Pain in the intensive cardiovascular care unit

2021 ◽  
pp. 956-968
Author(s):  
Siân Jaggar ◽  
Helen Laycock
Keyword(s):  
Intensive Care ◽  
Assessment Tools ◽  
Surgical Patients ◽  
Patient Comfort ◽  
Physiological Changes ◽  
Medical Patients ◽  
Ethical Implications ◽  
Cardiac Intensive Care ◽  
Cardiovascular Care ◽  
Effective Analgesia

Cardiac intensive care units admit a heterogeneous patient group Pain is common, occurring in up to 70% of medical and surgical patients Effective analgesia is important Pain is under-recognized and inadequately treated, particularly in medical patients Consequences of pain are widespread, involving multisystem physiological changes Pain causes significant psychological sequelae for patients, and ethical implications for physicians Pain management should utilize a systematic approach. Ensuring optimal patient comfort requires: Understanding of the potential causes of pain in cardiac intensive care Using validated pain assessment tools to identify the presence of pain and evaluate treatment effects Employing a multimodal, multidisciplinary management strategy

Acute pain in the intensive cardiac care unit

2016 ◽  
Author(s):  
Siân Jaggar ◽  
Helen Laycock
Keyword(s):  
Intensive Care ◽  
Systematic Approach ◽  
Assessment Tools ◽  
Patient Comfort ◽  
Cardiac Care ◽  
Medical Patients ◽  
Ethical Implications ◽  
Cardiac Intensive Care ◽  
Effective Analgesia ◽  
Cardiac Care Unit

◆ Cardiac intensive care units admit a heterogeneous patient group◆ Pain is common, occurring in up to 70% of medical and surgical patients◆ Effective analgesia is important◆ Pain is under-recognized and inadequately treated, particularly in medical patients◆ Consequences of pain are widespread, involving multisystem physiological changes◆ Pain causes significant psychological sequelae for patients, and ethical implications for physicians◆ Pain management should utilize a systematic approach. Ensuring optimal patient comfort requires:○ Understanding of the potential causes of pain in cardiac intensive care○ Using validated pain assessment tools to identify the presence of pain and evaluate treatment effects○ Employing a multimodal, multidisciplinary management strategy

Acute pain in the intensive cardiac care unit

2015 ◽  
Author(s):  
Siân Jaggar ◽  
Helen Laycock
Keyword(s):  
Intensive Care ◽  
Systematic Approach ◽  
Assessment Tools ◽  
Patient Comfort ◽  
Cardiac Care ◽  
Medical Patients ◽  
Ethical Implications ◽  
Cardiac Intensive Care ◽  
Effective Analgesia ◽  
Cardiac Care Unit

◆ Cardiac intensive care units admit a heterogeneous patient group◆ Pain is common, occurring in up to 70% of medical and surgical patients◆ Effective analgesia is important◆ Pain is under-recognized and inadequately treated, particularly in medical patients◆ Consequences of pain are widespread, involving multisystem physiological changes◆ Pain causes significant psychological sequelae for patients, and ethical implications for physicians◆ Pain management should utilize a systematic approach. Ensuring optimal patient comfort requires:○ Understanding of the potential causes of pain in cardiac intensive care○ Using validated pain assessment tools to identify the presence of pain and evaluate treatment effects○ Employing a multimodal, multidisciplinary management strategy

scholarly journals A prospective, observational, longitudinal cohort study of sedation practices in SGH intensive care units

2017 ◽  
Vol 27 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Yi Lin Lee ◽  
Kalyanasundaram Ganesh ◽  
Lian Kah Ti ◽  
Shin Yi Ng
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Early Period ◽  
Patient Comfort ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Medical Patients ◽  
Surgical Intensive Care ◽  
Icu Length Of Stay ◽  
Icu Discharge

