices when caring for a mechanically ventilated patient?: A systematic mixed-methods review

“…Thirteen studies highlighted variations in many aspects of sedation management. Studies are comprised of one qualitative study from Denmark ( Egerod, 2009 ) and 12 quantitative studies: three from the USA ( Gill et al., 2012 ; Guttormson et al., 2010 ; Tanios et al., 2009 ), two from Norway ( Randen and Bjørk, 2010 ; Woien et al., 2012 ), two from UK ( Freilich and Shaw, 2014 ; Yassin et al., 2015 ) and one each from Belgium ( Borkowska et al., 2018 ), France ( The SRLF Trial, 2013 ), Poland ( Kotfis et al., 2017 ), Brazil ( Salluh et al., 2009 ), and Sri Lanka ( Priyankara et al., 2017 ). Within this theme, there are four subthemes.…”

“…In contrast, a study from the USA, which asked the clinical pharmacist to respond on behalf of the ICU, found that the majority (93%) had a sedation assessment tool in use ( Gill et al., 2012 ). Additional studies from Belgium, the USA, and Norway, found that more than 50% of ICU health care staff reported the use or availability of a sedation tool, and similarly, in the UK, Sri Lanka and France, over 50% of ICUs reported its use ( Borkowska et al., 2018 ; Guttormson et al., 2010 ; Randen and Bjørk, 2010 ; Woien et al., 2012 ; Priyankara et al., 2017 ; The SRLF Trial, 2013 ; Yassin et al., 2015 ). Frequently mentioned sedation tools were the 'Richmond Agitation Sedation Scale', the 'Motor Activity Assessment Score' and several versions of the 'Ramsay Scale'.…”

“…Frequently mentioned sedation tools were the 'Richmond Agitation Sedation Scale', the 'Motor Activity Assessment Score' and several versions of the 'Ramsay Scale'. Varying popularity and predominance of use were found in studies from 7 countries and, in some studies, there was evidence that the type of sedation assessment tool used varied within the same hospital ( Borkowska et al., 2018 ; Gill et al., 2012 ; Guttormson et al., 2010 ; Kotfis et al., 2017 ; Priyankara et al., 2017 ; Randen and Bjørk, 2010 ; The SRLF Trial, 2013 ; Woien et al., 2012 ; Yassin et al., 2015 ). One qualitative study from Denmark reported that a non-sedation specific tool was used (Glasgow Coma Scale), highlighting a further variation in practice ( Egerod, 2009 ).…”

“…Poor implementation of a sedation protocol was reported by the lead intensivist for each sampled ICU in Poland, with only 19.4% of the responding ICUs using one, compared to 64% of participants from a sample of health care professionals in a surveyed USA study ( Kotfis et al., 2017 ; Tanios et al., 2009 ). Few individual participants reported using sedation protocols in the Norwegian surveys, and the lead intensivist of the Sri Lankan study reported that only 2 out of 7 ICUs used a sedation protocol ( Priyankara et al., 2017 ; Randen and Bjørk, 2010 ; Woien et al., 2012 ). In the USA and Belgium, most individual participants reported the implementation of a sedation protocol ( Borkowska et al., 2018 ; Guttormson et al., 2010 ).…”

“…One survey from the UK reported that 91% of its responding ICUs practiced daily interruption of sedation, compared with 10% of responding ICUs in a French survey ( Freilich and Shaw, 2014 ; The SRLF Trial, 2013 ). A wide variety of use was seen in a further nine studies when the prevalence of daily interruption of sedation was assessed ( Borkowska et al., 2018 ; Gill et al., 2012 ; Kotfis et al., 2017 ; Priyankara et al., 2017 ; Randen and Bjørk, 2010 ; Roberts et al., 2010 ; Tanios et al., 2009 ; Woien et al., 2012 ; Yassin et al., 2015 ). A survey in Brazil gathered perceptions on the daily interruption of sedation from participants who worked across several ICUs.…”