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Progress Toward Eliminating Inadequately Managed Pain in the ICU Through Interdisciplinary Care

Curtis N. Sessler, MD, FCCP
Author and Funding Information

Correspondence to: Curtis N. Sessler, MD, FCCP, Virginia Commonwealth University, Department of Internal Medicine, Box 980050, Richmond, VA 23298-0050; e-mail: csessler@vcu.edu


Dr. Sessler is Orhan Muren Professor of Medicine, Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, and Medical Director of Critical Care, Medical College of Virginia Hospitals.

The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(4):894-896. doi:10.1378/chest.08-2834
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Extract

Relief of pain and suffering is a core principle that guides all practitioners who provide care to patients, regardless of the clinical setting. Critically ill patients, however, seem to suffer disproportionately, as many of these individuals are in the throes of acute life-threatening illness or injury, or have undergone extensive surgery. Such patients typically have surgical incisions, numerous penetrating tubes and catheters, immobility, altered sensorium, and impaired communication. Additionally, discomfort from routine components of ICU care such as tracheal suctioning, being turned in bed, or undergoing dressing changes can be substantial and is often underappreciated.1 Many of these seemingly innocuous interventions are performed repeatedly over the course of a typical day in the ICU. Further, the continuous presence of tubes in the mouth or nose, ongoing mechanical ventilation, sleep deprivation, and delirium or other forms of altered sensorium can contribute emotional and physical discomfort and heighten the perception of pain.2 Accordingly, it is not surprising that most critically ill patients report that they experienced substantial pain during their ICU hospitalization.3,4 The majority of mechanically ventilated ICU patients receive opioid analgesic medications.5

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