Opioid Use in Critical Care | 2021
Rational Selection and Utilization of Opioid Analgesics in Critical Care
Abstract
Goal-directed analgesia and sedation protocols are associated with improved outcomes for critically ill patients. The first step to implementing these strategies is a critical understanding of the components of these protocols. Critically ill patients commonly experience pain that, unless recurrently assessed, is frequently unrecognized. There are several validated tools that can be implemented to reliably assess and quantify pain among intubated patients and/or patients unable to communicate. Following pain identification, clinicians should initiate multimodal strategies for pain prevention and treatment. When deciding on the choice of opioid medications, derangements in patients’ pathophysiology, presence of active metabolites, and other clinical and institutional factors should be considered. All pain and sedative medication administration should be guided by goal-directed protocols targeting an analgesia-first-based approach to achieve lighter sedation targets when possible. Additionally, daily pauses in sedation should be implemented to coincide with daily spontaneous breathing trials for all intubated patients.