Sarah A. Delgado is a clinical practice specialist at the American Association of Critical-Care Nurses, Aliso Viejo, CA. Contact author:
Am J Nurs. 2020 May;120(5):34-42. doi: 10.1097/01.NAJ.0000662808.81949.d6.
Nurses caring for critically ill adults are challenged to balance patient comfort with the risk of complications associated with analgesic therapy. Evidence gathered since 2013, when the Society of Critical Care Medicine (SCCM) published the Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit, known as the PAD guidelines, gave rise to the SCCM 2018 publication of the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, known as the PADIS guidelines. This article discusses how the PADIS guidelines go beyond the PAD guidelines, providing specific guidance related to risk factors for pain, the assessment and management of pain in critical illness, and the ways in which the experience of pain in critical illness is intertwined with that of agitation, delirium, immobility, and sleep disruption. Tables summarize the key points in the PADIS guidelines, clarify the distinctions between PADIS and PAD, and describe the implications for nurses.
护理危重症成人患者的护士面临着平衡患者舒适度与镇痛治疗相关并发症风险的挑战。自 2013 年重症监护医学学会（SCCM）发布《成人重症监护病房疼痛、躁动和谵妄管理临床实践指南》（简称 PAD 指南）以来，已有证据表明，SCCM 于 2018 年发布了《成人重症监护病房疼痛、躁动/镇静、谵妄、活动受限和睡眠障碍预防和管理临床实践指南》（简称 PADIS 指南）。本文讨论了 PADIS 指南如何超越 PAD 指南，提供了与疼痛风险因素、危重症患者疼痛评估和管理以及危重症患者疼痛体验与躁动、谵妄、活动受限和睡眠障碍相互交织相关的具体指导。表格总结了 PADIS 指南的要点，阐明了 PADIS 与 PAD 之间的区别，并描述了这些指南对护士的意义。
