Analgosedation Management in the Intensive Care Unit: A Narrative Systematic Review

Abstract

Background: Intensive care unit (ICU) patients' pain and sedation management is a significant nursing challenge. Sedatives and muscle relaxants administration has been long used for improving patients' comfort and tolerance to mechanical ventilation. This practice led to an increase in adverse ICU outcomes in terms of health status, hospitalization stay, infections, and mortality. The use of appropriate ICU pain and sedation assessment tools is limited. Methods: We conducted a narrative literature systematic review (from 2010 to 2022) whose primary aims were to analyze the analgosedation definition and identify ICU patients’ pain, agitation, and sedation assessment tools; secondary aims were to explore analgesia and sedation pharmacological and non-pharmacological treatments and nurses’ perceptions and attitudes regarding analgosedation issues. Results: We retrieved 45 eligible articles. Analgosedation foresees early pain management - using pharmacological and non-pharmacological approaches and then, if necessary, implementing adequate sedation. Recommended assessment tools are the Behavioral Pain Scale (BPS) and the Critical Care Observational Tool (CPOT) for pain assessment, the Richmond Agitation Sedation Scale (RASS), and the Sedation Agitation Scale (SAS) for sedation assessment. Guidelines and specific protocols recommend both pharmacological and non-pharmacological approaches. Health professionals report mainly barriers (lack of adherence to guidelines and protocols, workload, reduced awareness, and own perceptions) to analgosedation correct application. The implementation of ICU analgosedation strategies requires continuous health professionals’ commitment and collaboration and valid assessment tools use. Conclusion: ICU analgosedation management (pain control first, and then sedation if necessary) is limited due to health professionals' knowledge gaps, inappropriate use of assessment tools, guidelines, and specific protocols. Recommended assessment tools are the BPS and CPOT for pain assessment and the RASS and SAS for sedation assessment. Interventions to improve ICU analgosedation awareness and practice include training events, the use and consultation of literature guidelines, and the use of validated assessment tools.