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Top 10 Myths Regarding Sedation and Delirium in the ICU

Peitz, Gregory J. PharmD, BCPS1,2; Balas, Michele C. PhD, RN, APRN-NP, CCRN3; Olsen, Keith M. PharmD, FCCP, FCCM2; Pun, Brenda T. RN, MSN, ACNP4; Ely, E. Wesley MD, MPH5,6

doi: 10.1097/CCM.0b013e3182a168f5
Creating and Implementing the 2013 ICU Pain, Agitation, and Delirium Guidelines for Adult Icu Patients

The management of pain, agitation, and delirium in critically ill patients can be complicated by multiple factors. Decisions to administer opioids, sedatives, and antipsychotic medications are frequently driven by a desire to facilitate patients’ comfort and their tolerance of invasive procedures or other interventions within the ICU. Despite accumulating evidence supporting new strategies to optimize pain, sedation, and delirium practices in the ICU, many critical care practitioners continue to embrace false perceptions regarding appropriate management in these critically ill patients. This article explores these perceptions in more detail and offers new evidence-based strategies to help critical care practitioners better manage sedation and delirium, particularly in ICU patients.

1Department of Pharmaceutical and Nutrition Care, University of Nebraska Medical Center, Omaha, NE.

2Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE.

3The Ohio State University College of Nursing, Center for Critical and Complex Care, Columbus, OH.

4Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.

5Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University School of Medicine, Nashville, TN.

6VA-GRECC (Geriatric Research Education Clinical Center) for the VA Tennessee Valley Healthcare System, Vanderbilt University Medical Center, Nashville, TN.

Dr. Balas is currently a coinvestigator on a grant supported by the Alzheimer’s Association, has received honoraria from the France Foundation and ProCE, and is a consultant for the Centers for Disease Control and Cynosure Health. Dr. Olsen received honoraria from Covidien and is a coinvestigator on a grant supported by the National Institutes of Health. Ms. Pun has received honoraria from the France Foundation and ProCE. Dr. Ely has a grant/grants pending from Lilly; received honoraria from Hospira, Orion, and Abbott; and is a consultant for Cumberland and Masimo. Dr. Peitz has disclosed that he does not have any potential conflicts of interest.

Address requests for reprints to: Gregory J. Peitz, PharmD, BCPS, Department of Pharmaceutical and Nutrition Care, University of Nebraska Medical Center, 981090 Nebraska Medical Center, Omaha, NE 68198-1090. E-mail: gpeitz@nebraskamed.com

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins