BACKGROUND: Analgesia and sedation are key items in intensive care. Recently 
published S3 guidelines specifically address treatment of patients with elevated 
intracranial pressure.
METHODS: The Austrian Society of Anesthesiology, Resuscitation and Intensive 
Care Medicine carried out an online survey of neurointensive care units in 
Austria in order to evaluate the current state of practice in the areas of 
analgosedation and delirium management in this high-risk patient group.
RESULTS: The response rate was 88%. Induction of anesthesia in patients with 
elevated intracranial pressure is carried out with propofol/fentanyl/rocuronium 
in >80% of the intensive care units (ICU), 60% use midazolam, 33.3% use 
esketamine, 13.3% use barbiturates and 6.7% use etomidate. For maintenance of 
analgosedation up to 72 h, propofol is used by 80% of the ICUs, followed by 
remifentanil (46.7%), sufentanil (40%) and fentanyl (6.7%). For long-term 
sedation, 86.7% of ICUs use midazolam, 73.3% sufentanil and 73.3% esketamine. 
For sedation periods longer than 7 days, 21.4% of ICUs use propofol. Reasons for 
discontinuing propofol are signs of rhabdomyolysis (92.9%), green urine, 
elevated liver enzymes (71.4% each) and elevated triglycerides (57.1%). Muscle 
relaxants are only used during invasive procedures. Inducing a barbiturate coma 
is rated as a last resort by 53.3% of respondents. The monitoring methods used 
are bispectral index (BIS™, 61.5% of ICUs), somatosensory-evoked potentials 
(SSEP, 53.8%), processed electroencephalography (EEG, 38.5%), intraparenchymal 
partial pressure of oxygen (pO2, 38.5%) and microdialysis (23.1%). Sedation and 
analgesia are scored using the Richmond agitation and sedation score (RASS, 
86.7%), sedation agitation scale (SAS, 6.7%) or numeric rating scale (NRS, 50%) 
and behavioral pain scale (BPS, 42.9%), visual analogue scale (VAS), critical 
care pain observation tool (CCPOT, each 14.3%) and verbal rating scale (VRS, 
7.1%). Delirium monitoring is done using the confusion assessment method for 
intensive care units (CAM-ICU, 46.2%) and intensive care delirium screening 
checklist (ICDSC, 7.7%). Of the ICUs 46.2% do not carry out delirium monitoring.
CONCLUSION: We found good general compliance with the recommendations of the 
current S3 guidelines. Room for improvement exists in monitoring and the use of 
scores to detect delirium.