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Objective To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations. Design A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC. Setting Spanish ICUs in public and private hospitals. Results A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation – the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent. Conclusions This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.

Resumen Objetivo Conocer la practica clinica real de las UCI espanolas en relacion con la analgosedacion y delirium, y valorar como se ajusta a las recomendaciones actuales. Diseno Estudio transversal descriptivo elaborado mediante encuesta nacional sobre practicas de analgosedacion y delirium de los pacientes ingresados en UCI los dias 16 de noviembre de 2013 y 16 de octubre de 2014. Se envio un cuestionario a traves de Internet con el aval de la SEMICYUC. Ambito UCI tanto publicas como privadas de todo el territorio nacional. Resultados Se incluyeron un total de 166 UCI y a 1.567 pacientes. El 61,4% de las UCI contaban con un protocolo de sedacion. El 75% de las UCI monitorizaban la sedacion y agitacion, con RASS como la escala empleada con mayor frecuencia. El dolor se monitorizaba en algo mas de la mitad de las UCI, pero las escalas conductuales eran de muy baja implantacion. El delirium tambien presentaba un bajo nivel diagnostico. Entre los pacientes en ventilacion mecanica el midazolam continuaba siendo un sedante de muy amplio uso. Conclusiones Esta encuesta es la primera realizada en Espana sobre analgosedacion y delirium y nos muestra una fotografia sobre estas practicas, senala algunos aspectos como los relacionados con la monitorizacion y usos de escalas, junto con el manejo del delirium, en los que los resultados del estudio animan a desarrollar proyectos docentes que acerquen la practica clinica real a las recomendaciones nacionales e internacionales.

To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations.A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC.Spanish ICUs in public and private hospitals.A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation - the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent.This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.

The airway management is one of the principal skills that a physician needs to ensure optimal ventilation and oxygenation. In this guideline, Sedation and Analgesia Working Group of SEMICYUC describes rapid sequence intubation (RSI) and induction drugs and neuromuscular blocking agents. RSI is the best procedure to ensure optimal airway management in the majority of critically ill patients. Our choice of one induction drug or another can influence in the success of the airway management. As neuromuscular blocking agents can facilitate intubation, they influence the choice of the drug for intubation and of premedication. To optimize the use of drugs, the knowledge of pharmacodynamics, pharmacokinetics and side effects is imperative. A proper position of the patient is essential to establish an adequate airway management. Direct visualization of glottis and endotracheal tube pass through vocal cords is the best way to confirm the correct position of it. There are different devices to confirm correct position of the endotracheal tube.

Numerous diagnostic techniques require sedation and analgesia in order to be performed in a safe and comfortable way for the patient. Several of the most notable points of interest for the critical care specialist are the electrical cardioversion, the placing of implantable cardiac stimulation devices, the endoscopic techniques and the performing of bedside surgical procedures. In this current revision, the SEMICYUC Task Force for Sedation and Analgesia describes recommendations and best practices for administering sedation and analgesia in these situations.

We report the first case in the medical literature (to our knowledge) of a patient with human immunodeficiency virus infection who was being treated with ritonavir and developed signs of severe vascular involvement and irreversible coma after the administration of 3 mg of ergotamine tartrate.