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Background <p>The administration of sedatives and analgesics in intensive care units (ICUs) has evolved significantly over the past 20&#xa0;years, shifting from deep to light sedation strategies to minimize adverse effects. Despite this shift, substantial variability persists in sedation-analgesia practices. This study aimed to provide an updated national overview of sedation-analgesia management with a focus on discomfort assessment practices, including pain, delirium, anxiety, thirst, mood, and sleep disorders.</p> Methods <p>This was a one-day, multicenter, cross-sectional study conducted in French ICUs. Data were collected from all adult patients hospitalized in the ICU on the study day. A Unit-level survey documented ICU characteristics and sedation-analgesia protocols. Patient-level data included sedation levels, pain scores, and assessments of discomfort conditions. Statistical analyses were performed using descriptive methods and multilevel logistic regression.</p> Results <p>Among 258 French ICUs contacted, 128 units (50%) participated, enrolling 2,063 patients. Most ICUs were university-affiliated (54%) and mixed medical-surgical (58%); 63% had a written protocol for sedation-analgesia. Sedation and pain were assessed in 96% and 91% of ICUs, respectively. Light or no sedation was observed in 84% of patients, while 15% were deeply sedated – 63% of whom were misaligned with usual indications. Pain assessment was performed at rest in 90% of patients and during care in 62%. Pain prevalence increased with lighter sedation levels and during care. Hypnotics were used in 31% of patients, Mainly propofol and midazolam. Discomfort was reported in 44% of patients, mainly anxiety, sleep disorders, and thirst. Written protocols for sedation and analgesia were not associated with sedation depth, drug use, or delirium screening, but were linked to more frequent pain assessment at rest. Multivariable analyses showed that higher SOFA scores were associated with deep or misaligned deep sedation. The presence of a written protocol for sedation and analgesia reduced the risk of unassessed pain but was not associated with deep or misaligned deep sedation.</p> Conclusion <p>The shift toward lighter sedation has been successfully achieved; however, a broad spectrum of stressful symptoms persists, including pain, anxiety, thirst, and sleep disruption. These findings underscore the need for more effective strategies to optimize pain and overall patient comfort in non-deeply sedated ICU patients.</p>

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Epidemiology of pain, delirium, psychiatric disorders, discomfort and sedation-analgesia management in the intensive care unit: a one-day nationwide study

