Sedatives, analgesics, and paralytics in the ICU

To solicit practitioner-perceived opinions regarding current sedative/analgesic/paralytic practice including drug selection, admixture methods, and methods of assessing patient response to therapy via surgery tool; and to assess sedative/pain/paralytic drug use patterns including dosage, route selection, and combination therapy by collecting actual drug administration data from multiple centers.

Respondents completed a survey and collected drug administration data for 5 consecutive days in the intensive care unit (ICU) in which they practiced.

One hundred thirty-eight members of the Society of Critical Care Medicine Clinical Pharmacology and Pharmacy section and the Critical Care Practice Research Network of the American College of Clinical Pharmacy agreed to participate in the study.

Fifty-one percent of the participants completed surveys, and 45% returned drug administration data collection forms. Patients received sedative/pain/paralytic therapy 62% of the 5 days studied. The most frequently received drugs were opiates, followed by benzodiazepines. Intermittent intravenous injection, oral/enteral, and continuous infusion methods were used in most patients. Combination therapy was used 25% of the time, with benzodiazepine/opiate combinations used most often (46%). Administration protocols were rarely used. Paralytic agents were occasionally administered without sedative/pain therapy.

Patients received these agents during the majority of their ICU stay. Multicenter drug use data suggested a preference for opiate and benzodiazepine therapy. Many centers used continuous infusion therapy despite minimal pharmacokinetic/pharmacodynamic information on ICU patients. Further studies are needed to standardize end points, as well as obtain both pharmacokinetic/pharmacodynamic and stability data in ICU patients.