Acute pain in the intensive cardiac care unit

Author(s):  
Siân Jaggar ◽  
Helen Laycock

◆ 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

Author(s):  
Siân Jaggar ◽  
Helen Laycock

◆ 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


Author(s):  
Siân Jaggar ◽  
Helen Laycock

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


2018 ◽  
Vol 24 (8) ◽  
pp. S104-S105
Author(s):  
Fathima F. Jahufar ◽  
William Jakobleff ◽  
Joshua Josephs ◽  
Sandhya Murthy ◽  
Stephen Forest ◽  
...  

2021 ◽  
Vol 5 (2) ◽  
pp. 74
Author(s):  
Nifa Viranda Amelia

Selama pasien dirawat di ruang Intensive Cardiac Care Unit (ICCU), keluarga pasien mengalami kesulitan dan ketidakberdayaan. Bagi keluarga pasien, ruang rawat intensif merupakan tempat yang tidak menyenangkan.  Keluarga masuk dalam kondisi yang tidak terduga dan dibutuhkan ketepatan keluarga dalam mengambil keputusan guna keberlangsungan hidup terkait kondisi pasien yang membutuhkan penanganan.Lama perawatan pasien di ruang ICCU sangat beragam.  Lama rawat pasien ICCU berdampak langsung terhadap kualitas hidup pasien dan keluarga, risiko terjadinya di masa depan, dan besarnya pembiayaan dampak dari perawatan. Selama keluarga mendampingi perawatan pasien di ruang ICCU, keluarga akan mengalami berbagai reaksi emosional seperti kecemasan. Tujuan: Mengetahui hubungan lama hari rawat dengan tingkat kecemasan keluarga pasien di ruang ICCU. Metode: Korelasi dengan pendekatan cross sectional dengan sampel 42 responden di ruang ICCU, yang dipilih dengan menggunakan metode purposive sampling. Instrumen penelitian ini menggunakan kuesioner HARS.  Data dianalisis dengan uji korelasi Spearman. Hasil: Lama hari rawat pasien rata-rata 3,14 hari.  Kecemasan keluarga pasien ICCU paling banyak berada pada tingkat kecemasan berat (33,3%). Terdapat hubungan yang bermakna antara lama hari rawat dengan tingkat kecemasan keluarga pasien (p=0,0003) dengan keeratan hubungan yang sedang (r=0,532) di ruang ICCU. Diskusi: Semakin lama pasien dirawat di ruang ICCU maka semakin tinggi tingkat kecemasan yang dirasakan keluarga pasien karena kondisi pasien yang tidak stabil ataupun semakin parah. Kesimpulan: Keluarga pasien perlu diberikan informasi dan edukasi yang jelas terkait kondisi pasien dalam sehari atau saat ada perburukan kondisi.Kata kunci: kecemasan, keluarga, lama hari rawat, perawatan intensif, perawatan kritis. Correlation Between Length of Stay and Anxiety Levels of Patients’ Family in Intensive Cardiac Care Unit Room ABSTRACTWhile a patient is being treated in the Intensive Cardiac Care Unit (ICCU), the patient's family experiences difficulties and helplessness. For the patient's family, the intensive care unit is an unpleasant place. The family enters into unexpected conditions and is required to make proper decisions for survival related to patient conditions. The patient's length of stay in the ICCU room is very diverse. The length of stay of ICCU patients directly impacts patients' quality of life and their families, the risk of future incidence, and the extent of the treatment cost. While the family accompanies the patient treated in the ICCU room, the family will experience various emotional reactions such as anxiety. Objective: To reveal the correlation between length of stay and the anxiety levels of the patient’s family in the ICCU room. Methods: Correlation with cross-sectional approach with a sample of 42 respondents in the ICCU room, who were selected using a purposive sampling method. The research instrument used the HARS questionnaire. Data were analyzed using the Spearman correlation test. Results: The average length of the patient's stay was 3.14 days. Family anxiety of ICCU patients was mostly at the level of severe anxiety (33.3%). There was a significant correlation between length of stay and anxiety levels of the patient’s family (p=0.0003) with a moderate correlation coefficient (r=0.532) in the ICCU room. Discussion: The longer the patient is treated in the ICCU room, the higher the anxiety level felt by the patient’s family due to the patient's unstable or worsened condition. Conclusion: Clear information and education should be given to the patient's family regarding the patient's condition within one day or when the condition worsens.Keywords: anxiety, family, length of stay, intensive care, critical care


2017 ◽  
Vol 27 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Yi Lin Lee ◽  
Kalyanasundaram Ganesh ◽  
Lian Kah Ti ◽  
Shin Yi Ng

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.


Circulation ◽  
2020 ◽  
Vol 141 (2) ◽  
Author(s):  
Abdulla A. Damluji ◽  
Daniel E. Forman ◽  
Sean van Diepen ◽  
Karen P. Alexander ◽  
Robert L. Page ◽  
...  

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.


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