Pain treatment has the priority over the use of sedatives and antipsychotics. Good pain control is essential for the high risk patient adaptation to acute illness and intensive care environment.
Nevertheless, we must not forget the side effects of analgesics, in particular for opioid: respiratory depression, hypotension, bradycardia, nausea and vomiting, slowing of peristalsis, pruritus, urinary retention are dose-dependent effects, which lead us to limit the amount of opiates at the minimum necessary to control pain.
Recently, analgesia-based sedation has been responsible for increase the intensivists' sensitivity to the problem of pain control in ventilated patients and allowed to test the possibility of keeping awake even critically ill patients at high risk; unfortunately it resulted in an excessive use of opioid analgesics, exposing to the risk of probably avoidable side effects ...
The multimodal analgesia (intravenous acetaminophen, NSAIDs, use of adjuvants such as gabapentin or clonidine, locoregional analgesia where possible) could lead to a reduction of side effects with the same analgesic efficacy.
The international literature shows that the winning approach to decrease morbidity and mortality is to control the pain through the minimum effective dose of analgesics and control anxiety and agitation with other methods (pharmacological and non pharmacological) that have fewer side effects.
A new frontier in critical care: saving the injuried brain.
Gestire il doloreFlowchart dolore
Gestire la sedazioneFlowchart sedaz/agitaz
Gestire il deliriumFlowchart Delirium
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Finanziamento per la Ricerca Indipendente
(Decreto DGS 13456 del 22 dicembre 2010)