AnesthesiologyApr 7, 2007

Current sedation and pain relief methods for critically ill patients on mechanical ventilators: a multicenter patient study

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Updated Mar 29, 2026

Abstract

In a study of 1,381 mechanically ventilated patients, only 43% received sedation assessment and 42% received analgesia assessment on day 2 of their ICU stay, despite 72% and 90% receiving sedatives and opioids, respectively.

Assessment rates for sedation and analgesia were significantly lower than the rates of sedative and opioid use.
The implementation of protocols for sedation and analgesia was associated with a reduced proportion of treated patients who were not evaluated.
A significant number of patients were found to be in a deep state of sedation, ranging from 40-50%.
Dosages for primary sedatives and analgesics showed minor changes over the six-day ICU stay.
Less than 25% of patients had their procedural pain managed, with pain levels significantly increasing during procedures compared to baseline.

Simplified

BACKGROUND: The authors conducted a patient-based survey of practices to fully describe the assessment and the management of pain and sedation of a large cohort of mechanically ventilated patients during their first week of intensive care unit (ICU) stay.

METHODS: A total of 1,381 adult patients were included in a prospective, observational study in 44 ICUs in France. Pain and sedation assessment, analgesic and sedative use, and analgesic management during procedural pain were collected on days 2, 4, and 6 of the ICU stay.

RESULTS: The observed rates of assessment on day 2 for sedation (43%) and analgesia (42%) were significantly smaller than that of use of sedatives (72%) and opioids (90%), also noted on days 4 and 6. The use of protocols/guidelines for sedation/analgesia in the ICU reduced the proportion of patients who were treated, although not evaluated. A large proportion of assessed patients were in a deep state of sedation (40-50%). Minor changes in the dosages of the main prescribed agents for sedation (midazolam, propofol) and analgesia (sufentanil, fentanyl, morphine, remifentanil) were found across 6 days of the patient's ICU stay. Procedural pain was specifically managed for less than 25% of patients; during those procedures, the proportion of patients with pain significantly increased from the baseline pain evaluation.

CONCLUSIONS: Excessively deep states of sedation and a lack of analgesia during painful procedures must be prevented. To facilitate systematic pain and sedation assessment and to adjust daily drug dosages accordingly, it seems crucial to promote educational programs and elaboration of protocols/guidelines in the ICU.

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Current sedation and pain relief methods for critically ill patients on mechanical ventilators: a multicenter patient study

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