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Practices in sedation, analgesia, mobilization, delirium, and sleep deprivation in adult intensive care units (SAMDS-ICU): an international survey before and during the COVID-19 pandemic

  • Luz, Mariana1, 2, 3
  • Brandão Barreto, Bruna1, 2
  • de Castro, Roberta Esteves Vieira4
  • Salluh, Jorge5, 6
  • Dal-Pizzol, Felipe7
  • Araujo, Caio8
  • De Jong, Audrey9
  • Chanques, Gérald9
  • Myatra, Sheila Nainan10
  • Tobar, Eduardo11
  • Gimenez-Esparza Vich, Carolina12
  • Carini, Federico13
  • Ely, Eugene Wesley14, 15, 14, 16, 14
  • Stollings, Joanna L.14, 14
  • Drumright, Kelly17
  • Kress, John18
  • Povoa, Pedro19, 20, 21
  • Shehabi, Yahya22
  • Mphandi, Wilson23
  • Gusmao-Flores, Dimitri1, 2
  • 1 Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, CEP: 40411-900, Brazil , Salvador (Brazil)
  • 2 Universidade Federal da Bahia, Salvador, Bahia, Brazil , Salvador (Brazil)
  • 3 Hospital Universitário Professor Edgard Santos, Salvador, Brazil , Salvador (Brazil)
  • 4 Hospital Universitário Pedro Ernesto, Universidade Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil , Rio de Janeiro (Brazil)
  • 5 D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil , Rio de Janeiro (Brazil)
  • 6 Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil , Rio de Janeiro (Brazil)
  • 7 Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil , Criciúma (Brazil)
  • 8 Universidade Federal da Bahia, Salvador, BA, Brazil , Salvador (Brazil)
  • 9 Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, Montpellier, CEDEX 5, 9214, France , Montpellier, CEDEX 5 (France)
  • 10 Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India , Mumbai (India)
  • 11 Hospital Clínico Universidad de Chile, Santiago, Chile , Santiago (Chile)
  • 12 Vega Baja Orihuela Hospital, Alicante, Spain , Alicante (Spain)
  • 13 Hospital Italiano de Buenos Aires, Buenos Aires, Argentina , Buenos Aires (Argentina)
  • 14 Vanderbilt University Medical Center, Nashville, TN, USA , Nashville (United States)
  • 15 Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA , Nashville (United States)
  • 16 Tennessee Valley Healthcare System, Nashville, TN, USA , Nashville (United States)
  • 17 Tennessee Valley Healthcare System VA Medical Center, Nashville, TN, USA , Nashville (United States)
  • 18 University of Chicago, Chicago, IL, USA , Chicago (United States)
  • 19 Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal , Lisbon (Portugal)
  • 20 CHRC, CEDOC, NOVA Medical School, New University of Lisbon, Lisbon, Portugal , Lisbon (Portugal)
  • 21 OUH Odense University Hospital, Odense, Denmark , Odense (Denmark)
  • 22 Monash University, Melbourne, VIC, Australia , Melbourne (Australia)
  • 23 Hospital Américo Boavida, Luanda, Angola , Luanda (Angola)
Published Article
Annals of Intensive Care
Springer (Biomed Central Ltd.)
Publication Date
Feb 04, 2022
DOI: 10.1186/s13613-022-00985-y
Springer Nature
  • Research


BackgroundSince the publication of the 2018 Clinical Guidelines about sedation, analgesia, delirium, mobilization, and sleep deprivation in critically ill patients, no evaluation and adequacy assessment of these recommendations were studied in an international context. This survey aimed to investigate these current practices and if the COVID-19 pandemic has changed them.MethodsThis study was an open multinational electronic survey directed to physicians working in adult intensive care units (ICUs), which was performed in two steps: before and during the COVID-19 pandemic.ResultsWe analyzed 1768 questionnaires and 1539 (87%) were complete. Before the COVID-19 pandemic, we received 1476 questionnaires and 292 were submitted later. The following practices were observed before the pandemic: the Visual Analog Scale (VAS) (61.5%), the Behavioral Pain Scale (BPS) (48.2%), the Richmond Agitation Sedation Scale (RASS) (76.6%), and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (66.6%) were the most frequently tools used to assess pain, sedation level, and delirium, respectively; midazolam and fentanyl were the most frequently used drugs for inducing sedation and analgesia (84.8% and 78.3%, respectively), whereas haloperidol (68.8%) and atypical antipsychotics (69.4%) were the most prescribed drugs for delirium treatment; some physicians regularly prescribed drugs to induce sleep (19.1%) or ordered mechanical restraints as part of their routine (6.2%) for patients on mechanical ventilation; non-pharmacological strategies were frequently applied for pain, delirium, and sleep deprivation management. During the COVID-19 pandemic, the intensive care specialty was independently associated with best practices. Moreover, the mechanical ventilation rate was higher, patients received sedation more often (94% versus 86.1%, p < 0.001) and sedation goals were discussed more frequently in daily rounds. Morphine was the main drug used for analgesia (77.2%), and some sedative drugs, such as midazolam, propofol, ketamine and quetiapine, were used more frequently.ConclusionsMost sedation, analgesia and delirium practices were comparable before and during the COVID-19 pandemic. During the pandemic, the intensive care specialty was a variable that was independently associated with the best practices. Although many findings are in accordance with evidence-based recommendations, some practices still need improvement.

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