Management of Sedation, Analgesia and Delirium in Critically Injured Patients

Abstract

This chapter describes an integrated approach to the management of analgesia, sedation and delirium in critically injured patients. Pain is often difficult to assess especially in ventilated, unconscious patients and a dedicated assessment tool should be used. A multi-modal approach to analgesia that emphasises the early use of opiates alongside adjunctive agents is advocated. Regional analgesic techniques can be safely employed in selected major trauma patients and have been widely used by military healthcare providers. Excessive use of sedation is not indicated outside of specific circumstances, such as traumatic brain injury, as it can lead to worse outcomes. A protocolised approach to sedation has been shown to reduce the length of ICU and hospital stay. The type of sedative agent is of less importance, but an approach that uses Propofol in conjunction with an alpha 2 agonist is advocated. Delirium is common in critically ill patients and is an independent marker of poor prognosis; it should be screened for and any risk factors addressed as part of an integrated approach to management.