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Clinical Practice Guidelines and Consensus Statements About Pain Management in Critically Ill End-of-Life Patients: A Systematic Review

Durán-Crane, Alejandro ; Laserna, Andrés ; López-Olivo, María A ; Cuenca, John A ; Díaz, Diana Paola ; Cardenas, Yenny Rocío ; Urso, Catherine ; O’Connell, Keara ; Azimpoor, Kian ; Fowler, Clara ; Price, Kristen J ; Sprung, Charles L ; Nates, Joseph L

Critical care medicine, 2019-11, Vol.47 (11), p.1619-1626 [Periódico revisado por pares]

United States: Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc

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Título:
Clinical Practice Guidelines and Consensus Statements About Pain Management in Critically Ill End-of-Life Patients: A Systematic Review
Autor: Durán-Crane, Alejandro ; Laserna, Andrés ; López-Olivo, María A ; Cuenca, John A ; Díaz, Diana Paola ; Cardenas, Yenny Rocío ; Urso, Catherine ; O’Connell, Keara ; Azimpoor, Kian ; Fowler, Clara ; Price, Kristen J ; Sprung, Charles L ; Nates, Joseph L
Assuntos: Analgesics, Opioid - therapeutic use ; Anxiety - drug therapy ; Benzodiazepines - therapeutic use ; Consensus Development Conferences as Topic ; Contraindications, Drug ; Critical Illness - psychology ; Critical Illness - therapy ; Humans ; Hypnotics and Sedatives - therapeutic use ; Neuromuscular Blockade - adverse effects ; Pain - drug therapy ; Pain Management ; Pain Measurement ; Palliative Care ; Practice Guidelines as Topic ; Quality Indicators, Health Care ; Terminal Care ; Withholding Treatment
É parte de: Critical care medicine, 2019-11, Vol.47 (11), p.1619-1626
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Undefined-1
ObjectType-Feature-3
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Descrição: OBJECTIVES:To identify and synthesize available recommendations from scientific societies and experts on pain management at the end-of-life in the ICU. DATA SOURCES:We conducted a systematic review of PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and Biblioteca Virtual en Salud from their inception until March 28, 2019. STUDY SELECTION:We included all clinical practice guidelines, consensus statements, and benchmarks for quality. DATA EXTRACTION:Study selection, methodological quality, and data extraction were performed independently by two investigators. A quality assessment was performed by four investigators using the Appraisal of Guidelines for Research and Evaluation II instrument. The recommendations were then synthesized and categorized. DATA SYNTHESIS:Ten publications were included. The Appraisal of Guidelines for Research and Evaluation II statement showed low scores in various quality domains, especially in the applicability and rigor of development. Most documents were in agreement on five topics1) using a quantitative tool for pain assessment; 2) administering narcotics for pain relief and benzodiazepines for anxiety relief; 3) against prescribing neuromuscular blockers during withdrawal of life support to assess pain; 4) endorsing the use of high doses of opioids and sedatives for pain control, regardless of the risk that they will hasten death; and 5) using quality indicators to improve pain management during end-of-life in the ICU. CONCLUSIONS:In spite of the lack of high-quality evidence, recommendations for pain management at the end-of-life in the ICU are homogeneous and are justified by ethical principles and agreement among experts. Considering the growing demand for the involvement of palliative care teams in the management of the dying patients in the ICU, there is a need to clearly define their early involvement and to further develop comprehensive evidence-based pain management strategies. Based on the study findings, we propose a management algorithm to improve the overall care of dying critically ill patients.
Editor: United States: Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc
Idioma: Inglês

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Clinical Practice Guidelines and Consensus Statements About Pain Management in Critically Ill End-of-Life Patients: A Systematic Review

Durán-Crane, Alejandro ; Laserna, Andrés ; López-Olivo, María A ; Cuenca, John A ; Díaz, Diana Paola ; Cardenas, Yenny Rocío ; Urso, Catherine ; O’Connell, Keara ; Azimpoor, Kian ; Fowler, Clara ; Price, Kristen J ; Sprung, Charles L ; Nates, Joseph L

United States: Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc

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