title: Best Practices for Managing Pain, Sedation, and Delirium in the Mechanically Ventilated Patient.
abstract: Nursing management of pain, agitation, and delirium in mechanically ventilated patients is a challenge in critical care. Oversedation can lead to delayed extubation, prolonged ventilator days, unnecessary neurologic testing, and complications such as weakness and delirium. Undersedation can lead to self-extubation, invasive line removal, unnecessary patient distress, and injury to self or others. Acquiring an optimal level of sedation requires the bedside nurse to be more vigilant than ever with patient assessment and medication titration. This article provides a historical perspective of the management of pain, agitation, and delirium, and disseminates information contained in revised Society for Critical Care Medicine Clinical Practice Guidelines (January 2013) to promote their implementation in day-to-day nursing care.
authors.affiliation: Department of Physiological and Technological Nursing, College of Nursing, Augusta University, 987 St. Sebastian Way, Augusta, GA 30912, USA. Electronic address: kigarrett@augusta.edu.
authors.forename: Kitty M
authors.initials: KM
authors.lastname: Garrett
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects; D016292:Procedural Sedation / Q000451:nursing*; D003422:Critical Care / Q000592:standards; D064648:Critical Care Nursing / Q000592:standards*; D003693:Delirium / Q000451:nursing*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007362:Intensive Care Units; D059408:Pain Management / Q000451:nursing*; D017410:Practice Guidelines as Topic; D011595:Psychomotor Agitation; D012121:Respiration, Artificial / Q000451:nursing*; D016728:Self-Injurious Behavior; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives
keywords: ABCDEF Bundle; Agitation; Delirium; Mechanical ventilation; PAD Bundle; Pain; SCCM clinical practice guidelines; Sedation