ICU-Pain, agitation, delirium

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:
  • 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