Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit

Barr, Juliana; Fraser, Gilles L.; Puntillo, Kathleen; Ely, E. Wesley; Gélinas, Céline; Dasta, Joseph F.; Davidson, Judy E.; Devlin, John W.; Kress, John P.; Joffe, Aaron M.; Coursin, Douglas B.; Herr, Daniel; Tung, Avery; Robinson, Bryce R. H.; Fontaine, Dorrie K.; Ramsay, Michael A. E.; Riker, Richard R.; Sessler, Curtis N.; Pun, Brenda T.; Skrobik, Yoanna; Jaeschke, Roman

doi:10.1097/ccm.0b013e3182783b72

Cited by 3,184 publications

(3,429 citation statements)

References 429 publications

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“…Internationally, widespread failure of the adoption of frequent validated pain assessments by nurses has been reported 17, 18, despite the publication of the ACCM guidelines 14. Our data replicate these findings in a large sample of UK ICUs.…”

Section: Discussionsupporting

confidence: 80%

“…We audited practice against standards described by the American College of Critical Care Medicine 14. The PLAN and SEARCH networks geographically cover 43 acute NHS trusts across London, Essex, Surrey, Sussex and Hertfordshire, as defined by the Department of Health (Health and Social Care Information Centre, http://www.hscic.gov.uk).…”

Section: Methodsmentioning

confidence: 99%

“…Under these circumstances, staff rely on either subjective, often inaccurate assessments 12, or on unfamiliar but validated behavioural pain scales. To address these challenges, guidelines have been developed in both Europe 13 and the USA 14. The American College of Critical Care Medicine (ACCM) 14 has emphasised the need for regular pain assessment along with the use of validated tools, such as the critical care pain observational tool (CPOT) 15, and the behavioural pain scale (BPS) 16.…”

Section: Introductionmentioning

confidence: 99%

“…To address these challenges, guidelines have been developed in both Europe 13 and the USA 14. The American College of Critical Care Medicine (ACCM) 14 has emphasised the need for regular pain assessment along with the use of validated tools, such as the critical care pain observational tool (CPOT) 15, and the behavioural pain scale (BPS) 16. Despite their dissemination, recent surveys indicate limited use among nursing staff 17, 18.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Among 5 studies that examined antipsychotics compared with placebo, only 1 showed a reduction in the incidence of delirium. Based on the lack of evidence, the 2013 Society of Critical Care Medicine guidelines on pain, agitation and delirium provide no recommendation for using antipsychotics for delirium prevention in adult ICU patients 34. It is also worth mentioning that antipsychotics are known to cause several cardiovascular side effects, most notably QT prolongation 51…”

Section: Preventionmentioning

confidence: 99%