Objective: In 2013, the American College of Critical Care Medicine published a revised version of the pain, agitation, and delirium guidelines. The guidelines included an ICU pain, agitation, and delirium care bundle designed to facilitate implementation of the pain, agitation, and delirium guidelines.
Design: Review article.
Setting: Multispecialty critical care units.
Patients: Adult ICU patients.
Interventions: This article describes: 1) the ICU pain, agitation, and delirium care bundle in more detail, linking pain, sedation/agitation, and delirium management in an integrated and interdisciplinary fashion; 2) pain, agitation, and delirium implementation strategies; and 3) the potential synergistic benefits of linking pain, agitation, and delirium management strategies to other evidence-based ICU practices, including spontaneous breathing trials, ICU early mobility programs, and ICU sleep hygiene programs, in order to improve ICU patient outcomes and to reduce costs of care.
Results: Linking the ICU pain, agitation, and delirium management strategies with spontaneous awakening trials, spontaneous breathing trials, and early mobility and sleep hygiene programs is associated with significant improvements in ICU patient outcomes and reductions in their costs of care.
Conclusions: The 2013 ICU pain, agitation, and delirium guidelines provide critical care providers with an evidence-based, integrated, and interdisciplinary approach to managing pain, agitation/sedation, and delirium. The ICU pain, agitation, and delirium care bundle provides a framework for facilitating implementation of the pain, agitation, and delirium guidelines. Widespread implementation of the ICU pain, agitation, and delirium care bundle is likely to result in large-scale improvements in ICU patient outcomes and significant reductions in costs.
1Department of Anesthesia, Stanford University School of Medicine, Stanford, CA.
2Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA.
3Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
Dr. Barr has received speaking honoraria from the University of Hawaii, the American College of Chest Physicians, the Society of Critical Care Medicine, the Center for Quality Systems Improvement, the France Foundation, Sutter Health, and the Masimo Corporation. Dr. Pandharipande has received speaking honoraria from the France Foundation, Hospira, and Orion Pharma. He holds consultancies with Orion and Hospira and has research grants from the National Institutes of Health (HL111111) and Hospira.
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