Analgesia and sedation of mechanically ventilated patients – a national survey of clinical practice

Wøien, Hilde; Stubhaug, Audun; Bjørk, Ida Torunn

doi:10.1111/j.1399-6576.2011.02524.x

Cited by 53 publications

(71 citation statements)

References 138 publications

(262 reference statements)

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“…To date, there are no observational data regarding physician pain assessment practice. Rather, the available information has been derived from surveys evaluating recall of practice, largely completed by nursing staff 19, 20. Furthermore, the use of ICU pain assessment guidelines in the UK has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

et al. 2017

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SummaryPain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia‐related entries in patients’ records over a 24‐h period, in 45 adult intensive care units (ICUs) in London and the South‐East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two‐thirds of patients (n = 475, 64.5%, 95%CI 60.9–67.8%) received no physician‐documented pain assessment during the 24‐h study period. Just under one‐third (n = 215, 28.6%, 95%CI 25.5–32.0%) received no nursing‐documented pain assessment, and over one‐fifth (n = 159, 21.2%, 95%CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician‐documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.

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Section: Introductionmentioning

confidence: 99%

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

et al. 2017

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“…[6,12,17] The importance of balanced sedation and pain treatment in ICUs is evident, but regimes and use of medication differ widely and require improvement. [18][19][20][21] Patients receiving MV is an area of healthcare that warrants investigation due to the opportunity to improve both clinical outcomes and the economic costs of care. Despite all the available evidence, best sedation practices are still heterogeneous and insufficiently implemented worldwide.…”

mentioning

confidence: 99%

“…What has not been explored is the process by which CCNs and physicians assess patients' sedation needs and work together toward a defined level of sedation and pain for the ICU patient. [18] The judicious and appropriate use of sedative medications is an essential goal of providing safe and effective sedation nursing management for mechanically ventilated patients. One method of achieving this goal is the use of evidence based clinical practice guidelines which incorporate sedation scales for the maintenance of analgesia and sedation in ICU patients.…”

mentioning

confidence: 99%

Towards a Standardized Approach for Critical Care Nursing Practices: Development of Evidence Based Analgo-Sedation Guidelines for Adult Mechanically Ventilated Patients

Othman¹,

El-Hady²,

Ahmed³

et al. 2016

IOSR

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“…Jednocześnie wpływ stosowanych środków na ośrodkowy układ nerwowy oraz czynność mięśni oddechowych musi być ograniczony do pożądanego i najlepiej mierzalnego poziomu, stąd przytoczony powyżej termin sedoanalgezja. Pozwala ona na modulowanie ograniczenia świadomości i reakcji bólowych przy planowaniu zakończenia wentylacji mechanicznej na podstawie skal i protokołów sedacji oraz systemów aparaturowych [2,4,10].…”

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Zastosowanie deksmedetomidyny na oddziale intensywnej terapii dorosłych

Wujtewicz

Maciejewski²,

Misiołek³

et al. 2014

Anaesthesiol Intensive Ther

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Sedation and analgesia, which are universally used in intensive care units (ICUs), provide patients with comfort and safety. The current trends aim at light sedation; the objective is to ensure the minimal sedation level for improving patients' autonomy and enabling the professional staff to assess the patients' neurological status and cognitive functions. Reports in the literature have indicated that a sedative or an entire sedation procedure can affect cognitive processes, the duration of mechanical ventilation and treatment outcomes in critically ill patients. At present, special attention is given to post-sedation delirium. Although sedatives differ in their uptake points, which can influence the quality of sedation, their common characteristic is substantial impairment of cognitive functions, memory and respiration. Alpha 2-adrenergic receptor agonists, which comprise a novel group of agents, are used frequently for sedation. One of these medications is dexmedetomidine, which is designed to sedate adult ICU patients who exhibit a score ≥ -3 according to the Richmond Agitation-Sedation Scale. Recent studies comparing the use of dexmedetomidine and the other sedative agents that are most commonly administered in ICUs demonstrated that the former largely fulfils the expectations of intensivists.

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Analgesia and sedation of mechanically ventilated patients – a national survey of clinical practice

Abstract: Potential factors which may improve sedation and pain management of mechanically ventilated patients in Norwegian ICUs are more systematic assessments of pain and sedation, and the use of written protocols. Strategies which reduce side effects should be addressed.

Cited by 53 publications

References 138 publications

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Towards a Standardized Approach for Critical Care Nursing Practices: Development of Evidence Based Analgo-Sedation Guidelines for Adult Mechanically Ventilated Patients

Zastosowanie deksmedetomidyny na oddziale intensywnej terapii dorosłych

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