ICU-Pain, agitation, delirium
Posted On March 10, 2020
PAD = Pain, agitation, delirium
Pain
- Multimodal analgesia likely to reduce opiod use
- Acetaminophen: oral and rectal
- Low dose Ketamine: 0.5 mg/kg iv then 1-2 mcg mcg/kg/min infusion
- may cause hallucination & delirium
- Neuropathic pain:
- Gabapentin 15/mg/kg/d in divided dose
- Pregabalin 150 mg/d
- NSAID, iv lidocaine not recommended
Agitation/Sedation
- First manage pain
- Propofol recommended
- dexmedetomidine (Prodex): less delirium compared with Propofol
- unable to induce a deep sedation
- Alcohol withdraw: may need benzo
Delirium
- low dose dexmedetomidine hs may be helpful
Other measures
- Early mobility
- Avoid sleep disruption