Fentanyl as pre-emptive treatment of pain associated with turning mechanically ventilated patients: a randomized controlled feasibility study

Abstract

These results suggest an intravenous bolus of fentanyl of 1 µg/kg for medical patients or 1.5 µg/kg for surgical patients reduces the incidence of turning-associated pain in critically ill patients on mechanical ventilation. ClinicalTrials.gov: NCT 01950000.

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

“…It is, therefore, unclear how generalisable these results are to practice elsewhere; however, evidence from nursing literature shows that pain is managed poorly in ICUs in many countries 17, 18. This study did not address procedural pain; a recent trial of the management of procedural pain highlighted unacceptably high baseline pain scores, suggesting that there was a need to control background pain before adequate procedural pain therapy can be attempted 27. Finally, as a service evaluation study, we did not explore whether pain assessments influenced patient outcomes.…”

Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study

“…The clinical implications are that both major and minor physiological changes caused by nursing procedures are common. Therefore, we consider that major changes should be reported quickly so that adequate precautions could be taken, e.g., preemptive pain treatment as shown recently by Robleda et al, when these usually necessary procedures are performed, particularly when caring for severely compromised patients in the ICU. In addition, our study indicates that the physiological changes associated with routine nursing procedures should be considered in interventional studies; thus, severe coughing and patient/ventilator asynchrony, which may be inhibited by the use of, e.g., neuromuscular blockers, could contaminate the results of such studies.…”

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…The potential for harm with opioids, in a dosedependent proportion, was demonstrated. Two of 20 patients in the high-dose remifentanil group had 1-3 minutes of apnea, requiring bag and mask ventilation for 3 minutes (118), whereas 10% of patients in another study who were administered highdose fentanyl (at a dose of 1-1.5 µg/kg) experienced respiratory depression (120). Given this short-term consequence of higher dose opioids in critically ill patients, as well as the effectiveness of small doses of opioids in the three studies in maintaining low pain levels, opioids at the lowest effective doses for procedural pain are favored.…”