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Pain, Agitation, Delirium, and Immobility in the ICU

  • Juliane Jablonski
Chapter

Abstract

Surgical critical care patients may endure numerous invasive procedures in addition to the primary surgical intervention that led to hospitalization. Examples include the placement of chest, endotracheal, tracheostomy, and surgical drainage tubes, urinary catheters, blood draws, suctioning, and wound care. Such treatments in the intensive care unit (ICU) increase patients’ vulnerability to experiencing pain, as well as physical and psychological distress.

Critical care specialists are responsible for evaluating and managing all of the symptoms associated with pain, agitation, and delirium (PAD). Sedatives and analgesics are among the most commonly administered medications in the intensive care unit (ICU) especially for mechanically ventilated patients. Intensive care physicians must carefully address patient distress and agitation while simultaneously avoiding oversedation.

In the mission of providing comfort exist the potential unintentional harms of oversedation, delirium, and immobility leading to longer ventilator days, longer hospital stays, and increased mortality rates. ICU survivors can endure long-term, new, or worsening impairments in physical, cognitive, or mental health status persisting beyond acute care hospitalization. This phenomenon is termed post-intensive care syndrome.

In efforts to improve patient outcomes, a multidisciplinary approach is needed for the implementation of an evidence-based, goal-directed approach to managing pain, agitation, and delirium in the ICU. Pain, agitation, and delirium have come to the forefront as modifiable interventions in the care of the critically ill. The incidence and specific management of all three of these clinical entities have been shown to have a significant impact on outcomes related to mortality, length of stay (LOS) in the ICU and hospital, as well as post-neurological outcomes.

Keywords

Pain Agitation Delirium Sedation Immobility Post-intensive care syndrome 

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Authors and Affiliations

  1. 1.Surgical Critical CareHospital of the University of PennsylvaniaPhiladelphiaUSA

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