Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients

Size: px
Start display at page:

Download "Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients"

Transcription

1 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit January 2013 Volume 41 Number 1 Society of Critical Care Medicine 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權

2 Juliana Barr, MD, FCCM1; Gilles L. Fraser, PharmD, FCCM2; Kathleen Puntillo, RN, PhD, FAAN, FCCM3; E. Wesley Ely, MD, MPH, FACP, FCCM4; Céline Gélinas, RN, PhD5; Joseph F. Dasta, MSc, FCCM, FCCP6; Judy E. Davidson, DNP, RN7; John W. Devlin, PharmD, FCCM, FCCP8; John P. Kress, MD9; Aaron M. Joffe, DO10; Douglas B. Coursin, MD11; Daniel L. Herr, MD, MS, FCCM12; Avery Tung, MD13; Bryce R. H. Robinson, MD, FACS14; DorrieK. Fontaine, PhD, RN, FAAN15; Michael A. Ramsay, MD16; Richard R. Riker, MD, FCCM17; Curtis N. Sessler, MD, FCCP, FCCM18; Brenda Pun, MSN, RN, ACNP19; YoannaSkrobik, MD, FRCP20; Roman Jaeschke, MD21

3 Objective To revise the Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult published in Critical Care Medicine in 2002.

4 Methods The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multiinstitutional task force Expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients.

5 Methods Divided into four subcommittees Grading of Recommendations Assessment, Development and Evaluation method 1. PubMed 2. MEDLINE 3. Cochrane Database of Systematic Reviews 4. Cochrane Central Register of Controlled Trials 5. CINAHL 6. Scopus 7. ISI Web of Science 8. the International Pharmaceutical Abstracts.

6 Methods The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2), and either in favor of (+) or against ( ) an intervention.

7

8 Methods We recommend => strong recommendation We suggest => weak recommendation

9 Conclusion These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients. (Crit Care Med 2013; 41: )

10 1. Pain and Analgesia 2. Agitation and Sedation 3. Delirium 4. Strategies for Managing Pain, Agitation, and Delirium to Improve ICU Outcomes

11 1. Pain and Analgesia a. Incidence of pain ii. Pain in adult cardiac surgery patients is common and poorly treated; women experience more pain than men after cardiac surgery (B).

12 b. Pain assessment i. Routinely pain monitoring (+1B) ii. The Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) are the most valid and reliable behavioral pain scales for monitoring pain (except for brain injury) iii. Vital sign (+2C)

13

14

15 CPOT

16 c. Treatment of pain iii. intravenous (IV) opioidsbe considered as the first-line drug class of choice to treat non-neuropathic pain in critically ill patients (+1C) iv. Opioids are equally effective (C)

17 vi. We recommend that either enterally administered gabapentin or carbamazepine, in addition to IV opioids, be considered for treatment of neuropathic pain (+1A)

18 x. We suggest that thoracic epidural analgesia be considered for patients with traumatic rib fractures (+2B).

19 2. Agitation and Sedation a. Depth of sedation vs. clinical outcomes i. Maintaining light levels of sedation in adult ICU patients is associated with improved clinical outcomes (B).

20 ii. Maintaining light levels of sedation increases the physiologic stress response, but is not associated with an increased incidence of myocardial ischemia (B).

21 b. Monitoring depth of sedation and brain function i. The Richmond Agitation-Sedation Scale (RASS) and Sedation-Agitation Scale (SAS) are the most valid and reliable sedation assessment tools for measuring quality and depth of sedation in adult ICU patients (B).

22

23 c. Choice of sedative i. We suggest that sedation strategies using non-bzd sedatives (either propofolor dexmedetomidine) may be preferred over sedation with BZD (either midazolam or lorazepam) to improve clinical outcomes in mechanically ventilated adult ICU patients (+2B).

24 3. Delirium a. Outcomes associated with delirium i. Increased mortality (A). ii. Prolonged ICU and hospital LOS (A). iii. Development of post-icu cognitive impairment (B).

25 b. Detecting and monitoring delirium i. Recommend routine monitoring of delirium (+1B). ii. The Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most valid and reliable delirium monitoring tools (A). iii. Routine monitoring of delirium is feasible (B).

26

27

28 c. Delirium risk factors i. Four baseline risk factors are positively and significantly associated with the development of delirium in the ICU: preexisting dementia, history of hypertension and/or alcoholism, and a high severity of illness at admission (B).

29 iii. Conflicting data surround the relationship between opioid use and the development of delirium in adult ICU patients (B). iv. Benzodiazepine use may be a risk factor for the development of delirium in adult ICU patients (B).

30 vi. In mechanically ventilated adult ICU patients at risk of developing delirium, dexmedetomidine infusions administered for sedation may be associated with a lower prevalence of delirium compared to benzodiazepine infusions (B)

31 d. Delirium prevention i. We recommend performing early mobilizationof adult ICU patients whenever feasible to reduce the incidence and duration of delirium (+1B).

32

33 v. We do not suggest that either haloperidol or atypical antipsychotics be administered to prevent delirium in adult ICU patients ( 2C).

34 e. Delirium treatment i. There is no published evidence that treatment with haloperidol reduces the duration of delirium in adult ICU patients (No Evidence).

35 e. Delirium treatment i. There is no published evidence that treatment with haloperidol reduces the duration of delirium in adult ICU patients (No Evidence).

36 v. We suggest that in adult ICU patients with delirium unrelated to alcohol or benzodiazepine withdrawal, continuous IV infusions of dexmedetomidinerather than benzodiazepine infusions be administered for sedation to reduce the duration of delirium in these patients (+2B)

37 4. Strategies for Managing Pain, Agitation, and Delirium to Improve ICU Outcomes a. We recommend either daily sedation interruption or a light target level of sedation be routinely used in mechanically ventilated adult ICU patients (+1B).

