The goals of analgesia and sedation at the intensive care unit (ICU) are to
facilitate mechanical ventilation, prevent patient and caregiver injury, and
avoid the psychological and physiologic consequences of inadequate treatment
of pain, anxiety, agitation, and delirium. Most ICU patients, especially the
surgical and trauma ones, routinely experience pain at rest and with routine
procedures. Treating pain in ICU patients depends on a clinician?s ability to
perform a reproducible pain assessment and to monitor patients over time to
determine the adequacy of therapeutic interventions to treat pain.
Implementation of behavioral pain scales improves ICU pain management and
clinical outcomes, including better use of analgesic and sedative agents and
shorter durations of mechanical ventilation and ICU stay. Opioids are the
primary medications for managing pain in critically ill patients. Multimodal
approach to pain management in ICU patients has been recommended. Sedatives
are commonly administered to ICU patients to treat agitation and its negative
consequences. Sedation strategies using nonbenzodiazepine sedatives (propofol
or dexmedetomidine) may be preferred over sedation with benzodiazepines
(midazolam or lorazepam) to improve clinical outcomes in mechanically
ventilated adult ICU patients. It is recommend daily sedation interruption or
a light target level of sedation be routinely used in adult intensive care
patients using mechanical ventilation. Delirium affecting up to 80% of
mechanically ventilated adult ICU patients. ICU protocols that combine
routine pain and sedation assessments, with pain management and
sedation-minimizing strategies, along with delirium monitoring and
prevention, may be the best strategy for avoiding the complications of
oversedation. Protocolized pain, agitation and delirium assessment (PAD ICU),
is significantly associated with a reduction in the use of analgesic
medications, ICU length of stay, and duration of mechanical ventilation.