Management of Pain and Agitation for Patients in the Intensive Care Unit

Abstract

Patients admitted to the intensive care unit (ICU) commonly develop pain and agitation. Such symptoms are associated with adverse clinical outcomes, as they can cause delirium, self-removal of life-sustaining devices, difficulty in use of ventilatory supports, hemodynamic instability, intracranial hypertension, posttraumatic stress disorder, etc. Thus, prompt recognition and treatment of pain and agitation are imperative. Identification of possible causes of pain and agitation and nonpharmacological managements should be attempted initially. However, administration of analgesics and sedatives is necessary in many cases. Preemptive interventions prior to procedures to relieve pain are recommended. Intravenous opioids are considered as the first-line drug to treat pain in critically ill patients, especially in those who require mechanical ventilation. For most patients in the ICU, a light level of sedation is associated with improved clinical outcomes. However, patients with unstable medical conditions including severe acute respiratory distress syndrome, hemodynamic instability, refractory status epilepticus, and intracranial hypertension may require a deep level of sedation. Sedation strategies using non-benzodiazepine sedatives may be preferred over sedation with benzodiazepines in mechanically ventilated patients to shorten the duration of mechanical ventilation, length of ICU stay, and days with delirium. Often, ensuring that critically ill patients are free from pain and agitation may conflict with other clinical management goals. Therefore, provision of comprehensive care based on the patients’ condition cannot be overemphasized in the ICU. The purpose of this review is to address pain and agitation management strategies and introduce pharmacological characteristics of sedatives and analgesics commonly used in the ICU. Key Words: Pain; Agitation; Sedation; Analgesia; Intensive care; Critical care medicine