Protocolized Management of Pain, Sedation, and Delirium in the Mechanically Ventilated Oncology Population

Trisha Patel, Erica McGovern, Joanne K McGovern, Kerri L Mack and Jeffrey B Hoag

Cancer Treatment Centers of America Philadelphia, USA

^*Correspondance to: Jeffrey B Hoag 

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Abstract:

Purpose: To test the hypothesis that a protocolized approach to Pain, Agitation, Delirium (PAD) management in Mechanically Ventilated (MV) oncology patients would reduce the initiation and doses of sedatives used during intubation without increasing analgesic requirements.
Materials and Methods: PAD was managed using a protocol focusing on analgesia-first sedation, executed by a multi-disciplinary team. Data was obtained on interventions from routine assessments for PAD and treatment was based on protocol recommendations.
Results: 204 patients were identified with 68 patients pre- and 91 patients' post-protocol meeting inclusion criteria in the final analysis. Patients initiated on benzodiazepine infusions decreased from 31% to 5% (p<0.05). Total average Fentanyl Equivalent (FE) received during intubation remained significantly less post-protocol. No statistically significant difference was observed in FE
requirements during intubation for opioid tolerant patients. A non-significant decrease in duration of MV was observed in patients not terminally extubated (6 ± 7 vs. 4 ± 4, p=0.17).
Conclusion: Pain and agitation can be successfully managed in the oncology population by using a protocolized, multi-disciplinary approach that applies the recommendations in Society of Critical Care Medicine© guidelines. This approach may lead to decrease use of sedatives and analgesics, preventing harmful long-term effects in an opioid-tolerant population.

Keywords:

Pain; Agitation; Delirium; Sedation; Oncology; Mechanical ventilation

Cite the Article:

Patel T, McGovern E, McGovern JK, Mack KL, Hoag JB. Protocolized Management of Pain, Sedation, and Delirium in the Mechanically Ventilated Oncology Population. Clin Oncol. 2021;6:1805..