Impact of the 2018 Society of Critical Care Medicine Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Guidelines on Nonopioid Analgesic Use and Related Outcomes in Critically Ill Adults After Major Surgery

Abstract

We compared ICU nonopioid analgesic use, opioid use, and pain before and after Pain, Agitation/Sedation, Delirium, Immobility, and Sleep guideline publication at one academic center among critically ill adults receiving an opioid infusion and greater than or equal to 24 hours of mechanical ventilation after major surgery. The 2017 ( n = 77) and 2019 ( n = 57) groups were similar at baseline. The 2019 (vs 2017) patients were more likely to receive scheduled IV/oral acetaminophen (84% vs 69%; p = 0.05), less likely to receive a lidocaine patch (33% vs 50%; p = 0.05), and just as likely to receive ketamine (4% vs 3%; p = 1.0), an nonsteroidal anti-inflammatory drug (7% vs 3%; p = 0.26), or gabapentin/pregabalin (16% vs 9%; p = 0.23). Daily average opioid exposure (in IV morphine milligram equivalent) was not different (70 [42–99] [2017] vs 78 mg [49–109 mg]; p = 0.94). The 2019 (vs 2017) group spent more ICU days with severe pain ( p = 0.04). At our center, Pain, Agitation/Sedation, Delirium, Immobility, and Sleep guideline publication had little effect on nonopioid analgesic or opioid prescribing practices in critically ill surgical adults.

Informing the standardising of care for prolonged stay patients in the intensive care unit: A scoping review of quality improvement tools

“…• The ICU day (n = 24, 27 %) (Balas et al, 2022;Bardwell et al, 2020;Barr et al, 2020;Boehm et al, 2020;Collinsworth et al, 2021;Collinsworth et al, 2020;DeMellow et al, 2020;Heim et al, 2019;Hsieh et al, 2019;Jablonski et al, 2017;Kamdar et al, 2013;Lee et al, 2020;Liu et al, 2016;Loberg et al, 2022;Ma et al, 2021;Negro et al, 2022;Otusanya et al, 2021;Pun et al, 2019;Smith and Grami, 2016;Sosnowski et al, 2018;Sutton et al, 2021;Tonna et al, 2021;Wessman et al, 2017;Zucco and Damirji, 2018). • The ICU stay (n = 8, 9 %) (Dalal et al, 2016;Dykes et al, 2017;Kodali et al, 2015;Loeslie et al, 2017;Nelson et al, 2006;Noome et al, 2017;Suen et al, 2021;Tonna et al, 2021).…”

“…• Mortality (n = 14, 16 %) (Barcellos and Chatkin, 2020;Barnes-Daly et al, 2017;Chen et al, 2021a;Collinsworth et al, 2020;De Bie et al, 2021;Lemkin et al, 2020;Liu et al, 2016;Loberg et al, 2022;Nahouraii et al, 2019;Pun et al, 2019;Reiff et al, 2015;Verholen et al, 2021;Wilson et al, 2009;Cavalcanti et al, 2016), • Health care acquired infection (n = 9, 10 %) (Chua et al, 2010 De Bie et al, 2021;Heim et al, 2019;Hsieh et al, 2019;Loberg et al, 2022;Nahouraii et al, 2019;Pun et al, 2019;Sutton et al, 2021;Weiss et al, 2011;Wilson et al, 2009), • Delirium occurrence and duration (n = 8, 9 % n = 10, 11 %) ( Barnes-Daly et al, 2017;Boehm et al, 2020;Jablonski et al, 2017;Kamdar et al, 2013;Lee et al, 2020;Ma et al, 2021;Pun et al, 2019;Smith and Grami, 2016;Sutton et al, 2021;Tonna et al, 2021).…”

“…Chen et al, 2021b;Conroy et al, 2015;Dykes et al, 2017;Kamdar et al, 2013;Kang et al, 2020;Kodali et al, 2015;Loeslie et al, 2017;Noome et al, 2017;Sona et al, 2020;Sosnowski et al, 2018;A. Suen et al, 2020;Sutton et al, 2021;Tonna et al, 2021). Eight (10 %) studies reported seven different Patient-reported outcome measures (P-ROMs) (Cao et al, 2018;Conroy et al, 2015;Dykes et al, 2017;Kamdar et al, 2013;Loeslie et al, 2017;Sosnowski et al, 2018;Sutton et al, 2021;Tonna et al, 2021).…”

“…Suen et al, 2020;Sutton et al, 2021;Tonna et al, 2021). Eight (10 %) studies reported seven different Patient-reported outcome measures (P-ROMs) (Cao et al, 2018;Conroy et al, 2015;Dykes et al, 2017;Kamdar et al, 2013;Loeslie et al, 2017;Sosnowski et al, 2018;Sutton et al, 2021;Tonna et al, 2021). Of these:…”

“…• 2/9 (2 %) satisfaction with communication (Cao et al, 2018;Loeslie et al, 2017). • 2/9 (2 %) measured pain scores (Conroy et al, 2015;Sutton et al, 2021). • Two (2 %) measured perceived sleep quality (Kamdar et al, 2013;Tonna et al, 2021).…”