Thread by @gretchemaben

I can’t go to the whole session (have to leave early to moderate another), but get ready for some tweet-ucation coming your way on “Preventing and Managing Pain, Agitation, and Delirium in the ICU! #CHEST2020

The first session is "" with Dr. Kusum Matthews! #CHEST2020

Let's start with a clinical case of Patient MR. #CHEST2020

Pain in the critically ill patient is common at rest and with procedures. There are predictors of higher self-reported pain listed here. #CHEST2020

Negative sequelae of pain in the ICU are significant and can extend far after their discharge. #CHEST2020

These scales can be used to assess your patients for pain if they are awake. #CHEST2020

You can use the BPS or CPOT to assess your non-responsive patients. #CHEST2020

So now that we know our patient has pain, what are our options? Opioid are the first line therapy recommended for mechanically ventilated patients with non-neuropathic pain. You can use a multimodal therapy approach to aid in opioid dose reduction. #CHEST2020

What are your common opioid choices? Morphine is used less commonly due to metabolites that can accumulate in renal insufficiency and can cause more hemodynamic instability. Hydromorphone can have a neurotoxic metabolite. #CHEST2020

Intermittent boluses are associated with shorter time on the vent. #CHEST2020

Risks and side effects of opioids include oversedation, respiratory depression, delirium, GI side effects, and hypotension! #CHEST2020

Other considerations of opioid use include tolerance and withdrawal, as well as use at the end of life which differs from treatment for acute pain alone. #CHEST2020

Non-opioid adjuncts include topicals, acetaminophen, NSAIDS, nefopam, and gabapentin/pregabalin/carbamazepine. #CHEST2020

Ketamine is a NMDA receptor blocker that may reduce the risk of opioid hyperalgesia. Consider low-dose intermittent boluses for pain control. #CHEST2020

I'm a fan of non-pharmacologic strategies including music therapy and FAMILY INVOLVEMENT! #CHEST2020

Now what is NOT a sufficient analgesic? Dexmedetomidine, Propofol, and benzos! #CHEST2020

We tend to under-recognize pain or incorrectly attribute other things to pain. #CHEST2020

We sometimes under-treat pain in patients with opioid use disorders - these patients still need their pain treated! #CHEST2020