Acute and Critical Care

Guideline

Pharmacology
2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit: Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha; Acute Crit Care. 2022;37(1):1-25. Published online February 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00094; Correction in: Acute Crit Care 2023;38(1):149

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We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.

Citations

Citations to this article as recorded by

End‐of‐life care in the intensive care unit
M. Tanaka Gutiez, N. Efstathiou, R. Innes, V. Metaxa
Anaesthesia.2023;[Epub] CrossRef
ICU-Induced Disability Persists With or Without COVID-19—This Is a Call for F to A Bundle Action*
Heidi Engel
Critical Care Medicine.2022; 50(11): 1665. CrossRef
Actigraphy-Based Assessment of Sleep Parameters in Intensive Care Unit Patients Receiving Respiratory Support Therapy
Jiyeon Kang, Yongbin Kwon
Journal of Korean Critical Care Nursing.2022; 15(3): 115. CrossRef

Original Article

Neurology
The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study: Jaesub Park, Seung-Taek Oh, Sunyoung Park, Won-Jung Choi, Cheung Soo Shin, Se Hee Na, Jae-Jin Kim, Jooyoung Oh, Jin Young Park; Acute Crit Care. 2018;33(1):23-33. Published online February 6, 2018; DOI: https://doi.org/10.4266/acc.2017.00584

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Abstract PDF

Background
Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient’s clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown.
Methods
The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation.
Results
There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor’s mental health, was significantly reduced and pain tended to decrease.
Conclusions
Increasing the physician’s awareness of the patient’s mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.

Citations

Citations to this article as recorded by

Adaptation and Validation of a Chart‐Based Delirium Detection Tool for the ICU (CHART‐DEL‐ICU)
Karla D. Krewulak, Carmen Hiploylee, E. W. Ely, Henry T. Stelfox, Sharon K. Inouye, Kirsten M. Fiest
Journal of the American Geriatrics Society.2021; 69(4): 1027. CrossRef

Review

Pharmacology
Assessment and Treatment of Pain in Adult Intensive Care Unit Patients: Jun Mo Park, Ji Hyun Kim; Korean J Crit Care Med. 2014;29(3):147-159. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.147

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Abstract PDF

In most cases, patients admitted to an intensive care unit (ICU) have suffered from severe trauma, undergone major surgery or been treated for a serious medical illness. Although they often experience more intense pain than general ward patients, they are frequently unable to communicate their experiences to health care providers, thus preventing accurate assessment and treatment of their pain. If appropriate measures are not taken to treat pain in critically ill patients, stress response or sympathetic overstimulation can lead to complications. The short-term consequences of untreated pain include higher energy expenditure and immunomodulation. Longer-term, untreated pain increases the risk of post-traumatic stress disorder. Because pain is quite subjective, the accurate assessment of pain is very difficult in the patients with impaired communication ability. The current most valid and reliable behavioral pain scales used to assess pain in adult ICU patients are the Behavioral Pain Scale and the Critical-Care Pain Observation Tool. Once pain has been accurately assessed using these methods, various pharmacologic and non-pharmacologic therapies should be performed by the multidisciplinary care team. Accurate assessment and proper treatment of pain in adult ICU patients will improve patients outcome, which reduces the stress response and decreases the risk of post-traumatic stress disorder.

Citations

Citations to this article as recorded by

Nurses’ knowledge, practice, and associated factors of pain assessment in critically ill adult patients at public hospitals, Addis Ababa, Ethiopia
Temesgen Ayenew, Berhanu Melaku, Mihretie Gedfew, Haile Amha, Keralem Anteneh Bishaw
International Journal of Africa Nursing Sciences.2021; 15: 100361. CrossRef
Impact of Pain Management Algorithm on Pain Intensity of Patients with Loss of Consciousness Hospitalized in Intensive Care Unit: A Clinical Trial
Zahra Dehghani, Asadollah Keikhaei, Fariba Yaghoubinia, Aliakbar Keykha, Masoom Khoshfetrat
Medical - Surgical Nursing Journal.2019;[Epub] CrossRef
Ignorance may be Bliss (for Intensivists), but not for ICU Patients!
Atul P. Kulkarni, Sumitra G Bakshi
Indian Journal of Critical Care Medicine.2019; 23(4): 161. CrossRef

Randomized Controlled Trial

The Analgesic Effect of Remifentanil on Propofol Injection Pain: Younghoon Jeon, Min Je Choi, Choon Hak Lim; Korean J Crit Care Med. 2011;26(4):212-216.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.212

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Abstract PDF: BACKGROUND
Pain is a common side-effect of propofol injection. A remifentanil pretreatment has been reported to decrease the incidence and intensity of pain during a propofol injection and has been suggested to act through a central or peripheral effect. This trial was designed to explore the action site of remifentanil on reducing propofol injection pain, using the venous occlusion technique and a time interval between the applications of remifentanil and propofol.
METHODS
This randomized, double-blind study was designed to explore the action site of remifentanil on reducing propofol injection pain in 200 patients scheduled for elective surgery. The peripheral properties were examined using the venous occlusion technique for 30 s while a 1 min time interval between remifentanil and propofol injections was allowed for the central effect. Before the propofol injection, group A was pretreated with remifentanil (0.5 microg/ kg) with a venous occlusion, group B with remifentanil and a 1 min interval, and group C with remifentanil with a venous occlusion and a 1 min interval. Pain severity was assessed using a four-point scale.
RESULTS
40 patients (80%) complained of pain in the placebo group compared with 35 (70%) in group A, 20 (40%) in group B (p < 0.05) and 17 (34%) in group C (p < 0.05). The incidence and severity of propofol injection pain were lower in groups B and C than in group A (p < 0.05). However, there was no significant difference between groups B and C.
CONCLUSIONS
The remifentanil mediated analgesic effect occurs mainly through the central effect.

Original Article

The Effectiveness of Foot -Reflexo- Massage on the Postoperative Pain of Gastrectomy Patients: Houng Hwa Han, Young Ju Lee, Yun Jeong Chae, Jong Sin Eun, Hyun Ho Lee, Jee Won Park; Korean J Crit Care Med. 2005;20(2):136-143.

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Abstract PDF: BACKGROUND
The objects of this study were to determine the effects of foot reflexo massage on the postoperative pain of the subtotal gastrectomy patients according to quasi-experimental research design, and to provide demonstrative data for using the foot reflexo massage as an intervention for pain nursing. METHODS: The foot reflexo massages were performed on 34 subtotal gastrectomy patients after informed consent was obtained. They were divided into two groups, i.e. control group (n=17) and experimental group (n=17). After 6 hours and 12 hours from the subtotal gastrectomy, the massage was carried out on each foot for 10 minutes twice. Visual analogue scale (VAS) was employed as the measurement tools of pain, and the degree of postoperative pain was measured through frequency of prn (pro re nata) analgesia in chart review. RESULTS: The experimental group with foot reflexo massage 6 hours after the operation have significantly less score of postoperative pain than the control group (5.76+/-0.83, 4.35+/-1.0, p=.000). The experimental group with foot reflexo massage 12 hours after the operation have significantly less score of postoperative pain than the control group (5.12+/-0.53, 3.00+/-1.17, p=.000). The experimental group with foot reflexo massage have significantly less frequency of prn analgesics than the control group from six hours to twelve hours after the operation (p=.004). CONCLUSIONS: It is considered foot reflexo massage is effective for reducing postoperative pain of subtotal gastrectomy patients, as well as useful for an immediate nursing intervention.

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