Recall of intensive care unit stay in patients managed with a sedation protocol or a sedation protocol with daily sedative interruption: A pilot study

Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1X5.
Journal of critical care (Impact Factor: 2). 10/2010; 26(2):127-32. DOI: 10.1016/j.jcrc.2010.08.003
Source: PubMed


Analgesics and sedatives are integral for the relief of pain and anxiety in critically ill patients. However, these agents may contribute to amnesia for intensive care unit (ICU) events; which has been associated with development of posttraumatic stress disorder. Drug administration strategies that minimize sedative use have been associated with less amnesia. The objective of this pilot study was to evaluate recall of ICU stay in patients managed with 2 sedation strategies: a sedation protocol or a combination of sedation protocol and daily sedative/analgesic interruption.
A questionnaire was administered on day 3 following ICU discharge to evaluate patients' recollections of pain, anxiety, fear, and sleep, as well as memories for specific ICU procedures. Participants were ICU survivors who had been enrolled in SLEAP - a randomized pilot trial comparing two sedation strategies, at 3 university-affiliated medical/surgical ICUs.
Twenty-one patients who regained orientation within 72 hours of ICU discharge completed the questionnaire. More than 50% of patients recalled experiencing pain, anxiety, and fear to a moderate or extreme extent; and 57% reported inadequate sleep while in the ICU. Of the 21 patients, 48%, 33%, and 29% had no memories of endotracheal tube suctioning, being on a "breathing machine," and being bathed, respectively.
A notable percentage of patients discharged from the ICU report moderate to extreme pain, anxiety, and fear, and inability to sleep during their ICU stay; and 29% to 48% have no recall of specific ICU events.

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    • "Standard protocols for systematic pain and sedation assessment and treatment are associated with improved quality and outcomes (Girard et al., 2008; Jacobi et al., 2002). Despite this, studies show that the recommendations suggested are still not implemented (Ethier et al., 2011; Martin et al., 2007; Mehta et al., 2009). Fewer than 50% of patients treated with analgesics and sedatives were systematically assessed in a French multi-centre study (Payen et al., 2009). "
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