BACKGROUND: With drug shortages, newer sedative medications, and updates in 
research, management of sedation and delirium in patients receiving mechanical 
ventilation continues to evolve.
OBJECTIVE: To compare perceived and actual sedation practices for adults 
receiving mechanical ventilation in intensive care units (ICUs).
METHODS: This was a multicenter, 2-part study conducted in adult ICUs in US 
hospitals. It included a sedation practice survey completed by ICU pharmacists 
and an observational study evaluating actual sedation practices over a 24-hour 
period.
RESULTS: Surveys were completed for 85 ICUs; observational data for 496 patients 
were collected. Preferred sedatives from the survey data were propofol 
(short-term); propofol, midazolam, or lorazepam (intermediate); and lorazepam 
(long-term). Propofol was the most commonly used agent overall during the 
observational period (primarily for short-term and intermediate-length 
sedation); midazolam was the most commonly used for long-term sedation. Fentanyl 
was the preferred analgesic, and haloperidol and quetiapine were the preferred 
antipsychotics. Sedation treatment algorithms were used in only 50% of observed 
ICUs. Use of daily interruption of sedation was perceived to be 66% but was only 
observed in 36% of patients. Monitoring for delirium was reported among 25% of 
those surveyed but was observed in only 10% of patients. Targeted sedation goals 
were most frequently achieved when a treatment algorithm was used or when an 
opiate infusion was the single agent used for sedative management.
CONCLUSIONS: These data suggest differences in perceived and actual sedation 
practice in the US, as well as underutilization of evidence-based interventions. 
Most notable was the limited use of sedation treatment algorithms, daily 
interruption of sedation, and monitoring for delirium. Individual sedation and 
delirium protocols should be evaluated and updated based on evidence-based 
recommendations.