38 b. We suggest that analgesia-first sedation be used in mechanically ventilated adult ICU patients (+2B).

39 c. We recommend promoting sleep in adult ICU patients by optimizing patients environments, using strategies to control light and noise, clustering patient care activities, and decreasing stimuli at night to protect patients sleep cycles (+1C).

40 Thank you very much!!

Delirium Screening and Prevention Faculty Disclosures

Delirium Screening and Prevention Faculty Disclosures Delirium Screening and Prevention Faculty Disclosures I have nothing to disclose Kathleen Puntillo RN, PhD, FAAN, FCCM Professor Emeritus School of Nursing, UCSF Objectives Discuss prevalence, risk factors

More information

Delirium Screening and Prevention. Faculty Disclosures. Objectives 5/13/2014. I have nothing to disclose

Delirium Screening and Prevention. Faculty Disclosures. Objectives 5/13/2014. I have nothing to disclose Delirium Screening and Prevention Kathleen Puntillo RN, PhD, FAAN, FCCM Professor Emeritus School of Nursing, UCSF Faculty Disclosures I have nothing to disclose Objectives Discuss prevalence, risk factors

More information

Early Physical Rehabilitation in the ICU and Ventilator Liberation

Early Physical Rehabilitation in the ICU and Ventilator Liberation Early Physical Rehabilitation in the ICU and Ventilator Liberation 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 Respiratory Care 2012 Oct Vol 57 No 10 Pedro A Mendez-Tellez MD and Dale M Needham MD PhD

More information

Tracheostomy practice in adults with acute respiratory failure

Tracheostomy practice in adults with acute respiratory failure 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 Tracheostomy practice in adults with acute respiratory failure Bradley D. Freeman, MD, FACS; Peter E. Morris, MD, FCCP Crit Care Med 2012 Vol. 40, No. 10

More information

Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit

Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit Authors: Juliana Barr, MD, FCCM; Gilles L. Fraser, PharmD, FCCM; Kathleen Puntillo,

More information

The clinical implication and prognostic predictors of Tigecycline treatment for pneumonia involving multidrug-resistant Acinetobacter baumannii

The clinical implication and prognostic predictors of Tigecycline treatment for pneumonia involving multidrug-resistant Acinetobacter baumannii Journal of Infection (2011) 63, 351e361 The clinical implication and prognostic predictors of Tigecycline treatment for pneumonia involving multidrug-resistant Acinetobacter baumannii R 陳南丞 VS 余文良醫師 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時,

More information

PROTON PUMP INHIBITOR AND CLOPIDOGREL INTERACTION: Am J Gastroenterol Jan;105(1): Epub 2009 Nov 10.

PROTON PUMP INHIBITOR AND CLOPIDOGREL INTERACTION: Am J Gastroenterol Jan;105(1): Epub 2009 Nov 10. PROTON PUMP INHIBITOR AND CLOPIDOGREL INTERACTION: FACT OR FICTION? 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 Am J Gastroenterol. 2010 Jan;105(1):34-41. Epub 2009 Nov 10. Introduction Current consensus

More information

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock 2012

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock 2012 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock 2012 Definition Sepsis the presence of infection with

More information

Journal meeting. 時間 : Aug 4, 2014 地點 : ICU 討論室報告者 : 陳信宏主治醫師 : 楊俊杰醫師

Journal meeting. 時間 : Aug 4, 2014 地點 : ICU 討論室報告者 : 陳信宏主治醫師 : 楊俊杰醫師 Journal meeting 時間 : Aug 4, 2014 地點 : ICU 討論室報告者 : 陳信宏主治醫師 : 楊俊杰醫師 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 What is the future of ARDS after the Berlin definition? Carmen S.V. Barbas, Alexandre M.

More information

Summary of Delirium Clinical Practice Guideline Recommendations Post Operative

Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Intensive Care Unit Clinical Practice Guideline for Postoperative Clinical Practice Guidelines for the Delirium in Older Adults;

More information

Implementing the 2013 PAD Guidelines

Implementing the 2013 PAD Guidelines 1 of 20 8/11/2013 10:25 PM www.medscape.com Implementing the 2013 PAD Guidelines Top Ten Points to Consider Brenda T. Pun, MSN, RN, ACNP, Michele C. Balas, PhD, RN, APRN-NP, CCRN, Judy Davidson, DNP, RN,

More information

Vocal cord dysfunction: what do we know? K. Kenn and R. Balkissoon European Respiratory Journal 2011; 37:

Vocal cord dysfunction: what do we know? K. Kenn and R. Balkissoon European Respiratory Journal 2011; 37: 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 Vocal cord dysfunction: what do we know? K. Kenn and R. Balkissoon European Respiratory Journal 2011; 37: 194 200 Introduction Refractory or severe asthma

More information

AN INTRODUCTION TO EXTRACORPOREAL BLOOD PURIFICATION IN CRITICAL ILLNESS. Proceedings of Singapore Healthcare Volume 21 Number

AN INTRODUCTION TO EXTRACORPOREAL BLOOD PURIFICATION IN CRITICAL ILLNESS. Proceedings of Singapore Healthcare Volume 21 Number AN INTRODUCTION TO EXTRACORPOREAL BLOOD PURIFICATION IN CRITICAL ILLNESS Proceedings of Singapore Healthcare Volume 21 Number 2 2012 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時, 須獲得原期刊之同意授權 Mechanisms of Extracorporeal

More information

The Pharmacist s Role in Implementing the New Pain, Agitation, and Delirium Guidelines in the Critical Care Setting

