Description
Analgesia and sedation work together to successfully manage severely unwell patients. In all varieties of intensive care units—surgical, medical, neurosurgical, oncological, and cardiac—it is crucial. Incorporating a patient-centered approach, it addresses patient safety as well as the contributing and predisposing aspects of pain, agitation, and delirium. Protocol-based weaning procedures from sedative-analgesic medicines, adequate medication selection, monitoring, and patient-appropriate analgesia and sedation scales can all contribute to a good outcome. The goal of this session is to clarify why and how to get the right amount of sedation and analgesia. Attention is also focused on the several measures that are employed to accurately analyze it.
Résumé
- Sedation in the ICU is a complex clinical problem with current therapeutic approaches often causing adverse side effects. Agitated patients frequently exhibit hypertension and elevated stress levels, necessitating more intensive nursing care. Sedation aims to address anxiety, pain-related stress, and acute confusional states, particularly in mechanically ventilated patients, and to facilitate treatments, diagnostic procedures, and negate psychological stress responses.
- Effective sedation in the ICU requires a balanced approach between addressing the causes of agitation and administering sedatives. Under-sedation leads to agitation, anxiety, pain, and physiological disturbances, while over-sedation can result in prolonged sedation, delayed emergence, respiratory depression, and muscle atrophy. Treatment goals include patient comfort through pain management, anxiolysis, and amnesia.
- Pain management involves anticipating and recognizing pain through patient reports, observing signs, and identifying the source. Pain should be quantified, and appropriate analgesia administered, followed by periodic reassessments. Both behavioral pain scales and ICU pain scales, incorporating variables like facial expression, body movements, and compliance with ventilation, are used. Non-pharmacological interventions, such as proper positioning and fracture stabilization, are also crucial.
- Common medications used for sedation include benzodiazepines (e.g., midazolam), propofol, opioids, alpha-2 agonists (e.g., dexmedetomidine), ketamine, and etomidate. Each class has specific properties and potential side effects. Propofol, while effective, carries the risk of propofol-related infusion syndrome. Opioids provide analgesia but lack amnesia.
- Monitoring sedation levels involves using validated scales such as the Ramsay Agitation Sedation Scale (RASS) and the Sedation-Agitation Scale (SAS). These scales offer quantitative scores for standardizing treatment and analyzing sedation efficacy. Protocolized management, incorporating these scales, leads to shorter lengths of stay, optimized sedative use, and reduced delirium and cognitive dysfunction.
- Protocols for addressing pain, agitation, and delirium (PAD) in the ICU are essential, and the application of scoring systems should be documented. ICU PAD care bundles emphasize assessing pain and agitation regularly, utilizing appropriate pain assessment tools, and treating pain promptly. Targeted sedation strategies aim for patients to follow commands without agitation, prioritizing non-benzodiazepine sedatives. Delirium assessment involves using scales like CAM-ICU and ICDSC, with management focusing on non-pharmacological interventions and judicious use of medications.
Exemple de certificat
À propos des intervenants
Dr. Niklesh Jain
Director and Operational Head of Critical Care, Care CHL Hospitals Indore, Madhya Pradesh
Divulgation financière
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