Discussion #4
Discussion #4
Pain management in sedated and mechanically ventilated patients is always something that has interested me. Though we have scales and modalities through which we assess and manage pain in patients that aren’t coherent, it seems impossible that they are all completely foolproof in terms of accuracy and effectiveness.
Additionally, according to a 2013 article, these treatments may also have a negative effect on patient outcomes. I read an article titled Pharmacological Management of Sedation and Delirium in Mechanically Ventilated ICU Patients: Remaining Evidence Gaps and Controversies. This article explored the treatment of pain, anxiety, and delirium (PAD) in ICU patients. The authors assert that, drugs once thought to have a been effective in reducing PAD have been shown to have either little benefit, the potential for significant risk associated with any benefit, or in some cases, the potential to worsen patient outcome (Devlin et al., 2013).
The article provides health care practitioners with background on the most important areas of delirium pharmacotherapy in the ICU, information on the recent evidence based practice surrounding the treatment of PAD, and discusses areas in relation to this topic that require further investigation or study. The recommendations are all based on the Critical Care Medicine (ACCM) Pain, Agitation, and Delirium Clinical Practice Guidelines.
The guidelines include recommendations such as giving patients daily sedation interruptions while in the ICU; titrating medications to induce a light sleep as opposed to deep sedition, in addition from drug specific recommendations to guide health care practitioners.
The article stresses the importance of closing the gap between evidence-based recommendations and current PAD management practices. In order to achieve these guidelines as well as the many others suggested, the authors suggest a multi-faceted, interdisciplinary approach. They stress the importance of facility specific protocols for PAD management in addition to standardized order sets. The article concludes by saying that in order for the ACCM guidelines to be achieved and patient outcomes to be improved, comprehensive staff accountability and consistent patient education is vital.
Devlin, J. W., Fraser, G. L., Ely, E. W., Kress, J. P., Skrobik, Y., & Dasta, J. F. (2013). Pharmacological management of sedation and delirium in mechanically ventilated ICU patients: remaining evidence gaps and controversies. Semin Respir Crit Care Med, 34(2), 201–215.