The Pharmacist s Role in Implementing the New Pain, Agitation, and Delirium Guidelines in the Critical Care Setting The Pharmacist s Role in Implementing the New Pain, Agitation, and Delirium Guidelines in the Critical Care Setting Presented as a Breakfast Symposium and Live Webcast at the 47 th ASHP Midyear Clinical

More information

Critical Care Strategic Clinical Network Provincial ICU Delirium Framework

Critical Care Strategic Clinical Network Provincial ICU Delirium Framework Pain assessed and documentation using validated tool (CPOT and NRS) Assess and document q4h and prn 100% of patients assessed for pain and documented q4h A: Assess, Prevent & Manage Pain Self Reporting

More information

ICU Liberation for the Pharmacist. A. Kendall Gross, PharmD, BCPS, BCCCP Critical Care Pharmacist UCSF Medical Center

ICU Liberation for the Pharmacist. A. Kendall Gross, PharmD, BCPS, BCCCP Critical Care Pharmacist UCSF Medical Center ICU Liberation for the Pharmacist A. Kendall Gross, PharmD, BCPS, BCCCP Critical Care Pharmacist UCSF Medical Center Disclosure No conflicts of interest to disclose Objectives o Outline the elements of

More information

DELIRIUM IN ICU: Prevention and Management. Milind Baldi

DELIRIUM IN ICU: Prevention and Management. Milind Baldi DELIRIUM IN ICU: Prevention and Management Milind Baldi Contents Introduction Risk factors Assessment Prevention Management Introduction Delirium is a syndrome characterized by acute cerebral dysfunction

More information

Delirium Monograph - Update, Spring 2014

Delirium Monograph - Update, Spring 2014 Delirium Monograph - Update, Spring 2014 Since publication of the APM monograph on Delirium in January 2012, three structured reviews have been published adding data relevant to the practice of identification,

More information

Fighting the Fog A Collaborative Approach to Decreasing ICU Delirium

Fighting the Fog A Collaborative Approach to Decreasing ICU Delirium Fighting the Fog A Collaborative Approach to Decreasing ICU Delirium Kimberly Scherr NP Jennifer Barker RN Misericordia Hospital ICU Edmonton, AB CACCN Dynamics Sept 21, 2014 Delirium Delirium is an acute

More information

Pain, Agitation & Delirium (2013) Immobility & Sleep (2018) Catherine Jones Practice Educator GICU October 2018

Pain, Agitation & Delirium (2013) Immobility & Sleep (2018) Catherine Jones Practice Educator GICU October 2018 Pain, Agitation & Delirium (2013) Immobility & Sleep (2018) Catherine Jones Practice Educator GICU October 2018 1 Plan for session Why Pain Agitation & Delirium are important considerations in critical

More information

KEY REFERENCES laying the foundation for A of ABCDEF bundle

KEY REFERENCES laying the foundation for A of ABCDEF bundle KEY REFERENCES laying the foundation for A of ABCDEF bundle Puntillo K. Am J Crit Care (Response Procedural Pain) 2001;10:238-251 Payen J. Crit Care Med (Behavioral Pain Scale) 2001;29:2258-2263 Gelinas

More information

Managing Delirium: The best way to achieve clarity (of mind) Tim Walsh. Professor of Critical Care, Edinburgh University

Managing Delirium: The best way to achieve clarity (of mind) Tim Walsh. Professor of Critical Care, Edinburgh University Managing Delirium: The best way to achieve clarity (of mind) Tim Walsh Professor of Critical Care, Edinburgh University Lecture Plan: a route to clarity What is delirium? Why is delirium important? Step

More information

Disclosure. Hospira Pharmaceuticals. Unrestricted research funding Honoraria for CME education administered via France Foundation

Disclosure. Hospira Pharmaceuticals. Unrestricted research funding Honoraria for CME education administered via France Foundation Disclosure Hospira Pharmaceuticals Unrestricted research funding Honoraria for CME education administered via France Foundation Economics in Sedation: Responsible Use of the ICU Budget John W. Devlin,

More information

Ventilator-Associated Event Prevention: Innovations

Ventilator-Associated Event Prevention: Innovations Ventilator-Associated Event Prevention: Innovations Michael J. Apostolakos, MD Professor of Medicine Director, Adult Critical Care University of Rochester Mobility/Sedation in the ICU Old teaching: Keep

More information

The Pharmacist s Role in Implementing the New Pain, Agitation, and Delirium Guidelines in the Critical Care Setting

The Pharmacist s Role in Implementing the New Pain, Agitation, and Delirium Guidelines in the Critical Care Setting The Pharmacist s Role in Implementing the New Pain, Agitation, and Delirium Guidelines in the Critical Care Setting Presented as a Breakfast Symposium and Live Webcast at the 47 th ASHP Midyear Clinical

More information

ICU Delirium in Infants & Children: Cause for Concern or False Alarm. Objectives

ICU Delirium in Infants & Children: Cause for Concern or False Alarm. Objectives ICU Delirium in Infants & Children: Cause for Concern or False Alarm Peter (Pete) N. Johnson, Pharm.D., BCPS, BCPPS, FPPAG Associate Professor of Pharmacy Practice University of Oklahoma College of Pharmacy

More information

Sarah V. Cogle, PharmD, BCCCP Assistant Clinical Professor Auburn University Harrison School of Pharmacy Auburn, AL ALSHP Annual Clinical Meeting

Sarah V. Cogle, PharmD, BCCCP Assistant Clinical Professor Auburn University Harrison School of Pharmacy Auburn, AL ALSHP Annual Clinical Meeting Sarah V. Cogle, PharmD, BCCCP Assistant Clinical Professor Auburn University Harrison School of Pharmacy Auburn, AL ALSHP Annual Clinical Meeting 2018 I have no actual or potential conflict of interest

