The pain, agitation, and delirium practice guidelines for adult critically ill patients: a post-publication perspective

Abstract

The recently published Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit differ from earlier guidelines in the following ways: literature searches were performed in eight databases by a professional librarian; psychometric validation of assessment scales was considered in their recommendation; discrepancies in recommendation votes by guideline panel members are available in online supplements; and all recommendations were made exclusively on the basis of evidence available until December of 2010. Pain recognition and management remains challenging in the critically ill. Patient outcomes improve with routine pain assessment, use of co-analgesics and administration as well as dose adjustment of opiates to patient needs. Thoracic epidurals help ease patients undergoing abdominal aortic surgery. Little data exists to guide clinicians as to the type or dose of co-analgesics; no opiate choice is associated with better patient outcomes. Lighter or no sedation is beneficial, and interruption is desirable in patients who require deep sedation for specific pathologic states. Delirium screening is probably useful; no treatment modality can be unequivocally recommended, and the benefit of prophylaxis is established only for early mobilization. The details of these recommendations, as well as more recent publications that complement the guidelines, are provided in this commentary.

Predictors of ICU patients’ pain management satisfaction: A descriptive cross-sectional survey

“…6 Consequently, more than 70% of the ICU patients reported having pain while being in the ICU, of which two-thirds reported having moderate to severe pain. 7,8 Another study 9 reported that the incidence of pain in the ICU was 50% at rest for both surgical and medical patients, which increases to 80% during procedures such as suctioning and drain removal. When compared to other stressors, pain was ranked as the second most stressful stressor experienced by ICU patients.…”

“…10 Moreover, pain recognition and management among critically ill patients remains challenging. 9 Such a high level of persistent pain exposes patients to a higher risk of developing severe depressive and post-traumatic stress symptoms 11 and suicidal ideation. 12 Traditionally, the effectiveness of care in ICUs has been evaluated by length of stay, mortality, and measures of administrative efficiency.…”

Feasibility of smartphone use in monitoring pain and symptoms among patients with serious illness

“…[4] Moreover, pain has been positively associated with poorer quality of life [5][6][7] depression, [8,9] and greater caregiver burden. [10,11] Patient self-reporting has shown to be the best way to determine the depth and breadth of pain; [12] however, homebound patients not in immediate or constant contact with doctors and other healthcare staff often feel at a disadvantage in relation to communicating issues concerning pain. In addition, self-efficacy has been shown to improve pain management in chronic illness.…”

Mind over matter? Pain, withdrawal and sedation in paediatric critical care

“…Scores may not always provide that focus. Skrobik and Chanques [13] remind us that judgment plays a role in the final attribution of scientific value and importance, even where there is rigorous evidence.…”