The management of pain in the intensive care unit

The techniques used to sedate ventilated patients. A survey of methods used in 34 ICUs in Great Britain

A survey of sedation techniques for ventilated patients was performed by visiting 34 Intensive Care Units in Great Britain and Northern Ireland. The opiates in frequent used were phenoperidine (21 units - 62% of units), papaveretum (11 - 32%) and morphine (9-26%). Many units used more than one opiate. Levorphanol, buprenorphine, pethidine, fentanyl and codeine were little used. Frequent use of diazepam was found in 22 units (64%), of lorazepam in 11 (32%) and of Althesin in four (12%). Other sedative drugs, droperidol, chlormethiazole, chlorpromazine and ketamine were sued on an occasional basis. Continuous sedation using nitrous oxide was employed in nine (26%) of units-for more than 24 h in six (18%). All units used pancuronium - 31 (91%) used in frequently. Curare was in frequent use in five units (15%). There was wide variation in the way in which the drugs were used. A compromise between the ideal and the practicable method was common, depending more upon shortage of trained nursing staff than upon lack of funds for equipment or expensive drugs. The depth of sedation thought to be ideal depended on the state of the patient as well as the usual practice in the ICU - however a majority (23 = 67%) of units aimed to keep most patients well sedated and detached from the ICU environment. The use of very large doses of opiate to obtain the stress response was thought helpful in only six units (18%) and then in a minority of patients.