Pain, agitation and delirium. Amended 2013 guidelines of the American College of Critical Care Medicine

Intensive care patients regularly feel pain, not only during intensive care therapeutic measures but also when resting. The associated negative physiological and psychological sequelae can be serious and protracted in intensive care patients. Acute pain is predestined for the development of persistant neuropathic pain. This study informs the readership on the contents of the amended 2013 guidelines of the American College of Critical Care Medicine (ACCCM) on pain, agitation and delirium and presents strategies for implementation of the guidelines. The focus of the amended recommendations is to give recommendations for treatment, in particular with respect to practical implementation of evidence-based scientific knowledge in the daily routine of intensive care wards. The fundamental principles which are summarized in these guidelines are: the regular collation of pain, measurement of depth of sedation and delirium with valid and reliable measurement instruments, an adequate and preemptive analgesia, administration of sedatives only when necessary and titration of sedatives so that patients remain responsive and are able to react. The amended version of the guidelines is intended to achieve a high acceptance and clinical implementation in intensive care medical teams and therefore to improve the outcome of intensive care patients by optimized therapy.