ICU Sedation and Pain Management

Compared with sedatives used in the ISU such as dexmedetomidine or propofol, continuously administered benzodiazepines are associated with what?

When is the pharmacologic strategy of analgeosedation potentially inappropriate as a first-line approach?

Which scales have been recommended by the PAD guideline subcommittee to assess pain in the ICU patient?

Which opioid may offer an additional pain management strategy by increasing analgesia sensitivity by NMDA receptor antagonism?

What can interfere with delirium assessment in ICU patients?

Which enteral medication exhibits pharmacologic activity similar to dexmedetomidine and may help wean a patient from it?

Which sedative agent has the potential to cause propylene glycol toxicity when given as a continuous infusion?

What recommendations should ICU caregivers strive for within their institution?

Pharmacologic management of delirium should consist of which evidence-based pharmacologic therapy?

When selecting an opioid agonist for rapid-onset pain control, which agent should be considered first?

Sedatives in ICU

Benzodiazepines administered continuously are linked to longer ICU stays and increased ventilation time compared to sedatives like dexmedetomidine or propofol.

Analgeosedation Guidelines

Analgeosedation is preferred for ICU patients with agitation but is inappropriate as a first-line treatment in cases of drug-induced agitation, substance-use withdrawal (not opioids), or agitation with a reversible cause not related to pain.

Pain Recognition in ICU

Pain and discomfort are often underrecognized in ICU, with over 40% of patients feeling their pain was inadequately managed.
Recommended scales for pain assessment include the Critical Care Pain Observation Tool (CPOT), Behavioral Pain Scale (BPS), and Numerical Rating Scale (NRS).

Opioid Mechanism

All opioids work mainly by activating the mu-opioid receptor.
Methadone uniquely enhances pain management by acting as an NMDA receptor antagonist.

Delirium in ICU

Delirium is a common consequence of ICU care, leading to increased length of stay, mortality, and costs.
Sedation can hinder the accurate assessment of delirium.

Enteral Medication for Weaning

Clonidine, a central acting alpha-2 agonist, possesses pharmacologic effects similar to dexmedetomidine and can assist in weaning patients from it if they have a functional GI tract.

Sedative Toxicity

Lorazepam, when continuously infused, poses a risk for propylene glycol toxicity.

ICU Care Recommendations

ICU caregivers should prioritize regular assessments of sedation, pain, and agitation to enhance patient care.

Delirium Pharmacologic Management

Current evidence suggests avoiding haloperidol, quetiapine, and donepezil in the pharmacologic management of delirium.

Opioid Selection for Pain Control

Fentanyl is recommended as the first choice for opioid agonist selection aimed at achieving rapid pain control.

This quiz covers essential topics related to sedation and pain management in the Intensive Care Unit (ICU). It discusses the use of sedatives like benzodiazepines, dexmedetomidine, and propofol, as well as guidelines for analgeosedation and pain recognition. Key concepts such as opioid mechanisms and delirium in ICU patients are also explored.