Kathleen Puntillo1, Judith Eve Nelson2, David Weissman3, Randall Curtis4, Stefanie Weiss5, Jennifer Frontera6, Michelle Gabriel7, Ross Hays4, Dana Lustbader8, Anne Mosenthal9, Colleen Mulkerin10, Daniel Ray11, Rick Bassett12, Renee Boss13, Karen Brasel3, Margaret Campbell14. 1. University of California at San Francisco, San Francisco, CA, USA. 2. Icahn School of Medicine at Mount Sinai, New York, NY, USA. judith.nelson@mssm.edu. 3. Medical College of Wisconsin, Milwaukee, WI, USA. 4. University of Washington, Seattle, WA, USA. 5. Icahn School of Medicine at Mount Sinai, New York, NY, USA. 6. Cleveland Clinic, Cleveland, OH, USA. 7. Veteran's Administration Palo Alto, Palo Alto, CA, USA. 8. North Shore-Long Island Jewish Health System, Hyde Park, NY, USA. 9. University Medical and Dental of New Jersey, Newark, NJ, USA. 10. Hartford Hospital, Hartford, CT, USA. 11. Lehigh Valley Health Network, Allentown, PA, USA. 12. St. Luke's Hospital, Boise, ID, USA. 13. Johns Hopkins University School of Medicine, Baltimore, MD, USA. 14. Wayne State University College of Nursing, Detroit, MI, USA.
Abstract
PURPOSE: Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management. METHODS: We conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst. RESULTS: Evidence-based methods to assess pain are the enlarged 0-10 Numeric Rating Scale (NRS) for ICU patients able to self-report and the Critical Care Pain Observation Tool or Behavior Pain Scale for patients who cannot report symptoms verbally or non-verbally. The Respiratory Distress Observation Scale is the only known behavioral scale for assessment of dyspnea, and thirst is evaluated by patient self-report using an 0-10 NRS. Opioids remain the mainstay for pain management, and all available intravenous opioids, when titrated to similar pain intensity end points, are equally effective. Dyspnea is treated (with or without invasive or noninvasive mechanical ventilation) by optimizing the underlying etiological condition, patient positioning and, sometimes, supplemental oxygen. Several oral interventions are recommended to alleviate thirst. Systematized improvement efforts addressing symptom management and assessment can be implemented in ICUs. CONCLUSIONS: Relief of symptom distress is a key component of critical care for all ICU patients, regardless of condition or prognosis. Evidence-based approaches for assessment and treatment together with well-designed work systems can help ensure comfort and related favorable outcomes for the critically ill.
PURPOSE: Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management. METHODS: We conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst. RESULTS: Evidence-based methods to assess pain are the enlarged 0-10 Numeric Rating Scale (NRS) for ICU patients able to self-report and the Critical Care Pain Observation Tool or Behavior Pain Scale for patients who cannot report symptoms verbally or non-verbally. The Respiratory Distress Observation Scale is the only known behavioral scale for assessment of dyspnea, and thirst is evaluated by patient self-report using an 0-10 NRS. Opioids remain the mainstay for pain management, and all available intravenous opioids, when titrated to similar pain intensity end points, are equally effective. Dyspnea is treated (with or without invasive or noninvasive mechanical ventilation) by optimizing the underlying etiological condition, patient positioning and, sometimes, supplemental oxygen. Several oral interventions are recommended to alleviate thirst. Systematized improvement efforts addressing symptom management and assessment can be implemented in ICUs. CONCLUSIONS: Relief of symptom distress is a key component of critical care for all ICU patients, regardless of condition or prognosis. Evidence-based approaches for assessment and treatment together with well-designed work systems can help ensure comfort and related favorable outcomes for the critically ill.
Authors: Judith E Nelson; Kathleen A Puntillo; Peter J Pronovost; Amy S Walker; Jennifer L McAdam; Debra Ilaoa; Joan Penrod Journal: Crit Care Med Date: 2010-03 Impact factor: 7.598
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Authors: Jennifer A Frontera; J Randall Curtis; Judith E Nelson; Margaret Campbell; Michelle Gabriel; Anne C Mosenthal; Colleen Mulkerin; Kathleen A Puntillo; Daniel E Ray; Rick Bassett; Renee D Boss; Dana R Lustbader; Karen J Brasel; Stefanie P Weiss; David E Weissman Journal: Crit Care Med Date: 2015-09 Impact factor: 7.598
Authors: Judith E Nelson; Kusum S Mathews; David E Weissman; Karen J Brasel; Margaret Campbell; J Randall Curtis; Jennifer A Frontera; Michelle Gabriel; Ross M Hays; Anne C Mosenthal; Colleen Mulkerin; Kathleen A Puntillo; Daniel E Ray; Stefanie P Weiss; Rick Bassett; Renee D Boss; Dana R Lustbader Journal: Chest Date: 2015-02 Impact factor: 9.410
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Authors: Eliza R Gentzler; Heather Derry; Daniel J Ouyang; Lindsay Lief; David A Berlin; Cici Jiehui Xu; Paul K Maciejewski; Holly G Prigerson Journal: Am J Respir Crit Care Med Date: 2019-06-01 Impact factor: 21.405