Abstract
BackgroundThe present study was designed to (1) establish current sedation practice in UK critical care to inform evidence synthesis and potential future primary research and (2) to compare practice reported via a survey with actual practice assessed in a point prevalence study (PPS).MethodsUK adult general critical care units were invited to participate in a survey of current sedation practice, and a representative sample of units was invited to participate in a PPS of sedation practice at the patient level. Survey responses were compared with PPS data where both were available.ResultsSurvey responses were received from 214 (91 %) of 235 eligible critical care units. Of these respondents, 57 % reported having a written sedation protocol, 94 % having a policy of daily sedation holds and 94 % using a sedation scale to assess depth of sedation. In the PPS, across units reporting a policy of daily sedation holds, a median of 50 % (IQR 33–75 %) of sedated patients were considered for a sedation hold. A median of 88 % (IQR 63–100 %) of patients were assessed using the same sedation scale as reported in the survey. Both the survey and the PPS indicated propofol as the preferred sedative and alfentanil, fentanyl and morphine as the preferred analgesics. In most of the PPS units, all patients had received the unit’s reported first-choice sedative (median across units 100 %, IQR 64–100 %), and a median of 80 % (IQR 67–100 %) of patients had received the unit’s reported first-choice analgesic. Most units (83 %) reported in the survey that sedatives are usually administered in combination with analgesics. Across units that participated in the PPS, 69 % of patients had received a combination of agents – most frequently propofol combined with either alfentanil or fentanyl.ConclusionsClinical practice reported in the national survey did not accurately reflect actual clinical practice at the patient level observed in the PPS. Employing a mixed methods approach provided a more complete picture of sedation practice in terms of breadth and depth of information.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1532-x) contains supplementary material, which is available to authorized users.
Highlights
The present study was designed to (1) establish current sedation practice in United Kingdom (UK) critical care to inform evidence synthesis and potential future primary research and (2) to compare practice reported via a survey with actual practice assessed in a point prevalence study (PPS)
National survey National Health Service (NHS) adult general critical care units were identified from databases maintained by Intensive Care National Audit & Research Centre (ICNARC), and the Scottish Intensive Care Society Audit Group [5]
Most (88 %) PPS patients were assessed using the same sedation scale/score reported in the survey; there was some variation across units
Summary
The present study was designed to (1) establish current sedation practice in UK critical care to inform evidence synthesis and potential future primary research and (2) to compare practice reported via a survey with actual practice assessed in a point prevalence study (PPS). Specific objectives were to establish (1) through a survey of all UK adult general critical care units, reported current sedation practice; and (2) through a point prevalence study (PPS) in a representative sample of UK adult general critical care units, the current prevalence of use of sedative agents and regimens. This combination of study designs was selected to give the most complete picture of current practice in terms of both the breadth and the depth of information and to examine reported versus actual clinical practice
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