Maintaining comfort, cognitive function, and mobility in surgical intensive care unit patients

Vogt, Kelly; Frankel, Heidi L.

doi:10.1097/ta.0000000000000282

Cited by 4 publications

(5 citation statements)

References 117 publications

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“…The high compliance rates were achieved without automatic prompts to record either scale ( Pun et al, 2005 ). This, and other studies, has shown that when properly implemented, pain, sedation, and delirium protocols can effectively allow critical care nurses to make decisions to improve the quality of care with regard to sedation and analgesia in the ICU ( Bec & Johnson, 2008 ;Hughes, et al, 2013 ;Porhomayon et al, 2013 ;Quenot et al, 2007 ;Rose et al, 2015 ;Vogt & Frankel, 2014 ).…”

Section: Nurse-driven Protocolsmentioning

confidence: 94%

“…These samples include critically ill patients with older median ages compared with surgical and trauma patient populations ( Porhomayon et al, 2013 ;Robinson et al, 2008 ); thus, the findings may not be generalizable to these groups. In orthopedic, general surgery, and cardiac surgery patients, an analgosedation methodology has been noted to reduce agitation when analgesia needs are addressed upfront ( Vogt & Frankel, 2014 ). Optimizing the analgosedative needs in postoperative or critically injured patients can be challenging because of concurrent polysubstance abuse/ withdrawal ( Robinson et al, 2008 ), the requirement of multiple surgical procedures, and altered mental status ( Porhomayon et al, 2013 ).…”

Section: Continuous Versus Intermittent Sedationmentioning

confidence: 98%

“…Analgosedation regimens using morphine and remifentanil have been implemented successfully to decrease weaning time from mechanical ventilation and reducing ICU length of stay ( Devabhakthuni, Armahizer, Dasta, & Kane-Gill, 2012 ;Hughes et al, 2013 ). In addition to analgosedation, light sedation, which allows the patient to remain arousable and follow commands, may be a preferred method of patient management ( Robinson et al, 2013 ;Vogt & Frankel, 2014 ). It has been reported that patients in light sedation protocols experience fewer ventilator days, fewer ICU days, and fewer adverse psychological effects from their ICU admission ( Hughes et al, 2013 ).…”

Section: Continuous Versus Intermittent Sedationmentioning

confidence: 98%

“…Generally, critically ill patients experience pain from routine care and necessary medical procedures ( Brush & Kress, 2009 ;Vogt & Frankel, 2014 ). However, the pain experienced by traumatically injured patients is a consequence of surgical management, the systemic inflammatory response, and the injury itself ( Glowacki, 2015 ;Malchow & Black, 2008 ;Porhomayon et al, 2013 ).…”

mentioning

confidence: 99%

“…Complications of inadequate pain management include venous thrombotic events, pulmonary complications, exacerbated stress response, posttraumatic stress disorder, and an increase in agitation, length of stay, and mortality rates ( Malchow & Black, 2008 ). The mainstay of pain management historically has been the utilization of analgesics ( Vogt & Frankel, 2014 ), often via continuous infusion; however, many patients experience adverse effects including neurologic and respiratory depression, hypotension, delayed ventilator weaning, and increased intensive care unit (ICU) length of stay ( Malchow & Black, 2008 ). Currently, an analgesia first methodology (analgosedation) has been recommended because uncontrolled pain often leads to agitation ( Davidson, Winkleman, Gelinas, & Dermenchyan, 2015 ;Sessler & Varney, 2008 ;Vogt & Frankel, 2014 ).…”

mentioning

confidence: 99%

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Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit

Sacco

LaRiccia

2016

Journal of Trauma Nursing

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Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial. During this time, unit champions were integral to successful trial execution. Outcome measurement included patient and unit outcomes, nursing satisfaction, and a pre- and postimplementation patient comparison. Following implementation, unit length of stay decreased by 4.16% and there was a 17.81% decrease in average time on the ventilator following the initiation of weaning. Patient reports of nurse sensitivity and responsiveness to pain increased from 93.7 to 94.9. Nurses reported satisfaction with the practice change and improvements in care. In comparing pre- and postimplementation patient data, there was a significant decrease in mean analgesic treatment duration and an increase in the use of antipsychotics for delirium management. Following the trial period, this guideline was permanently adopted across the adult critical care service. The development of a nurse-driven analgosedation guideline was noted to be both feasible and successful.

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Section: Nurse-driven Protocolsmentioning

confidence: 94%

Section: Continuous Versus Intermittent Sedationmentioning

confidence: 98%

Section: Continuous Versus Intermittent Sedationmentioning

confidence: 98%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit

Sacco

LaRiccia

2016

Journal of Trauma Nursing

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Clinical relevance of the routine daily chest X-Ray in the surgical intensive care unit

Resnick

Inaba

Karamanos

et al. 2017

The American Journal of Surgery

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Pain Assessment in Mechanically Ventilated, Noncommunicative Severe Trauma Patients

López-López

Pérez-Pérez

Montesinos

et al. 2018

Journal of Trauma Nursing

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The aim of this study was to measure pain levels in noncommunicative patients with severe trauma who required tracheal suctioning and mobilization and to determine the utility of the Behavioral Indicators of Pain Scale (ESCID) in these cases. The pain scores for the procedures were recorded on Days 1, 3, and 6 of the patients' stay in the intensive care unit. These assessments were performed at 3 moments: before, during, and after the application of the procedures. Because of the longitudinal character of the study, data were fitted into a multivariate model using the Generalized Estimating Equations method. The sample of 124 patients comprised 77.4% males and 22.6% females with an average age of 45.93 (SD = 16.43) years. A significant increase (p < .01) in the ESCID score was observed during the application of the procedures that produced similar pain levels. Kappa coefficient value obtained for interobserver agreement of ESCID scale scores during the application of care procedures at the intervals being evaluated was greater than 0.84, which should be interpreted as almost perfect. The ESCID scores increased during 2 care procedures that are frequently carried out in intensive care units and indicated that they produced similar pain levels.

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Maintaining comfort, cognitive function, and mobility in surgical intensive care unit patients

Cited by 4 publications

References 117 publications

Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit

Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit

Clinical relevance of the routine daily chest X-Ray in the surgical intensive care unit

Pain Assessment in Mechanically Ventilated, Noncommunicative Severe Trauma Patients

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