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  • 发表日期：

    2025年11月11日

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  • Florian Blanchard,
  • Angelina Barage,
  • Belaïd Bouhemad,
  • Camille Miard,
  • Isaure Breteau,
  • Frédéric Martino,
  • Matthieu Biais,
  • Paul-Henri Wicky,
  • Pauline Perez,
  • Bernard Allaouchiche,
  • Christophe Huz,
  • Vincent Susset,
  • Samir Jaber,
  • Vincent Legros,
  • Sigismond Lasocki,
  • Aurore Rodrigues,
  • Marwan Bouras,
  • Charles-Edouard Luyt,
  • Maxime Beilvert,
  • Mouhamed Djahoum Moussa,
  • Clément Devautour,
  • Fanny Vardon,
  • Arthur James,
  • Gerald Chanques,
  • Jean-Michel Constantin,
  • Olivier Baldesi,
  • Bruno Marquer,
  • Christophe Henry,
  • Younes Ait Tamlihat,
  • Soizic Gergaud,
  • Emmanuel Rineau,
  • Etienne Escudier,
  • Albrice Levrat,
  • Marie-Helene Hausermann,
  • Emanuele Turbil,
  • Yannick Brunin,
  • Sebastien Pili-Floury,
  • Gael Piton,
  • Thibault Vieille,
  • Favier Laurent,
  • Marion Monnin,
  • Thibault Camozzi,
  • Julien Grouille,
  • Yves Cohen,
  • Guillaume Van Der Meersch,
  • Antoine Dewitte,
  • Floriane Hilaire,
  • Jordan Leray,
  • Guillaume Brunin,
  • Anne-Laure Frachea,
  • Philippe Aries,
  • Sylvain Gourier,
  • Nicolas Herzog,
  • Olivier Langeron,
  • Nicolas Pichon,
  • Carreira Serge,
  • Léo Souletie,
  • Clement Gakuba,
  • Jean-Luc Hanouz,
  • Benoit Savary,
  • Karim Chaoui,
  • Camille Foucault,
  • Johanna Rayar,
  • Michel Badet,
  • David Sauvajon,
  • Juliette Audibert,
  • Abdelkader Ouchenir,
  • Stephane Charre,
  • Isabelle Desmeulles,
  • Anne-Astrid Bourion,
  • Anthony Le Meur,
  • Mathieu Boutonnet,
  • Olivier Duranteau,
  • Clément Hoffmann,
  • Donat Nicolas,
  • Sophie Cayot,
  • Russell Chabanne,
  • Vedat Eljezi,
  • Emmanuel Futier,
  • Alexandre Lautrette,
  • Bertrand Souwein,
  • Thierry Gillart,
  • Guillaume Chevrel,
  • Sébastien Clerc,
  • Nicolas Mongardon,
  • Adrien Auvet,
  • Jean-Philippe Rigaud,
  • Antoine Marchalot,
  • Belaid Bouhemad,
  • Maxime Nguyen,
  • Benjamin Kowalski,
  • Capucine Martinet,
  • Julien Duvivier,
  • Andres Jurado,
  • Florent Bavozet,
  • Aude Garin,
  • Caroline Blazejewski,
  • Caroline Varillon,
  • Evelina Ochin,
  • Kawtar Rghioui,
  • Djillali Annane,
  • Nicholas Heming,
  • Roland Amathieu,
  • Elodie Piquet,
  • Rezk Tounsi,
  • Alexandre Behouche,
  • Géraldine Dessertaine,
  • Asaël Berger,
  • Jean Kempf,
  • Marie Anne Hoppe,
  • Quentin Levrat,
  • Fabrice Bruneel,
  • Laura Gouzien,
  • Jacques Duranteau,
  • Stéphan Francois,
  • Thibaut Genty,
  • Marc Valette,
  • Benoit Brassard,
  • Jacques Desbordes,
  • Céline Dupre,
  • Mounir Soufane,
  • Benoit Tavernier,
  • Victor Verbrackel,
  • Marie Verdin,
  • Pierre Bouju,
  • Guillaume Grillet,
  • Céline Guichon,
  • Anne-Claire Lukaszewicz,
  • Mehdi Mezidi,
  • Jean-Christophe Richard,
  • Jean Ruiz,
  • Emmanuel Vivier,
  • Antoine Bianchi,
  • Bénédicte Grigoresco,
  • Marc Leone,
  • Pierre Simeone,
  • Lionel Velly,
  • Mehran Monchi,
  • Cyril Cadoz,
  • Sebastien Gette,
  • Mathieu Schoeffler,
  • Chanques Gerald,
  • Boris Jung,
  • Klouche Kada,
  • Vincent Das,
  • Anne-Florence Dureau,
  • Levy Bruno,
  • Mickael Lescroart,
  • Karim Asehnoune,
  • Karim Lakhal,
  • Bertrand Rozec,
  • Florence Fagot-Gandet,
  • Remi Plattier,
  • Michaël Mervant,
  • Emmanuel Couadau,
  • Monsel Antoine,
  • Enora Atchade,
  • Adrein Bougle,
  • Bernard Cholley,
  • Benjamin Chousterman,
  • Alain Combes,
  • Maxens Decavèle,
  • Vincent Degos,
  • Alexandre Demoule,
  • Cyrielle Desnos,
  • Clement Devautour,
  • Murielle Fartoukh,
  • Eva Fonsèque,
  • Alexandra Gannac,
  • Axel Hirwe,
  • Benjamin Huot,
  • Alice Jacquens,
  • Jean-Paul Mira,
  • Natacha Kapandji,
  • Desmard Mathieu,
  • Phillipe Montravers,
  • Benoit Plaud,
  • Thomas Rambaud,
  • Magali Savalle,
  • Alexandre Sitbon,
  • Demeret Sophie,
  • Pierre Trouiller,
  • Franck Verdonk,
  • Laure Baudouin,
  • Ouarda Krid,
  • Denis Frasca,
  • Quentin Saint-Genis,
  • Arnaud Thille,
  • Aguila Radjou,
  • Salvatore Muccio,
  • Pascal Beuret,
  • Veber Benoit,
  • Emmanuel Besnier,
  • Thomas Clavier,
  • Vincent Compère,
  • Pauline Garel,
  • Philippe Gouin,
  • Fabienne Tamion,
  • Maximilien Urli,
  • Tifany Vatignez,
  • Gregoire Trebbia,
  • Daniel Da Silva,
  • Pierre Jaquet,
  • Maxime Medjani,
  • Jérome Morel,
  • Jerome Hoff,
  • Julien Lorber,
  • Laurène Blum,
  • Arnaud Desvergez,
  • Olivier Collange,
  • Paul-Michel Mertes,
  • Jonathan Chelly,
  • Laurent Ducros,
  • Guillaume Ducos,
  • Anna Gaubert,
  • Beatrice Riu,
  • Seguin Thierry,
  • Minville Vincent,
  • Marjorie Brottier,
  • Hugues Georges,
  • Remerand Francis,
  • Marc Laffon,
  • Georges Simon,
  • Agathe Delbove,
  • Yannick Fedun,
  • Mélissa Crotet,
  • Bérengère Vivet,
  • Loïc Dopeux,
  • Ravan Ramin,
  • Julien Gaubert-Duclos,
  • Ariane Gentile Bressan

