Critical Care and Shock

A national point-prevalence survey of the practice of sedation, analgesia, neuromuscular blockade and delirium assessment in adult intensive care units in Singapore

Abstract

Introduction: The aim of this survey is to establish current practices of sedation, analgesia, neuromuscular-blockade use and delirium assessment in adult ICUs in Singapore.

Methods: All adult ICUs from the government-restructured hospitals were invited to participate in a point-prevalence survey on the 30th October 2008, under the direction of the Society of Intensive Care Medicine’s National Investigators for Clinical Epidemiology and Research. Data collected for all adult ICU inpatients included demographics, practices on sedation, analgesia and neuromuscular blockade as well as delirium assessment and management.

Results: There were 93 patients from 11 ICUs. The mean age was 61.2 years with a predominance of Chinese (76.3%) and a slight male predominance of 57.0%. Sedation was administered in 25.8% of the patients with the use of sedation scales in 75.0%. Only 20.8% of the sedated patients were on a sedation protocol. The majority of patients had daily interruption of sedation. Analgesia assessment was done in most patients (78.5%) with the use of analgesia scales. Analgesia was used in approximately one third of patients. Only 2 patients were on neuromuscular blockade. There was no usage of any formal delirium assessment tools at all with almost one third of patients being physically restrained.

Conclusions: This national multi-centre study reveals several deficits in the adult ICU with regards to sedation and delirium assessment and management. Several initiatives should be implemented to improve patients’ safety and quality of care in the ICU.