Evans Susan L, Olney William J, Bernard Andrew C, Gesin Gail
From the Department of Surgery (S.L.E.), Carolinas Medical Center, Atrium Health, Charlotte, North Carolina; Department of Pharmacy (W.J.O.), Acute Care Surgery, UK HealthCare, Lexington, Kentucky; Department of Surgery (A.C.B.), University of Kentucky, Lexington, Kentucky; and Division of Pharmacy (G.G.), Atrium Health, Charlotte, North Carolina.
J Trauma Acute Care Surg. 2024 Jan 1;96(1):166-177. doi: 10.1097/TA.0000000000004154. Epub 2023 Oct 12.
Pain, agitation, and delirium (PAD) are primary drivers of outcome in the ICU, and expertise in managing these entities successfully is crucial to the intensivist's toolbox. In addition, there are unique aspects of surgical patients that impact assessment and management of PAD. In this review, we address the continuous spectrum of assessment, and management of critically ill surgical patients, with a focus on limiting PAD, particularly incorporating mobility as an anchor to ICU liberation. Finally, we touch on the impact of PAD in specific populations, including opioid use disorder, traumatic brain injury, pregnancy, obesity, alcohol withdrawal, and geriatric patients. The goal of the review is to provide rapid access to information regarding PAD and tools to assess and manage these important elements of critical care of surgical patients.
疼痛、躁动和谵妄(PAD)是重症监护病房(ICU)患者预后的主要驱动因素,成功管理这些情况的专业知识对于重症医学专家的技能组合至关重要。此外,外科患者还有一些独特之处,会影响PAD的评估和管理。在本综述中,我们探讨了危重症外科患者评估和管理的连续过程,重点是限制PAD,特别是将活动能力作为ICU解放的关键因素。最后,我们阐述了PAD在特定人群中的影响,包括阿片类药物使用障碍、创伤性脑损伤、妊娠、肥胖、酒精戒断和老年患者。本综述的目的是提供有关PAD的快速信息获取途径以及评估和管理外科患者重症监护这些重要要素的工具。