摘要

Background

The administration of sedatives and analgesics in intensive care units (ICUs) has evolved significantly over the past 20 years, shifting from deep to light sedation strategies to minimize adverse effects. Despite this shift, substantial variability persists in sedation-analgesia practices. This study aimed to provide an updated national overview of sedation-analgesia management with a focus on discomfort assessment practices, including pain, delirium, anxiety, thirst, mood, and sleep disorders.

Methods

This was a one-day, multicenter, cross-sectional study conducted in French ICUs. Data were collected from all adult patients hospitalized in the ICU on the study day. A Unit-level survey documented ICU characteristics and sedation-analgesia protocols. Patient-level data included sedation levels, pain scores, and assessments of discomfort conditions. Statistical analyses were performed using descriptive methods and multilevel logistic regression.

Results

Among 258 French ICUs contacted, 128 units (50%) participated, enrolling 2,063 patients. Most ICUs were university-affiliated (54%) and mixed medical-surgical (58%); 63% had a written protocol for sedation-analgesia. Sedation and pain were assessed in 96% and 91% of ICUs, respectively. Light or no sedation was observed in 84% of patients, while 15% were deeply sedated – 63% of whom were misaligned with usual indications. Pain assessment was performed at rest in 90% of patients and during care in 62%. Pain prevalence increased with lighter sedation levels and during care. Hypnotics were used in 31% of patients, Mainly propofol and midazolam. Discomfort was reported in 44% of patients, mainly anxiety, sleep disorders, and thirst. Written protocols for sedation and analgesia were not associated with sedation depth, drug use, or delirium screening, but were linked to more frequent pain assessment at rest. Multivariable analyses showed that higher SOFA scores were associated with deep or misaligned deep sedation. The presence of a written protocol for sedation and analgesia reduced the risk of unassessed pain but was not associated with deep or misaligned deep sedation.

Conclusion

The shift toward lighter sedation has been successfully achieved; however, a broad spectrum of stressful symptoms persists, including pain, anxiety, thirst, and sleep disruption. These findings underscore the need for more effective strategies to optimize pain and overall patient comfort in non-deeply sedated ICU patients.