Background: Critically ill patients require sedation for patient comfort and ventilator synchrony. Despite the extensive use of sedation, to date there is no consensus on the best sedation practices. We attempt to investigate our local sedation practices. Method: This was a single-centre prospective, observation cohort study in medical and surgical intensive care unit (ICU) patients who were ventilated and sedated for more than 24 hours. Baseline demographics were obtained and patients followed-up for 28 days or to ICU discharge. Details on sedatives, ventilation duration, vasopressors and renal replacement therapy use, hospital/ICU length of stay, mortality, delirium, and sedation depth were collected and analysed. Results: From March to July 2012, 58 patients were recruited with a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 20.2 ±8.5. Hospital mortality rates were 32.8%. Patients were followed-up for 387 ICU patient-days. In the early period (first 48 h), the most popular sedative used was propofol (74.1%), followed by morphine (29.3%). In the subsequent period (>48 h), most patients were not sedated (47.6%); morphine became the most popular sedation drug (32.5%) followed by propofol (31%). Ketamine, haloperidol and diazepam were not given. In total, 1994 Richmond Agitation and Sedation Score (RASS) assessments were performed over 387 ICU patient-days; 11.1% of RASS assessments were prescribed a sedation target, and 86% of them met the prescribed targets. Delirium was observed in 22.4% of patients. Compared with medical patients, surgical patients were more likely to be prescribed a sedation target (14.2% vs. 7.4%, p<0.01), require lower doses of sedation, have a RASS score of between −2 to 1 (84.8% vs. 72.3%, p<0.01) and have fewer incidences of delirium (4.1% vs. 12.1%, p=0.01). Conclusion: Propofol and morphine were the most commonly prescribed sedatives. Different sedation practices between units may contribute to a reduction in delirium incidence.

scholarly journals Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 141 (2) ◽  
Author(s):  
Abdulla A. Damluji ◽  
Daniel E. Forman ◽  
Sean van Diepen ◽  
Karen P. Alexander ◽  
Robert L. Page ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Intensive Care ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Assessment Tools ◽  
Age Related ◽  
Geriatric Conditions ◽  
Cardiac Intensive Care

Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardiac intensive care units (CICUs), where care is commensurate with high age-related cardiovascular disease risks but where the associated geriatric conditions (including multimorbidity, polypharmacy, cognitive decline and delirium, and frailty) may be inadvertently exacerbated and destabilized. The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of cardiovascular disease care. Given these fundamental and broad challenges of patient aging, CICU management priorities and associated decision-making are particularly complex and in need of enhancements. In this American Heart Association statement, we examine age-related risks and describe some of the distinctive dynamics pertinent to older adults and emerging opportunities to enhance CICU care. Relevant assessment tools are discussed, as well as the need for additional clinical research to best advance CICU care for the already dominating and still expanding population of older adults.

scholarly journals Editor’s Choice-The cardiovascular implications of sedatives in the cardiac intensive care unit

2017 ◽  
Vol 7 (7) ◽  
pp. 671-683 ◽  
Author(s):  
Sammy Zakaria ◽  
Helaine J Kwong ◽  
Jonathan E Sevransky ◽  
Marlene S Williams ◽  
Nisha Chandra-Strobos
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Work Of Breathing ◽  
Invasive Mechanical Ventilation ◽  
Cardiovascular Effects ◽  
Neuromuscular Blocking ◽  
Patient Comfort ◽  
Critically Ill Patient ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Patients admitted to the cardiac intensive care unit frequently develop multi-organ system dysfunction associated with their cardiac disease. In many cases, invasive mechanical ventilation is required, which often necessitates sedation for patient-ventilator synchrony, reduction of work of breathing, and patient comfort. In this paper, we describe the use of common sedatives available in the endotracheally intubated critically ill patient and emphasize the clinical and cardiovascular effects. We review γ-aminobutyric acid agonists such as etomidate, benzodiazepines, and propofol, the centrally acting α2-agonist dexmedetomidine, and the N-methyl-D-aspartate receptor antagonist ketamine. Additionally, we outline the use of opioids and their role in potentiating other sedatives. We note that some sedatives are associated with increased delirium rates, and emphasize that judicious strategies minimizing sedative use are associated with decreases in morbidity and mortality. We also discuss standardized sedation assessment scales and highlight the importance of sedation weaning. Finally, we offer recommendations for sedation use during therapeutic hypothermia, and discuss the use of adjuvant neuromuscular blocking agents.

Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 123-130
Author(s):  
Klein-Weigel ◽  
Richter ◽  
Arendt ◽  
Gerdsen ◽  
Härtwig ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Quality Management ◽  
High Risk Group ◽  
Surgical Patients ◽  
Medical Patients ◽  
Risk Status ◽  
Vte Prophylaxis ◽  
Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and “hot spots” quality management-audits proved to be valuable instruments.

Role of Sildenafil in the Treatment of Persistent Pulmonary Hypertension of Newborn (PPHN) - Should it Be Withdrawn from Market of Bangladesh due to Threat of being Misuses

2020 ◽  
Vol 35 (2) ◽  
pp. 100-104
Author(s):  
Maksudur Rahman ◽  
Mohammad Abdullah Al Mamun ◽  
MAK Azad Chowdhury ◽  
Abu Sayeed Munsi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cardiac Intensive Care Unit ◽  
Cross Sectional ◽  
Cardiac Intensive Care ◽  
Hospital Protocol

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses. Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed. Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9). Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates. DS (Child) H J 2019; 35(2) : 100-104

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