Analgosedation: Improving Patient Outcomes in ICU Sedation and Pain Management

Ryan Wiatrowski, BSN, RN, CCRN; Colleen Norton, PhD, RN, CCRN; David Giffen, BSN, RN

Disclosures

Pain Manag Nurs. 2016;17(3):204-217. 

In This Article

Abstract and Introduction

Abstract

Sedation practices in the critical care unit have been trending toward lighter sedation since the start of the new millennium, but patients continue to experience inadequate pain management and excessive sedation. This paper includes a brief examination of the problem of pain management in the ICU; trends in sedation practices, including light sedation and the daily interruption of sedation; and a literature review of analgosedation. While the analgosedation literature is relatively sparse, it offers a promising, patient-centered method for managing the triad of pain, agitation, and delirium, while reducing common complications associated with long-term ventilation. This paper concludes with a recommended method for analgosedation, the nursing implications, and a discussion of limitations and recommendations.

Introduction

Pain is a common experience among critically ill patients and is often unrecognized and/or undertreated, which can hinder a patient's recovery (Alderson & McKechnie, 2013; Joshi & Ogunnaike, 2005; Pasero, et al., 2009; Stites, 2013). Because of the nature of critically ill patients' ailments, mechanical ventilation is often a necessary lifesaving intervention that can impede the assessment of pain (McConville & Kress, 2012; Wunsch et al., 2010). Sedative hypnotic drugs such as benzodiazepines and general anesthetics are favored in current sedation practices; however, both have been associated with side effects that delay recovery and neither have analgesic properties (Devabhakthuni, Armahizer, Dasta, & Kane-Gill, 2012; Kress, Pohlman, O'Connor, & Hall, 2000; Maraboto, 2013; Mehta, McCullagh, & Burry, 2009; Weinert & Calvin, 2007). To complicate matters, many patients experience oversedation, which delays recovery further (Devabhakthuni et al., 2012; Mehta et al., 2009). To mitigate oversedation, daily interruptions of sedation have become accepted as a key practice for minimizing sedative use and its associated complications (Kress et al., 2000; Pun & Dunn, 2007b; Sedwick, Lance-Smith, Reeder, & Nardi, 2012; Siegele, 2009). Analgosedation is another sedative-minimizing technique; while not eliminating the use of sedatives entirely, it prioritizes pain control and analgesia use, saving sedative agents for rescue therapy only (Devabhakthuni et al., 2012). Clearly, pain management is of utmost importance in the critical care setting, as prevalent sedative practices may not optimally minimize sedative use and may lead to uncontrolled levels of pain among critically ill patients. Analgosedation, an emerging practice, is explored in this article with the hope of providing better pain management and sedation to critically ill patients.

Comments

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