Management of Pain and Distress in the Adult ICU patient

The literature presents vast amounts of scientific evidence as to the significance of pain in the process of severe illness, yet evidence on the effectiveness of pain assessment and pain management for the adult critically ill patient is scarce. In critically ill adult patients the process of clinical decision making for pain interventions remains very complex. The Critically Ill Assessment (CIA) scale is introduced, a new pain-distress observational tool for critically ill adult patients, either ventilated or non-ventilated. The CIA scale proves to be a reliable and valid assessment tool for uncomfortable adult critically ill patients. The complexity of adherence to clinical guidelines is discussed. Issues of implementation need to be taken seriously, the introduction of a new health care professional: the implementologist, can be useful. The development and implementation of a new pain-distress treatment algorithm, based on assessment with the C.I.A., is described. Attitude versus behaviour towards a new clinical strategy was investigated. Attitude by the results of a questionnaire, behaviour as compliance to the algorithm. The correlation between clinical sedation scales and the bispectral index (BIS) was investigated and was found modest. The BIS has failed to demonstrate consistent reproducibility as a monitor of sedation in heterogeneous populations of ICU patients. The challenges to pain management are described and taken to a broader perspective in making it part of the multimodality approach, as well as indicating it as an essential component of quality care. High quality pain management should be a goal for every patient. The key is in the education!

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