More information

Canadian Practices for the Treatment of Delirium. Lisa Burry, BScPharm, PharmD

Canadian Practices for the Treatment of Delirium. Lisa Burry, BScPharm, PharmD Canadian Practices for the Treatment of Delirium Lisa Burry, BScPharm, PharmD Disclosures & Acknowledgements Conflicts of interest: None Acknowledgements: our patients and the clinical staff that supported

More information

Sedation of the Critically Ill Patient

Sedation of the Critically Ill Patient Buffalo theory of sedation It s a well known fact that a herd of buffalo can only move as fast as the slowest buffalo. And when the herd is hunted, it s the slowest and weakest ones at the back that are

More information

Sedation and Delirium Questions

Sedation and Delirium Questions Sedation and Delirium Questions TLC Curriculum William J. Ehlenbach, MD MSc Assistant Professor of Medicine Pulmonary & Critical Care Medicine Question 1 Deep sedation in ventilated critically patients

More information

Analgesia, Sedation and Delirium The Latest Evidence in Assessment & Treatment

Analgesia, Sedation and Delirium The Latest Evidence in Assessment & Treatment Analgesia, Sedation and Delirium The Latest Evidence in Assessment & Treatment Julie Miller, RN, BSN, CCRN How many of you routinely assess for delirium in your patients? 2013 SCCM Guidelines Pain Recommend

More information

Management of pain, agitation, and delirium in critically ill patients

Management of pain, agitation, and delirium in critically ill patients REVIEW ARTICLE Management of pain, agitation, and delirium in critically ill patients Pratik P. Pandharipande 1,2, Mayur B. Patel 2,3, Juliana Barr 4 1 Division of Critical Care, Department of Anesthesiology,

More information

ANALGESIA AND SEDATION IN MECHANICAL VENTILATION

ANALGESIA AND SEDATION IN MECHANICAL VENTILATION ANALGESIA AND SEDATION IN MECHANICAL VENTILATION Erik Stoltenberg, MD Abbott Northwestern Hospital February 27, 2018 DISCLOSURE Nothing to disclose AllinaHealthSystem 1 OBJECTIVE To apply knowledge of

More information

Interaction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico

Interaction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico Interaction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico Balance is not that easy! Weaning Weaning is the liberation of a patient from

More information

Doug Paul, D.O. FACOS Medical Director, Trauma Services Kettering Health Network

Doug Paul, D.O. FACOS Medical Director, Trauma Services Kettering Health Network Doug Paul, D.O. FACOS Medical Director, Trauma Services Kettering Health Network A paradigm shift (or revolutionary science) is, a change in the basic assumptions, or paradigms, within the ruling theory

More information

Sedation and delirium- drugs and clinical management

Sedation and delirium- drugs and clinical management Sedation and delirium- drugs and clinical management Shannon S. Carson, MD Associate Professor and Chief Division of Pulmonary and Critical Care Medicine University of North Carolina Probability of transitioning

More information

+ Change in baseline mental status, inattention, and either disorganized thinking or altered level of consciousness. Delirium. Disclosure.

+ Change in baseline mental status, inattention, and either disorganized thinking or altered level of consciousness. Delirium. Disclosure. 47 th Annual Meeting August 2-4, 2013 Orlando, FL Identification, Prevention and Treatment of Delirium: The Role of the Health System Pharmacist Jennifer Cortes, PharmD, BCPS Medical ICU Clinical Pharmacy

More information

ICU LIBERATION: IMPLEMENTING THE ABCDEF BUNDLE AND IMPROVING THE LIVES OF ICU PATIENTS

ICU LIBERATION: IMPLEMENTING THE ABCDEF BUNDLE AND IMPROVING THE LIVES OF ICU PATIENTS ICU LIBERATION: IMPLEMENTING THE ABCDEF BUNDLE AND IMPROVING THE LIVES OF ICU PATIENTS J. MATTHEW ALDRICH, MD ASSOCIATE CLINICAL PROFESSOR OF ANESTHESIA AND PERIOPERATIVE CARE UNIVERSITY OF CALIFORNIA

More information

Conflict of Interest. Patient Case. Objectives. The Balancing Act. Why We Need Sedation

Conflict of Interest. Patient Case. Objectives. The Balancing Act. Why We Need Sedation Agitation in the ICU Have we swung the pendulum too far from benzodiazepines? Conflict of Interest The author of this presentation has no conflicts of interest to disclose Nina Vadiei, PharmD PGY1 Pharmacy

More information

PRESCRIBING PRACTICE IN DELIRIUM. John Warburton Critical Care Pharmacist

PRESCRIBING PRACTICE IN DELIRIUM. John Warburton Critical Care Pharmacist PRESCRIBING PRACTICE IN DELIRIUM John Warburton Critical Care Pharmacist Learning outcomes Modifiable medication risk factors for delirium An appreciation of contributing factors modifiable with medicines

More information

Improving the Management of Pain, Agitation, and Delirium (PAD) in the Intensive Care Unit: Translating Evidence Into Practice

Improving the Management of Pain, Agitation, and Delirium (PAD) in the Intensive Care Unit: Translating Evidence Into Practice Improving the Management of Pain, Agitation, and Delirium (PAD) in the Intensive Care Unit: Translating Evidence Into Practice Christine M. Groth, Pharm.D., BCCCP NYS Partnership for Patients September

More information

Kendiss Olafson MD FRCPC MPH Section of Critical Care University of Manitoba

Kendiss Olafson MD FRCPC MPH Section of Critical Care University of Manitoba Kendiss Olafson MD FRCPC MPH Section of Critical Care University of Manitoba Outline Sedation in ICU Purpose/Goals Common Drugs Sedation delivery strategies Mobility in the ICU Weakness with critical illness

More information

KICU Spontaneous Awakening Trial (SAT) Questionnaire

KICU Spontaneous Awakening Trial (SAT) Questionnaire KICU Spontaneous Awakening Trial (SAT) Questionnaire Please select your best answer(s): 1. What is your professional role? 1 Staff Nurse 2 Nurse Manager 3 Nurse Educator 4 Physician 5 Medical Director

More information

Sedation in The ICU: The Biological Cost of the Depression of Consciousness

Sedation in The ICU: The Biological Cost of the Depression of Consciousness Sedation in The ICU: The Biological Cost of the Depression of Consciousness Michael Ramsay MD FRCA Chairman Department of Anesthesia Baylor University Medical Center Professor Texas A&M University Clinical

More information

NIH Public Access Author Manuscript Crit Care Med. Author manuscript; available in PMC 2015 December 01.

