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A Critical Appraisal of Sedation, Analgesia and Delirium in Neurocritical Care

Published online by Cambridge University Press:  02 December 2014

Jeanne S. Teitelbaum ,
Omar Ayoub  and
Yoanna Skrobik
Jeanne S. Teitelbaum*
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University
Omar Ayoub
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Yoanna Skrobik
Affiliation:
Department of Medicine, Hôpital maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
*
Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Ave, Montreal, Quebec, H3A 2B4, Canada.
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Abstract

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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 care practitioner 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 care in Montreal. Bedside pain assessment tools are psychometrically validated in the neuro-critically ill but sedation and delirium tools are not. Rigorous pain and sedation assessments 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, sedation and delirium in the NICU. Systematic evaluation of pain improves outcome. No evidence-based therapeutic recommendations can be proffered.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 6 , November 2011 , pp. 815 - 825
Copyright
Copyright © The Canadian Journal of Neurological 2011

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