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Pain and agitation are very common in adult, critically ill patients. The Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) Guidelines were published in 2018 to guide clinicians in the assessment, prevention, and management of pain and agitation. Recommended tools to assess for pain include the Numeric Rating Scale, Behavioral Pain Scale, and Critical Care Pain Observational Tool. Opioids are the drug of choice for treating pain in critically ill adults. Non-opiate pain medications including acetaminophen, nonsteroidal anti-inflammatory drugs, ketamine, lidocaine, and neuropathic pain medications are additional adjunctive therapies. Nonpharmacologic therapies for pain must also be considered. The Richmond Agitation Sedation Scale and Sedation-Agitation Scale are the two recommended tools to assess for level of arousal in critically ill adults. Non-benzodiazepine therapies including propofol or dexmedetomidine are first-line therapies for sedation in critically ill adults. Safety screens and conduction, if safety screens passed, of Spontaneous Awakening Trials and Spontaneous Breathing Trials should be conducted daily in mechanically ventilated, critically ill, adult patients.

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Pain and Sedation: Assessment, Prevention, and Treatment in the Intensive Care Unit

  • 章节

  • 发表日期：

    2025年

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  • Joanna L. Stollings,
  • Sybil E. Watkins

摘要

Pain and agitation are very common in adult, critically ill patients. The Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) Guidelines were published in 2018 to guide clinicians in the assessment, prevention, and management of pain and agitation. Recommended tools to assess for pain include the Numeric Rating Scale, Behavioral Pain Scale, and Critical Care Pain Observational Tool. Opioids are the drug of choice for treating pain in critically ill adults. Non-opiate pain medications including acetaminophen, nonsteroidal anti-inflammatory drugs, ketamine, lidocaine, and neuropathic pain medications are additional adjunctive therapies. Nonpharmacologic therapies for pain must also be considered. The Richmond Agitation Sedation Scale and Sedation-Agitation Scale are the two recommended tools to assess for level of arousal in critically ill adults. Non-benzodiazepine therapies including propofol or dexmedetomidine are first-line therapies for sedation in critically ill adults. Safety screens and conduction, if safety screens passed, of Spontaneous Awakening Trials and Spontaneous Breathing Trials should be conducted daily in mechanically ventilated, critically ill, adult patients.