NIH Public Access Author Manuscript Crit Care Med. Author manuscript; available in PMC 2015 December 01. NIH Public Access Author Manuscript Published in final edited form as: Crit Care Med. 2014 December ; 42(12): e791 e795. doi:10.1097/ccm.0000000000000660. Effectiveness of Implementing a Wake up and Breathe

More information

Comfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know

Comfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know Comfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know Sandy Staveski RN, PhD, CPNP-AC/PC, CNS; Cincinnati Children s Hospital Medical Center Mary Rummell,

More information

WAKE UP AND TREAT DELIRIUM : PITFALLS OF THE PAD GUIDELINES

WAKE UP AND TREAT DELIRIUM : PITFALLS OF THE PAD GUIDELINES WAKE UP AND TREAT DELIRIUM : PITFALLS OF THE PAD GUIDELINES Tudy Hodgman, Pharm D, FCCM, BCPS The goal of this discussion will be to review the literature published since the PAD guidelines were released

More information

KEY REFERENCES Laying the foundation for D of ABCDEF bundle

KEY REFERENCES Laying the foundation for D of ABCDEF bundle KEY REFERENCES Laying the foundation for D of ABCDEF bundle Ely E. JAMA. 2001;286:2703-2710 (CAM-ICU) Bergeron N. Intensive Care Med. 2001;27:859-864 (ICDSC) Dubois M. Intensive Care Med. 2001;27:1297-1304

More information

Collaborative Regional Benchmarking Group (North of England, North Yorkshire & Humber and West Yorkshire)

Collaborative Regional Benchmarking Group (North of England, North Yorkshire & Humber and West Yorkshire) Best Practice Guidance Sedation These recommendations are bound by the current evidence and best practice at the time of writing and so will be subject to change as further developments are made in this

More information

Dexmedetomidine: the various roles and utilization strategies. Julie Belfer, PharmD September 2014

Dexmedetomidine: the various roles and utilization strategies. Julie Belfer, PharmD September 2014 Dexmedetomidine: the various roles and utilization strategies Julie Belfer, PharmD September 2014 Disclosure No disclosures concerning possible financial or personal relationships with commercial entities

More information

Update on the Management and Monitoring of Deep Analgesia and Sedation in the Intensive Care Unit

Update on the Management and Monitoring of Deep Analgesia and Sedation in the Intensive Care Unit AACN Advanced Critical Care Volume 24, Number 2, pp.101 107 2013, AACN ECG Challenges Earnest Alexander, PharmD, and Gregory M. Susla, PharmD Department Editors Update on the Management and Monitoring

More information

NYSPFP HIIN: VAE/Delirium Prevention. Operationalizing the Pain, Agitation and Delirium Assessments

NYSPFP HIIN: VAE/Delirium Prevention. Operationalizing the Pain, Agitation and Delirium Assessments NYSPFP HIIN: VAE/Delirium Prevention Operationalizing the Pain, Agitation and Delirium Assessments March 28, 2017 1 Agenda Topic Welcome and Introductions A Guide for Success: Implementing the Confusion

More information

ICU Delirium and sedation: understanding their role in long-term patient outcomes. Yoanna Skrobik MD FRCP(c)

ICU Delirium and sedation: understanding their role in long-term patient outcomes. Yoanna Skrobik MD FRCP(c) ICU Delirium and sedation: understanding their role in long-term patient outcomes Yoanna Skrobik MD FRCP(c) Conflicts of interest Member, SCCM Pain, Agitation and Delirium guidelines writing committee

More information

Sleep in the ICU: helped by drugs? Yoanna Skrobik MD FRCP(c) MSc.

Sleep in the ICU: helped by drugs? Yoanna Skrobik MD FRCP(c) MSc. Sleep in the ICU: helped by drugs? Yoanna Skrobik MD FRCP(c) MSc. Conflicts of interest Member, SCCM Pain, Agitation and Delirium guidelines writing committee Vice-chair, SCCM Pain, Agitation, Delirium,

More information

Juliana Barr. Associate Professor of Anesthesiology, Perioperative and Pain Medicine at the Palo Alto Veterans Affairs Health Care System.

Juliana Barr. Associate Professor of Anesthesiology, Perioperative and Pain Medicine at the Palo Alto Veterans Affairs Health Care System. Associate Professor of Anesthesiology, Perioperative and Pain Medicine at the Palo Alto Veterans Affairs Health Care System NIH Biosketch available Online Bio BIO Dr. Barr is currently an Associate Professor

More information

Sedation Hold/Interruption and Weaning Protocol ( Wake-up and Breathe )

Sedation Hold/Interruption and Weaning Protocol ( Wake-up and Breathe ) PROTOCOL Sedation Hold/Interruption and Weaning Protocol ( Wake-up and Breathe ) Page 1 of 6 Scope: Population: Outcome: Critical care clinicians and providers. All ICU patients intubated or mechanically

More information

From the Department of Pharmacy (JM, CAF) and Department of Pulmonary and Critical

From the Department of Pharmacy (JM, CAF) and Department of Pulmonary and Critical PrintClose Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay * Author(s): Marshall, John PharmD; Finn, Christine A.

