Pain, agitation and delirium in the intensive care unit

IF 0.2 Q4 ANESTHESIOLOGY Anaesthesia and Intensive Care Medicine Pub Date : 2024-11-01 DOI:10.1016/j.mpaic.2024.08.004
Christopher McGovern, Richard Cowan, Richard Appleton, Barbara Miles
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Abstract

Pain, agitation and delirium are common during critical illness and are associated with many adverse consequences. A key aim of critical care is the facilitation of a calm, comfortable patient who can interact with their family and staff. Intensive care unit (ICU) patients frequently have pain from a variety of sources, many of which are not readily appreciated or actively managed. This article explores the challenges of assessing pain in the ICU and outlines methods that can be used to better identify and manage pain in this patient group. Agitation in ICU is often multifactorial, with many of its sources under-recognized. We will discuss the potential reasons that ICU patients become agitated, methods for measuring agitation and the actions that can be taken to alleviate it. Although the use of sedative and anxiolytic drugs is common in the ICU, their use is not without risks. This article will outline these risks, the variety of drugs available and how to use these drugs to a targeted effect. We will also explore delirium, its risk factors, precipitants and associated morbidity and mortality. This article will discuss how to diagnose delirium and the methods used to prevent and manage it.
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重症监护室中的疼痛、躁动和谵妄
疼痛、躁动和谵妄是危重病人常见的症状,会带来许多不良后果。重症监护的一个关键目标是让病人平静、舒适,并能与家人和医护人员互动。重症监护病房(ICU)患者经常会有各种来源的疼痛,其中许多疼痛并不容易被察觉或积极控制。本文探讨了评估重症监护病房疼痛所面临的挑战,并概述了可用于更好地识别和管理这类患者疼痛的方法。重症监护病房中的躁动通常是多因素的,其中许多原因未得到充分认识。我们将讨论 ICU 患者躁动的潜在原因、测量躁动的方法以及可以采取的缓解措施。虽然在重症监护病房使用镇静和抗焦虑药物很常见,但使用这些药物并非没有风险。本文将概述这些风险、可用药物的种类以及如何有针对性地使用这些药物。我们还将探讨谵妄、其风险因素、诱因以及相关的发病率和死亡率。本文将讨论如何诊断谵妄以及用于预防和管理谵妄的方法。
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来源期刊
CiteScore
0.50
自引率
0.00%
发文量
152
期刊介绍: Anaesthesia and Intensive Care Medicine, an invaluable source of up-to-date information, with the curriculum of both the Primary and Final FRCA examinations covered over a three-year cycle. Published monthly this ever-updating text book will be an invaluable source for both trainee and experienced anaesthetists. The enthusiastic editorial board, under the guidance of two eminent and experienced series editors, ensures Anaesthesia and Intensive Care Medicine covers all the key topics in a comprehensive and authoritative manner. Articles now include learning objectives and eash issue features MCQs, facilitating self-directed learning and enabling readers at all levels to test their knowledge. Each issue is divided between basic scientific and clinical sections. The basic science articles include anatomy, physiology, pharmacology, physics and clinical measurement, while the clinical sections cover anaesthetic agents and techniques, assessment and perioperative management. Further sections cover audit, trials, statistics, ethical and legal medicine, and the management of acute and chronic pain.
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Editorial Board Contents Medical gases Spinal anaesthesia Premedication
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