Table 3.
Strategies used to assess and treat agitation and pain
| Total, % ( n ) a | Physicians, % ( n ) b | Nurses, % ( n ) c | |
|---|---|---|---|
| Availability of a written analgo-sedation protocol (= Yes) | 31 (281) | 41 (131) | 26 (150) |
| Frequency of use of analgo-sedation protocolsd | |||
| Never | 6 (16) | 3 (4) | 8 (12) |
| <1×/day | 27 (76) | 21 (27) | 33 (49) |
| 1×/day | 28 (80) | 40 (53) | 18 (27) |
| >1×/day | 38 (107) | 36 (47) | 40 (60) |
| Availability of a sedation scale (= Yes) | 86 (773) | 82 (265) | 88 (508) |
| Type of sedation scales usede | |||
| RASS | 20 (152) | 24 (64) | 17 (88) |
| SAS | 13 (102) | 13 (34) | 13 (68) |
| MAAS | 1 (7) | 2 (6) | 0 (1) |
| Ramsay sedation scale | 64 (491) | 69 (184) | 60 (307) |
| GCS | 59 (456) | 54 (142) | 62 (314) |
| Other sedation scalef | 13 (103) | 9 (24) | 16 (79) |
| Frequency of use of sedation scales on a given patient per daye | |||
| Never used, irregularly used, <1×/day | 8 (59) | 8 (21) | 7 (38) |
| 1 to 2×/day | 9 (67) | 14 (38) | 6 (29) |
| 3 to 5×/day | 36 (276) | 46 (122) | 30 (154) |
| 6 to 11×/day | 30 (233) | 26 (68) | 32 (165) |
| 12×/day | 13 (98) | 3 (7) | 18 (91) |
| > 12×/day | 4 (29) | 2 (5) | 5 (24) |
| Other | 0 (2) | 0 (1) | 0 (1) |
| Reported indications for using sedation scales | |||
| To assess the level of sedation | 93 (839) | 90 (291) | 95 (548) |
| To adjust dosage of sedatives | 73 (657) | 77 (249) | 71 (408) |
| To assess the level of pain | 37 (333) | 43 (139) | 34 (194) |
| To adjust dosage of analgesics | 33 (299) | 38 (123) | 31 (176) |
| Use of daily sedation interruption | |||
| Never | 31 (282) | 22 (70) | 37 (212) |
| Used in <25% of the patients | 44 (393) | 38 (122) | 47 (271) |
| Used in 25 to 75% of the patients | 17 (149) | 25 (80) | 12 (69) |
| Used in >75% of the patients | 5 (45) | 9 (28) | 3 (17) |
| Opiates are stopped during daily sedation interruption (= Yes)g | 40 (249) | 34 (85) | 45 (164) |
| Assessment of analgesia in patients unable to self-report | |||
| No assessment | 7 (59) | 4 (12) | 8 (47) |
| Through physiological parameters | 88 (787) | 80 (257) | 92 (530) |
| Through behavior | 85 (765) | 81 (263) | 87 (502) |
| During daily sedation interruption | 42 (373) | 47 (151) | 39 (222) |
| Post-analgesia | 55 (492) | 46 (150) | 59 (342) |
| BPS | 9 (84) | 10 (32) | 9 (52) |
| CPOT scale | 2 (18) | 2 (6) | 2 (12) |
| Other pain scaleh | 19 (172) | 9 (30) | 25 (142) |
ATICE, Adaptation to the Intensive Care Environment, BPS, Behavioral Pain Scale; CPOT, Critical Care Pain Observation Tool; GCS, Glasgow Coma Scale; MAAS, Motor Activity Assessment scale; RASS, Richmond Agitation and Sedation Scale; SAS, Sedation Agitation Scale. aNumber does not total 898 because not all respondents answered each item. bNumber does not total 323 because not all respondents answered each item. cNumber does not total 575 because not all respondents answered each item. dNumber totals only those with an analgo-sedation protocol available. eNumber includes only those with a sedation scale available within their unit. Some respondents have indicated the use of more than one scale. fRespondents were asked to indicate any other scale used (for example: ATICE, 1% (7); Bloomsbury, 2% (14); Brussels, 2% (18)). gNumber totals only those using daily sedation interruption. hRespondents were asked to indicate any other scale used (for example: ATICE, 1% (7); DOLO-USI, 13% (113); Visual Analogic Scale, 14% (119)).