Hola a tod@s, my dear friends.

From the ICU of the Hospital Universitario Puerta de Hierro-Majadahonda, doctors Carlos Chamorro and Miguel Angel Romera give us their point of view in the journal Medicina Intensiva.

We want to share a small summary of the article. From common sense and science we can carry out the corresponding actions of improvement in this field so particular and so useful in our day by day. Many thanks to the authors.

“Pain and fear are still the most frequent memories refered by our patients after their admission to ICU.

Recently, an important member of the goverment of our country said in a program of high television audience her experience as a patient in a unit of intensive care (ICU). In addition to expressing her deep appreciation and the professionalism of all staff involved in the healing of her serious process, described her stay and ICU memories with “feelings of pain and fear”, adding the comment: “the UCI is the branch of the hell and people who’s been there knows it”.

 Although these opinions seem hard, we, as intensivists, should not surprise or bother. On the contrary, they should do once again reflect on our daily work and vision that has our society.

The use of inappropriate strategies for sedation and analgesia has adverse consequences as the prolongation of the time of ventilation with its associated comorbidity, the increase in the incidence of delirium, a longer stay in ICU and hospital and even more mortality. But the impact goes beyond hospital discharge to neuromuscular and psychological consequences that adversely affect the quality of life of the patient.

Based on this evidence, the latest published guides of sedation and analgesia in the critical patient stresses the need to monitor and properly treat the pain along with the maintenance of the patient awake during mechanical ventilation, except for contraindications, also associating daily evidence of spontaneous ventilation and an earlier mobilization of the patient.

If we want to humanize our ICUs, ‘sitting in the armchair’ should not be a priority objective in the treatment. The early mobilization is useful but should be applied gradually, according to the situation of the patient and not just when the doctor sees fit. In this context, minimizing sedation and performed an early mobilization, the development of rigorous protocols of sedation and analgesia acquires still more relevant for its application to such demonstrations or during diagnostic or therapeutic testing that may cause pain, anxiety or fear the patient.

Protocols for analgesia and sedation should be used among other actions, for catheter insertions, tracheal aspirations, placement and removal of chest tubes, nasogastric or bladder tubes. For example, the withdrawal of a chest tube, a surgical drainage or the placement of an arterial catheter are among the most painful procedures in the ICU.

The ICU is the best place to manage and monitor the effect of any painkiller.

It is necessary to raise awareness of the need for an approach of comprehensive, multidisciplinary care, critical patient that includes, among other measures, a proper analgosedacion, assessment, prevention and proper handling of delirium, including measures to facilitate the well-being in the ICU and the night’s rest, the valuation of the early withdrawal of mechanical ventilation or the early commencement of rehabilitation including a progressive mobilization adjusted to the situation of the patient, without forgetting essential care more humane of the patient and family, as already mentioned above.

This strategy should include, not only health professionals, also managers with some measures, often relegated for various reasons, such as facilitating an appropriate relationship patient-nurse, full-time physiotherapists in ICU or correcting some structural defects, given some examples. Only in this way we could choose to delete the perception of the ICU as a «branch of hell».  This will reduce the feeling of fear that patients have before and during their income, and will help to improve its evolution and incorporation, again, to the society after critical illness.”
Happy Tuesday,