More information

Saman Arbabi M.D., M.P.H., F.A.C.S. Kathleen O'Connell M.D. Bryce Robinson M.D., M.S., F.A.C.S., F.C.C.M

Saman Arbabi M.D., M.P.H., F.A.C.S. Kathleen O'Connell M.D. Bryce Robinson M.D., M.S., F.A.C.S., F.C.C.M Form "EAST Multicenter Study Proposal" Study Title Primary investigator / Senior researcher Email of Primary investigator / Senior researcher Co-primary investigator Are you a current member of EAST? If

More information

Disclosures. Learning Objectives. Updates in Critical Care Pharmacy: Reviewing Pain, Agitation, and Delirium in the Adult Critically Ill 5/15/2016

Disclosures. Learning Objectives. Updates in Critical Care Pharmacy: Reviewing Pain, Agitation, and Delirium in the Adult Critically Ill 5/15/2016 Updates in Critical Care Pharmacy: Reviewing Pain, Agitation, and Delirium in the Adult Critically Ill Chris Oswald, PharmD, BCPS, BCCCP Clinical Pharmacist Saint Alphonsus Regional Medical Center (Boise,

More information

Conducting Delirium Research

Conducting Delirium Research Optimizing Clinical Trials When Conducting Research Research funding: Disclosure NHLBI, NIA, AstraZeneca John W. Devlin, PharmD, FCCP, FCCM, Professor of Pharmacy, Northeastern University Scientific Staff,

More information

Goals for sedation during mechanical ventilation

Goals for sedation during mechanical ventilation New Uses of Old Medications Gina Riggi, PharmD, BCCCP, BCPS Clinical Pharmacist Trauma ICU Jackson Memorial Hospital Disclosure I do not have anything to disclose Objectives Describe the use of ketamine

More information

Juliana Barr, MD, FCCM

Juliana Barr, MD, FCCM Juliana Barr, MD, FCCM Staff Anesthesiologist and Intensivist, VA Palo Alto Health Care System Associate Professor, Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine

More information

Approach to agitated patient in ICU

Approach to agitated patient in ICU Approach to agitated patient in ICU 12-2-2016 Kodati Rakesh Senior resident Pulmonary medicine Agitation Psychomotor disturbance characterized by a marked increase in both motor and psychological activities,

More information

7/6/ ANNUAL MEETING BRINGING THE ABC(DEF) S TO THE ICU ICU TRIAD DISCLOSURE ICU TRIAD SEDATION AND ANALGESIA OBJECTIVES

7/6/ ANNUAL MEETING BRINGING THE ABC(DEF) S TO THE ICU ICU TRIAD DISCLOSURE ICU TRIAD SEDATION AND ANALGESIA OBJECTIVES ICU TRIAD BRINGING THE ABC(DEF) S TO THE ICU GINA RIGGI, PHARMD, BCPS, BCCCP CLINICAL HOSPITAL PHARMACIST- TRAUMA INTENSIVE CARE UNIT JACKSON MEMORIAL HOSPITAL MIAMI, FLORIDA Figure 1. Reade M and Finfer

More information

Delirium in the intensive care unit: a narrative review of published assessment tools and the relationship between ICU delirium and clinical outcomes

Delirium in the intensive care unit: a narrative review of published assessment tools and the relationship between ICU delirium and clinical outcomes The Intensive Care Society 2008 Delirium in the intensive care unit: a narrative review of published assessment tools and the relationship between ICU delirium and clinical outcomes C Waters Delirium is

More information

Overview of Presentation. Delirium Definition. Assessing & Managing ICU Delirium: What is the Evidence?

Overview of Presentation. Delirium Definition. Assessing & Managing ICU Delirium: What is the Evidence? Assessing & Managing ICU Delirium: What is the Evidence? Dale Needham, MD, PhD Professor Pulmonary & Critical Care Medicine, and Physical Medicine & Rehabilitation Medical Director, Critical Care Physical

More information

Delirium. Delirium. Delirium Etiology and Pathophysiology. Fall 2018

Delirium. Delirium. Delirium Etiology and Pathophysiology. Fall 2018 Three most common cognitive problems in adults 1. (acute confusion) 2. Dementia 3. Depression These problems often occur together Can you think of common stimuli for each? 1 1 State of temporary but acute

More information

Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium

Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Online Data Supplement Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility (ABCDE) Bundle Authors-Michele C. Balas, Eduard

More information

Drug induced delirium

Drug induced delirium Drug induced delirium Knut Erik Hovda, MD, PhD, FACMT, FEAPCCT The Norwegian CBRNe Centre of Medicine Department of Acute Medicine Oslo University hospital Content 1. Introduction 2. Risk factors 3. Prevalence

More information

Current Clinical Patterns in the Management of Alcohol Withdrawal Syndrome (AWS)

Current Clinical Patterns in the Management of Alcohol Withdrawal Syndrome (AWS) 1 Current Clinical Patterns in the Management of Alcohol Withdrawal Syndrome (AWS) The goal of the survey is to evaluate current practices for the inpatient management of AWS in adult hospitals located

More information

Monday, October 17 3:45 p.m. 5:45 p.m. Convention Center: Spirit of Pittsburgh Ballroom A

Monday, October 17 3:45 p.m. 5:45 p.m. Convention Center: Spirit of Pittsburgh Ballroom A Critical Care PRN and Society of Critical Care Medicine Focus Session Sedation and Delirium in the ICU: Update on the Status of the 2011 SCCM Guidelines Activity No. 0217-0000-11-079-L01-P (Application-Based

