وصف
Did you know Pain, agitation and delirium (PAD) increase the burden of disease for critically ill patients, contributing to adverse outcomes. The 2013 PAD Guidelines for managing patients with these interrelated problems were updated in 2018, based on new evidence and input from a diverse, intraprofessional committee, resulting in “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility and Sleep Disruption in Adult Patients in the ICU,” or the PADIS Guidelines.
ملخص
- Delirium in ICU patients can lead to worsened conditions, increased ICU and hospital stays, higher mortality, and reduced functional status. Diagnosis involves using tools like the Intensive Care Delirium Screening Checklist (ICDSC) and the Confusion Assessment Method for the ICU (CAM-ICU), requiring patients to be at least mildly sedated and responsive. The ICDSC uses an eight-factor scoring system, while CAM-ICU assesses changes in behavior, inattention, level of consciousness, and disorganized thinking.
- Sedation levels are crucial alongside delirium assessment, utilizing the Richmond Agitation and Sedation Scale (RASS). The goal is light sedation, with patients briefly awakening to voice. Biomarkers such as S100B protein, procalcitonin, and CRP can indicate delirium, although their routine measurement is not common practice.
- Delirium prevention and treatment involve both non-pharmacological and pharmacological interventions. Non-pharmacological strategies include reducing delirium-inducing medications, pain management, infection control, ensuring proper nutrition and hydration, providing occupational and physical therapy, promoting sleep, supporting vision and hearing, and engaging family.
- Pharmacological interventions may include haloperidol or atypical antipsychotics like quetiapine and risperidone. Protocols for daily awakening from sedation and trials comparing dexmedetomidine to other sedatives suggest potential benefits. Furthermore, Pain management should be prioritized using the minimal effective dose of opioids, with assessment tools for pain evaluation.
- PADIS guidelines (Pain, Agitation, Delirium, Immobility, and Sleep Disruption) emphasize reliable pain assessment methods, recommending acetaminophen and low-dose ketamine as adjuncts. They also highlight the importance of addressing procedural pain with pre-procedural opioids or NSAIDs and encourage non-pharmacological approaches like massage and music therapy. Finally, Light sedation is the ultimate goal, aiming for patient comfort, pain relief, calmness, cooperation, and tolerance of mechanical ventilation, with regular sleep and daily sedation breaks.
نموذج شهادة
حول المتحدثين
Dr Surabhi Awasthi
MD(Anaes),AMPH (ISB),FICM,FIECMO,PGDMLS,PGDHHM. Director and Head Critical Care Medicine. Delhi, India
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