Sedation practice in Nordic and non-Nordic ICUs: A European survey

Background and aims: A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries. Design and methods: A cross-sectional survey of ICU nurses attending the fourth European federation of Critical Care Nursing associations (EfCCNa) in Denmark, 2011. Data included use of protocols; sedation, pain and delirium assessment tools; collaborative decision-making; sedation and analgesic medications; and educational preparation related to sedation. Results: Response rate was 42% (n=291) from 22 countries where 53% (n=148) used sedation protocols. Nordic nurses reported greater use of sedation (91% versus 67%, p<0·01) and pain (91% versus 69%, p<0·01) assessment tools than non-Nordic nurses. Decision-making on sedation was more inter-professionally collaborative in Nordic ICUs (83% versus 61%, p<0·01), units were smaller (10 versus 15 beds, p<0·01) and nurse-patient ratio was higher (1:1, 75% versus 26%, p<0·01). Nordic nurses reported greater consistency in maintaining circadian rhythm (66% versus 49%, p<0·01), less use of physical restraints (14% versus 36%, p<0·01), less use of neuromuscular blocking agents (3% versus 16%, p<0·01), and received more sedation education (92% versus 76%, p<0·01). Delirium assessment was not performed systematically in most settings. Conclusions: Organizational and contextual factors, such as ICU size, staffing ratio and inter-professional collaboration, are contributing factors to sedation management in European ICUs. The Nordic context might be more germane to the goal of lighter sedation and better pain management. Relevance to clinical practice: Our study raises awareness of current sedation practice, paving the way towards optimized ICU sedation management.