More information

9/28/2016. Sedation Strategies in the ICU. Outline. ICU sedation. Recent clinical practice guidelines Top 10 myths A practical approach

9/28/2016. Sedation Strategies in the ICU. Outline. ICU sedation. Recent clinical practice guidelines Top 10 myths A practical approach Sedation Strategies in the ICU UW Medicine EMS and Trauma Conference Seattle, Washington September 26 th, 2016 C. Terri Hough, MD MSc Associate Professor of Medicine Division of Pulmonary and Critical

More information

ABCs of ICU Delirium Marian Maxwell, Pharm.D., BCCCP January 6, 2018

ABCs of ICU Delirium Marian Maxwell, Pharm.D., BCCCP January 6, 2018 ABCs of ICU Delirium Marian Maxwell, Pharm.D., BCCCP January 6, 2018 Disclosures I do not have any financial/non-financial relationships to disclose. Learning Objectives Define delirium and discuss the

More information

ICU Liberation ABCDEF Bundle Implementation: Focus on Delirium

ICU Liberation ABCDEF Bundle Implementation: Focus on Delirium ICU Liberation ABCDEF Bundle Implementation: Focus on Delirium Diane Byrum MSN RN CCRN-K CCNS FCCM Quality Implementation Consultant Innovative Solutions For Healthcare Education, LLC Oak Island, NC ICU

More information

AGITATION ONSET, FREQUENCY, AND ASSOCIATED TEMPORAL FACTORS IN CRITICALLY ILL ADULTS. Patient Safety Issues

AGITATION ONSET, FREQUENCY, AND ASSOCIATED TEMPORAL FACTORS IN CRITICALLY ILL ADULTS. Patient Safety Issues Patient Safety Issues AGITATION ONSET, FREQUENCY, AND ASSOCIATED TEMPORAL FACTORS IN CRITICALLY ILL ADULTS By Ruth S. Burk, RN, PhD, ANP-BC, Mary Jo Grap, RN, PhD, Cindy L. Munro, RN, PhD, ANP-C, Christine

More information

Delirium Prevalence in Acute Care Hospitalized Patients

Delirium Prevalence in Acute Care Hospitalized Patients Delirium Prevalence in Acute Care Hospitalized Patients Linda Cason DNP, CNS, RN-BC, NE-BC, CNRN Brittany Farmer MSN, CNS, ACCNS-AG, CCRN Kim Salee MSN, RN, AGCNS-BC, CWOCN Abby Schmitt MSN, RN-BC Objectives

More information

A Randomized Placebo-controlled Trial of Clonidine Impact on Sedation of Mechanically Ventilated ICU Patients

A Randomized Placebo-controlled Trial of Clonidine Impact on Sedation of Mechanically Ventilated ICU Patients Iranian Journal of Pharmaceutical Research (205), 4 (): 67-75 Received: September 203 Accepted: December 203 Copyright 205 by School of Pharmacy Shaheed Beheshti University of Medical Sciences and Health

More information

Early Goal-Directed Sedation Versus Standard Sedation in Mechanically Ventilated Critically Ill Patients: A Pilot Study*

Early Goal-Directed Sedation Versus Standard Sedation in Mechanically Ventilated Critically Ill Patients: A Pilot Study* Early Goal-Directed Sedation Versus Standard Sedation in Mechanically Ventilated Critically Ill Patients: A Pilot Study* Yahya Shehabi, FCICM, FANZCA, EMBA 1,2,3 ; Rinaldo Bellomo, MD, FCICM, FRACP 2,3

More information

Comfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know

Comfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know Comfort Management in the Adult with Congenital Heart Disease What the ICU Bedside Nurse Needs to Know Sandy Staveski RN, MS, CPNP-AC/PC, CNS, CCRN Pediatric Intensive Care Nurse Practitioner Lucile Packard

More information

Pathway to Pain Control

Pathway to Pain Control Pathway to Pain Control Assessing, Preventing, and Managing Pain in the Intensive Care Unit Caitlin S. Brown, PharmD Brianne M. Ritchie, PharmD, MBA, BCCCP, BCPS Pharmacy Grand Rounds November 21, 2017

More information

Jennifer Mando-Vandrick, PharmD, BCPS Clinical Pharmacist, Emergency Department Director, PGY2 Critical Care Pharmacy Residency Duke University

Jennifer Mando-Vandrick, PharmD, BCPS Clinical Pharmacist, Emergency Department Director, PGY2 Critical Care Pharmacy Residency Duke University Jennifer Mando-Vandrick, PharmD, BCPS Clinical Pharmacist, Emergency Department Director, PGY2 Critical Care Pharmacy Residency Duke University Hospital Objectives Review pertinent pharmacotherapy common

More information

Management of Delirium in the ICU. Yahya Shehabi

Management of Delirium in the ICU. Yahya Shehabi Management of Delirium in the ICU Yahya Shehabi Hello! Doctor, your patient is CAM + ve Good morning Dr, Am one of the RC, Just examined Mr XXX he is CAM +ve Positive what? Sir replied RC: I meant he is

More information

Do benzos, opioids, or strong anticholinergics cause delirium? Lisa Burry

Do benzos, opioids, or strong anticholinergics cause delirium? Lisa Burry Do benzos, opioids, or strong anticholinergics cause delirium? Lisa Burry Delirium in the ICU Occurs in up to 85% of MICU/SICU MV patients 20-50% of lower severity ICU patients develop delirium Hypoactive

More information

Vanderbilt University Medical Center Multidisciplinary Surgical Critical Care

Vanderbilt University Medical Center Multidisciplinary Surgical Critical Care Vanderbilt University Medical Center Multidisciplinary Surgical Critical Care PROTOCOLIZING AND MONITORING SEDATION, ANALGESIA AND DELIRIUM IN THE CRITICALLY ILL Introduction Critically ill patients are

