Critical Care volume 29,
Article number: 483 (2025) Published: 11 November 2025
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.
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