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.
Highlights
Sedation plays a key role in the management of critically ill patients in the intensive care units(ICUs)
Materials and methods A tick-box questionnaire was used in the survey. This questionnaire was distributed to the medical officer-in-charge of all intensive care units at National Hospital of Sri Lanka (NHSL)
Data were obtained from the 7 Intensive care units at NHSL namely medical, surgical, cardiothoracic, neurosurgical, neurology, trauma and cardiology
Summary
Sedation plays a key role in the management of critically ill patients in the intensive care units(ICUs). The optimum doses of sedatives and analgesics are best judged by regular assessment of the patient to identify the needs. This is best achieved by adopting sedation scales with a scoring system. There are established guidelines for the management of sedation in ICUs. Despite the existence of these guidelines, there is a wide variability in sedation practices worldwide.[10,11] There are no data on the current sedation practices of ICUs in Sri Lanka.
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