Perceived barriers to the use of sedation protocols and daily sedation interruption: a multidisciplinary survey

J Crit Care. 2009 Mar;24(1):66-73. doi: 10.1016/j.jcrc.2008.03.037. Epub 2008 Jun 30.


Background: Although use of sedation protocols and daily sedation interruption (DSI) improve outcome, their current use and barriers affecting their use are unclear.

Methods: We designed a multidisciplinary, Web-based survey to determine current use of sedation protocols and DSI and the perceived barriers to each, and administered it to members of the Society of Critical Care Medicine.

Results: The 904 responders were physicians (60%), nurses (14%), or pharmacists (12%); 45% worked in a university hospital. Of 64% having a sedation protocol, 78% used it for >or=50% of ventilated patients. Reasons for lack of protocol use included no physician order (35%), lack of nursing support (11%), and a fear of oversedation (7%). Daily sedation interruption was used by only 40%. Barriers to DSI included lack of nursing acceptance (22%), concern about risk of patient-initiated device removal (19%), and inducement of either respiratory compromise (26%) or patient discomfort (13%). Clinicians who prefer propofol were more likely to use DSI than those who prefer benzodiazepines (55% vs 40, P < .0001).

Conclusions: Current intensive care unit sedation practices are heterogeneous, and the barriers preventing the use of both sedation protocols and DSI are numerous. These barriers should be addressed on an institutional basis to boost the use of these evidence-based practices.

MeSH terms

  • Attitude of Health Personnel*
  • Clinical Protocols*
  • Conscious Sedation / adverse effects
  • Conscious Sedation / methods*
  • Conscious Sedation / nursing
  • Conscious Sedation / statistics & numerical data
  • Critical Care* / methods
  • Critical Care* / statistics & numerical data
  • Diffusion of Innovation
  • Evidence-Based Practice
  • Guideline Adherence / statistics & numerical data*
  • Health Knowledge, Attitudes, Practice
  • Health Services Needs and Demand
  • Humans
  • Medical Staff, Hospital / education
  • Medical Staff, Hospital / psychology
  • Nursing Staff, Hospital / education
  • Nursing Staff, Hospital / psychology
  • Patient Care Team
  • Patient Selection
  • Pharmacists / psychology
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Respiration, Artificial
  • Safety
  • Surveys and Questionnaires
  • United States