Abstract
Suboptimal sedation practices continue to be frequent, although the updated guidelines for management of pain, agitation, and delirium in mechanically ventilated (MV) patients have been published for several years. Causes of low adherence to the recommended minimal sedation protocol are multifactorial. However, the barriers to translation of these protocols into standard care for MV patients have yet to be analyzed. In our view, it is necessary to develop fresh insights into the interaction between the patients' responses to nociceptive stimuli and individualized regulation of patients' tolerance when using analgesics and sedatives. By better understanding this interaction, development of novel tools to assess patient pain tolerance and to define and predict oversedation or delirium may promote better sedation practices in the future.
Highlights
Ventilated (MV) patients can have a wide variety of discomforts resulting from multiple sources, including pathophysiological abnormalities, emotional alterations, and intensive care procedures as well [1,2,3,4]
In a nationwide cross-sectional survey, we found that intensive care units (ICU) physicians’ perception of patients’ tolerance to the support levels of ventilation with light sedation was highly varied across institutions
The effectiveness of interventions based on the prediction model need to be investigated in further experimental trials. These findings indicate that agitation is predictable by evaluating variables related to nocioceptive stimuli
Summary
Suboptimal sedation practices continue to be frequent, the updated guidelines for management of pain, agitation, and delirium in mechanically ventilated (MV) patients have been published for several years. The barriers to translation of these protocols into standard care for MV patients have yet to be analyzed. It is necessary to develop fresh insights into the interaction between the patients’ responses to nociceptive stimuli and individualized regulation of patients’ tolerance when using analgesics and sedatives. By better understanding this interaction, development of novel tools to assess patient pain tolerance and to define and predict oversedation or delirium may promote better sedation practices in the future
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