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Chapter 5 - Analgesia, Sedation, and Paralysis in the Neurocritical Care Unit

Published online by Cambridge University Press:  24 July 2019

By
Yousef Hannawi  and
Wendy C. Ziai
Edited by
Michel T. Torbey
Michel T. Torbey
Affiliation:
Ohio State University
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Summary

An intensive care unit (ICU) stay is often a stressful and painful experience. Recent surveys indicate that 50–80% of patients experience pain during their ICU stay [1]. Critically ill patients experience pain more readily than healthy subjects; a phenomenon known as hypernociception. The most painful experiences for ICU patients are endotracheal suctioning and being turned in bed. In addition, many patients have pain at rest without a noxious stimulus [1]. This decreased threshold of pain in the ICU has been attributed to immobility and systemic inflammation. In addition to pain, ICU patients often suffer from stress, which has been frequently attributed to painful procedures. Other factors that may play a role in ICU stress include inability to communicate due to endotracheal intubation, interruption of sleep, hallucinations, and nightmares. This stressful experience is not without complications, as one retrospective study found that 25% of ICU patients with self-reported stressful experiences during their ICU stay, such as nightmares, anxiety, respiratory distress, or pain, showed symptoms of post-traumatic stress disorder four years later [2], thus, the importance of adequate analgesia and sedation to achieve patient comfort.

Type
Chapter
Information
Neurocritical Care , pp. 33 - 49
Publisher: Cambridge University Press
Print publication year: 2019

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