A critical appraisal of sedation, analgesia and delirium in neurocritical care.
Teitelbaum JS, Ayoub O, Skrobik Y.
Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
Can J Neurol Sci. 2011 Nov;38(6):815-25.
Abstract
Administering analgesics, sedatives and antipsychotics is challenging in the Neurological Intensive Care Unit (NICU). We reviewed this literature and our current practice to better inform the critical carepractitioner and to identify gaps for future research. We electronically searched observational, intervention and outcome studies addressing sedation, analgesia and delirium in the NICU, and their bibliographies. Practice patterns were assessed in three critical care units with specialized neurological carein Montreal. Bedside pain assessment tools are psychometrically validated in the neuro-critically ill but sedationand delirium tools are not. Rigorous pain and sedationassessments appear feasible; delirium screening has not been tested. Publications addressing outcomes and responses to pharmacologic treatment lack consistency, rigor or both. In daily practice, pharmacologic management varies greatly. Clearly, little information exists on analgesia, sedationand delirium in the NICU. Systematic evaluation of pain improves outcome. No evidence-based therapeutic recommendations can be proffered.
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