<p>Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review Article</p>

Abstract

Background Agitation and anxiety occur frequently in ICU and affect about 30–80% of patients in ICU present with delirium worldwide, and it is associated with adverse clinical outcomes. This review aimed to systematically review articles and finally draw an evidence-based guideline for an area with limited resources. Methods The review was reported based on preferred reporting items for systemic and meta-analysis (PRISMA) protocol. We searched literature from PubMed, Google Scholar, and Medline database using keywords like the level of sedation, sedation score, pain assessment in ICU, and sedative drugs in ICU from an article published in English. After extraction with a patient population and exclusion, five randomized clinical trials, four systemic reviews and meta-analysis, four observation cohort study, and two practical guidelines were used for the review. Conclusion In addition to high validity and reliability, RASS has the advantage of easiness to remember for nurses making it a preferred sedation assessment tool in an adult ICU setting. Light sedation with daily interruption was recommended with an aim of an awake and alert patient ready for the weaning trial. Propofol was preferred when sedation is for a short duration and when intermittent awakening is required. Ketamine is the preferred induction for asthmatic hypotensive and patient requiring prolonged continuous sedation. With a similar time for sedation, diazepam shows a shorter time for intubation compared to midazolam. Besides diazepam has shown a cheaper cost of sedation than midazolam. This makes it a drug of preference in a low resource setting.

Intervención de enfermería en la administración de sedoanalgesia en el paciente críticamente enfermo

“…Se recomendó una sedación ligera con interrupción diaria con el objetivo de tener un paciente despierto y alerta, preferiblemente con Propofol cuando la sedación es de corta duración y cuando se requiere despertar intermitente, la ketamina es la inducción preferida para asmáticos hipotensos y pacientes que requieren sedación continúa prolongada, mientras que el diazepam muestra un tiempo más corto y económico para la intubación en comparación con el midazolam. Por otra parte, estudios previos han señalado que el Propofol puede estar asociado con un despertar más rápido que las benzodiazepinas, sin embargo, esto puede ser afectado por la administración concomitante de opiáceos para la analgesia, de hecho, los pacientes que reciben sedantes por largos períodos pueden desarrollar tolerancia y requerir mayores dosis con el tiempo 15 .…”

Bibliometric Analysis of 100 Most-Cited Articles in Delirium

“…However, our study found that cohort studies are the main cited articles in this field, and there are a large number of systematic reviews or meta-analyses of cohort studies. In order to evaluate the assessment of delirium and predict its risk factors, a cohort study is a more appropriate method, which we think is the reason for the large number of articles cited in this type of article ( 22 , 23 ). There is only one non-clinically relevant article, which introduces a hypothetical model of delirium that suggests that drugs that restore microglial choline to control or directly inhibit neuroinflammation need clinical trials ( 24 ).…”

Pairing spontaneous awakening and breathing trials to improve weaning of intensive care unit patients: A Systematic Review Protocol

“…ICU nursing clinical practice caring for mechanically ventilated sedated patients (MVSPs) entails evidence-based practice (EBP) for holistic care, including with regard to psychosocial wellbeing (e.g., stress and anxiety), as well as biomedical symptoms and pain management. The majority (85%) of MVSPs receive sedatives at some point to minimize anxiety and discomfort associated with life disruption, the intensive care unit (ICU) ambiance, and mechanical ventilation (MV) itself (1). More specifically, non-stop IV infusions of sedatives are used to facilitate invasive MV with minimized injury and patient suffering (2).…”