Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review Article
Derartu Neme,1 Zemedu Aweke,1 Haileleul Micho,2 Simeneh Mola,1 Bedru Jemal,1 Teshome Regasa1 1Department of Anesthesiology, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia; 2Department of Biochemistry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopi...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2020-12-01
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| Series: | International Journal of General Medicine |
| Subjects: | |
| Online Access: | https://www.dovepress.com/evidence-based-guideline-for-adult-sedation-pain-assessment-and-analge-peer-reviewed-article-IJGM |
| _version_ | 1818597224877129728 |
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| author | Neme D Aweke Z Micho H Mola S Jemal B Regasa T |
| author_facet | Neme D Aweke Z Micho H Mola S Jemal B Regasa T |
| author_sort | Neme D |
| collection | DOAJ |
| description | Derartu Neme,1 Zemedu Aweke,1 Haileleul Micho,2 Simeneh Mola,1 Bedru Jemal,1 Teshome Regasa1 1Department of Anesthesiology, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia; 2Department of Biochemistry, College of Medicine and Health Science, Dilla University, Dilla, EthiopiaCorrespondence: Zemedu Aweke Department of Anesthesiology, College of Medicine and Health ScienceDilla University, P.O. 0419, 4620, Dilla, EthiopiaTel +251 912406236Email zemeduawoke@gmail.comBackground: Agitation and anxiety occur frequently in ICU and affect about 30– 80% of patients in ICU present with delirium worldwide, and it is associated with adverse clinical outcomes. This review aimed to systematically review articles and finally draw an evidence-based guideline for an area with limited resources.Methods: The review was reported based on preferred reporting items for systemic and meta-analysis (PRISMA) protocol. We searched literature from PubMed, Google Scholar, and Medline database using keywords like the level of sedation, sedation score, pain assessment in ICU, and sedative drugs in ICU from an article published in English. After extraction with a patient population and exclusion, five randomized clinical trials, four systemic reviews and meta-analysis, four observation cohort study, and two practical guidelines were used for the review.Conclusion: In addition to high validity and reliability, RASS has the advantage of easiness to remember for nurses making it a preferred sedation assessment tool in an adult ICU setting. Light sedation with daily interruption was recommended with an aim of an awake and alert patient ready for the weaning trial. Propofol was preferred when sedation is for a short duration and when intermittent awakening is required. Ketamine is the preferred induction for asthmatic hypotensive and patient requiring prolonged continuous sedation. With a similar time for sedation, diazepam shows a shorter time for intubation compared to midazolam. Besides diazepam has shown a cheaper cost of sedation than midazolam. This makes it a drug of preference in a low resource setting.Keywords: sedation, ICU, propofol, ketamine |
| first_indexed | 2024-12-16T11:44:25Z |
| format | Article |
| id | doaj.art-624da2fd01c243b8aac5538cc357f563 |
| institution | Directory Open Access Journal |
| issn | 1178-7074 |
| language | English |
| last_indexed | 2024-12-16T11:44:25Z |
| publishDate | 2020-12-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of General Medicine |
| spelling | doaj.art-624da2fd01c243b8aac5538cc357f5632022-12-21T22:32:52ZengDove Medical PressInternational Journal of General Medicine1178-70742020-12-01Volume 131445145260084Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review ArticleNeme DAweke ZMicho HMola SJemal BRegasa TDerartu Neme,1 Zemedu Aweke,1 Haileleul Micho,2 Simeneh Mola,1 Bedru Jemal,1 Teshome Regasa1 1Department of Anesthesiology, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia; 2Department of Biochemistry, College of Medicine and Health Science, Dilla University, Dilla, EthiopiaCorrespondence: Zemedu Aweke Department of Anesthesiology, College of Medicine and Health ScienceDilla University, P.O. 0419, 4620, Dilla, EthiopiaTel +251 912406236Email zemeduawoke@gmail.comBackground: Agitation and anxiety occur frequently in ICU and affect about 30– 80% of patients in ICU present with delirium worldwide, and it is associated with adverse clinical outcomes. This review aimed to systematically review articles and finally draw an evidence-based guideline for an area with limited resources.Methods: The review was reported based on preferred reporting items for systemic and meta-analysis (PRISMA) protocol. We searched literature from PubMed, Google Scholar, and Medline database using keywords like the level of sedation, sedation score, pain assessment in ICU, and sedative drugs in ICU from an article published in English. After extraction with a patient population and exclusion, five randomized clinical trials, four systemic reviews and meta-analysis, four observation cohort study, and two practical guidelines were used for the review.Conclusion: In addition to high validity and reliability, RASS has the advantage of easiness to remember for nurses making it a preferred sedation assessment tool in an adult ICU setting. Light sedation with daily interruption was recommended with an aim of an awake and alert patient ready for the weaning trial. Propofol was preferred when sedation is for a short duration and when intermittent awakening is required. Ketamine is the preferred induction for asthmatic hypotensive and patient requiring prolonged continuous sedation. With a similar time for sedation, diazepam shows a shorter time for intubation compared to midazolam. Besides diazepam has shown a cheaper cost of sedation than midazolam. This makes it a drug of preference in a low resource setting.Keywords: sedation, ICU, propofol, ketaminehttps://www.dovepress.com/evidence-based-guideline-for-adult-sedation-pain-assessment-and-analge-peer-reviewed-article-IJGMsedationicuanalgesia |
| spellingShingle | Neme D Aweke Z Micho H Mola S Jemal B Regasa T Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review Article International Journal of General Medicine sedation icu analgesia |
| title | Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review Article |
| title_full | Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review Article |
| title_fullStr | Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review Article |
| title_full_unstemmed | Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review Article |
| title_short | Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review Article |
| title_sort | evidence based guideline for adult sedation pain assessment and analgesia in a low resource setting intensive care unit review article |
| topic | sedation icu analgesia |
| url | https://www.dovepress.com/evidence-based-guideline-for-adult-sedation-pain-assessment-and-analge-peer-reviewed-article-IJGM |
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