Recent Advances In Policies Of Analgesia & Sedation In The ICU
Mohamed Ibrahim Mohamed Gohar;
Abstract
Ensuringpatientcomfortandsafetyisauniversalgoalfor criticalcarePractitioners.
Patientsundergoingmechanical ventilationexperiencesignificantstresssuperimposedon their acutemedicalproblem,rangingfrom anxiety abouttheir surroundings andconditiontodistress withpotentialpain from necessary nursing careand procedures. Non- pharmacologic therapies such as comfortable positioning in bed and verbal reassurance are reasonable initial considerations, but the use of sedatives and analgesics to promote tolerance to the intensivecareunit (ICU) environmentis typically the rule.
Sedation needs vary widely in mechanically ventilated patients. ICU patients frequentlyexhibit unpredictable pharmacology with accumulation of drug in tissue stores, resulting in a prolonged clinicaleffect.Othervariablesthatconfound attempts to predict drug effect includerenal and hepatic dysfunction, drug-drug interactions, hypoproteinemia, and shock.
As a result, sedatives and analgesics must be titrated to discernible and reproducible clinical end-points. Because the drugsusedin this contextare extremely potent,clinicians musthaveheightenedawarenessofthepotentialfor enduringeffectsandareencouraged toemploystrategies that maximizethe benefit while minimizingthe risk.
Theriskfor untreatedpainor agitation is a primary concern. Most mechanicallyventilated patients experience some degree of pain even in the absence of surgical incisions or trauma accordingly, it is critical for clinicians to direct initial attentiontowardanalgesia whenthey administer sedation.
Untreatedpainmay causemany adverse effects, includingincreased endogenous catecholamine activity, myocardialischemia, hypercoagulability, hypermetabolic states, sleepdeprivation,anxietyanddelirium.Treating this pain has beenshownto amelioratesomeof these effects. Untreatedagitation, particularly in the delirious patient, may result in similar problems, includingpatient self-injury via removal of life-sustaining devices.
Protocolized target-basedsedation and analgesia is central to effective managementofsedation. Importantcomponentsincludeidentifyinggoalsandspecifictargets,usingvalidandreliabletoolstomeasurepain,agitation,andsedation,andtitratinga logicallyselectedcombinationof sedativesand analgesicstodefinedend-points.
Patientsundergoingmechanical ventilationexperiencesignificantstresssuperimposedon their acutemedicalproblem,rangingfrom anxiety abouttheir surroundings andconditiontodistress withpotentialpain from necessary nursing careand procedures. Non- pharmacologic therapies such as comfortable positioning in bed and verbal reassurance are reasonable initial considerations, but the use of sedatives and analgesics to promote tolerance to the intensivecareunit (ICU) environmentis typically the rule.
Sedation needs vary widely in mechanically ventilated patients. ICU patients frequentlyexhibit unpredictable pharmacology with accumulation of drug in tissue stores, resulting in a prolonged clinicaleffect.Othervariablesthatconfound attempts to predict drug effect includerenal and hepatic dysfunction, drug-drug interactions, hypoproteinemia, and shock.
As a result, sedatives and analgesics must be titrated to discernible and reproducible clinical end-points. Because the drugsusedin this contextare extremely potent,clinicians musthaveheightenedawarenessofthepotentialfor enduringeffectsandareencouraged toemploystrategies that maximizethe benefit while minimizingthe risk.
Theriskfor untreatedpainor agitation is a primary concern. Most mechanicallyventilated patients experience some degree of pain even in the absence of surgical incisions or trauma accordingly, it is critical for clinicians to direct initial attentiontowardanalgesia whenthey administer sedation.
Untreatedpainmay causemany adverse effects, includingincreased endogenous catecholamine activity, myocardialischemia, hypercoagulability, hypermetabolic states, sleepdeprivation,anxietyanddelirium.Treating this pain has beenshownto amelioratesomeof these effects. Untreatedagitation, particularly in the delirious patient, may result in similar problems, includingpatient self-injury via removal of life-sustaining devices.
Protocolized target-basedsedation and analgesia is central to effective managementofsedation. Importantcomponentsincludeidentifyinggoalsandspecifictargets,usingvalidandreliabletoolstomeasurepain,agitation,andsedation,andtitratinga logicallyselectedcombinationof sedativesand analgesicstodefinedend-points.
Other data
| Title | Recent Advances In Policies Of Analgesia & Sedation In The ICU | Other Titles | الجديد فى سياسات الأدوية المسكنة والمهدئة بوحدة العناية المركزة | Authors | Mohamed Ibrahim Mohamed Gohar | Issue Date | 2015 |
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