More information

Critical Care Pharmacological Management of Delirium

Critical Care Pharmacological Management of Delirium Critical Care Pharmacological Management of Delirium Policy Title: in the Critical Care Unit Executive Summary: This policy provides guidance Pharmacological Management of delirium in the Critical Care

More information

POST-INTUBATION ANALGESIA AND SEDATION. August 2012 J Pelletier

POST-INTUBATION ANALGESIA AND SEDATION. August 2012 J Pelletier POST-INTUBATION ANALGESIA AND SEDATION August 2012 J Pelletier Intubated patients experience pain and anxiety Mechanical ventilation, endotracheal tube Blood draws, positioning, suctioning Surgical procedures,

More information

5 older patients become delirious every minute

5 older patients become delirious every minute Management of Delirium: Nonpharmacologic and Pharmacologic Approaches Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley

More information

Putting the Pieces of the Puzzle Together: A Journey through ABCDEF

Putting the Pieces of the Puzzle Together: A Journey through ABCDEF Putting the Pieces of the Puzzle Together: A Journey through ABCDEF Kristy Colford RN,BSN, CCRN Clinical Nurse Educator Avera McKennan Intensive Care Kristy Colford- Have No Disclosures ZOOM in & ZOOM

More information

SEDATION, AGITATION, DELIRIUM Daniel Lollar, MD

SEDATION, AGITATION, DELIRIUM Daniel Lollar, MD SEDATION, AGITATION, DELIRIUM Daniel Lollar, MD OVERVIEW Correctable causes of agitation Pain assessment opioids Agitation assessment BZNs, propofol, precedex comparisons Delirium haldol, antipsychotics

More information

North Wales Critical Care Network

North Wales Critical Care Network North Wales Critical Care Network SEDATION GUIDELINES FOR ADULTS IN CRITICAL CARE Approved 6.9.12 1 Sedation guidelines for intensive care Betsi Cadwaladr University Health Board (Adapted from guidelines

More information

Can Goal Directed Sedation Improve Outcomes?

Can Goal Directed Sedation Improve Outcomes? Can Goal Directed Sedation Improve Outcomes? Yahya SHEHABI, FANZCA, FCICM, EMBA Professor and Program Director Critical care Monash Health and Monash University - Melbourne School of Medicine, University

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Page VJ, Casarin A, Ely EW, et al. Evaluation

More information

Current awareness of delirium in the intensive care unit: a postal survey in the Netherlands

Current awareness of delirium in the intensive care unit: a postal survey in the Netherlands SPECIAL REPORT Current awareness of delirium in the intensive care unit: a postal survey in the Netherlands F.L. Cadogan 1, B. Riekerk 2, R. Vreeswijk 1, J.H. Rommes 2, A.C. Toornvliet 1, M.L.H. Honing

More information

Sedation and Analgesia in the Critically Ill

Sedation and Analgesia in the Critically Ill 12th Congress of the World Federation of Societies of Intensive and Critical Care Medicine August 29 (Sat.) September 1 (Tue.), 2015 COEX, Seoul, Korea ONE STEP FURTHER: THE PURSUIT OF EXCELLENCE IN CRITICAL

More information

Early Goal Directed Sedation In Critically Ill Patients

Early Goal Directed Sedation In Critically Ill Patients Early Goal Directed Sedation In Critically Ill Patients Yahya Shehabi, FCICM, FANZCA, EMBA Professor, Intensive Care Medicine Clinical School of Medicine, University New South Wales School of Epidemiology

More information

COMPARISON OF SEDATION FOR ALCOHOL WITHDRAWAL Crispo et al 911

COMPARISON OF SEDATION FOR ALCOHOL WITHDRAWAL Crispo et al 911 Comparison of Clinical Outcomes in Nonintubated Patients with Severe Alcohol Withdrawal Syndrome Treated with Continuous-Infusion Sedatives: Dexmedetomidine versus Benzodiazepines Angela L. Crispo, 1 Mitchell

More information

The Difficult to Sedate ICU Patient

The Difficult to Sedate ICU Patient The Difficult to Sedate ICU Patient Dan Burkhardt, M.D. Associate Professor Department of Anesthesia and Perioperative Care University of California San Francisco burkhard@anesthesia.ucsf.edu Richmond

More information

Brain dysfunction in the ICU

Brain dysfunction in the ICU High cortisol levels are associated with brain dysfunction but low prolactin cortisol ratio levels are associated with nosocomial infection in severe sepsis Duc Nam Nguyen Luc Huyghens Johan Schiettecatte

More information

BPG 06: Sedation. Patients receive appropriate sedation to meet their needs, optimising comfort and with minimal adverse effects.

BPG 06: Sedation. Patients receive appropriate sedation to meet their needs, optimising comfort and with minimal adverse effects. Statement of Best Practice BPG 06: Sedation Patients receive appropriate sedation to meet their needs, optimising comfort and with minimal adverse effects. 1: Introduction Indication for sedation will

More information

EFFECT OF ABCDE BUNDLE IMPLEMENTATION DELIRIUM IN INTENSIVE CARE UNIT PATIENTS ON PREVALENCE OF. Delirium Assessment. 1.0 Hour

EFFECT OF ABCDE BUNDLE IMPLEMENTATION DELIRIUM IN INTENSIVE CARE UNIT PATIENTS ON PREVALENCE OF. Delirium Assessment. 1.0 Hour Delirium Assessment EFFECT OF ABCDE BUNDLE IMPLEMENTATION ON PREVALENCE OF DELIRIUM IN INTENSIVE CARE UNIT PATIENTS By Mandy Bounds, RN, MSN, CCRN, Stacey Kram, RN-BC, DNP, PCCN, CCRN, Karen Gabel Speroni,

More information