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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Stakeholder perspectives on the reduction of opioid exposure in ICU: A modified Delphi survey
Lize-Mari Du Toit1, Sean M Bagshaw2, John Basmaji3
1Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Purpose:
The global opioid epidemic highlights the need to re-evaluate pain management strategies and find alternatives to minimize opioid exposure. Opioids are primary analgesics and sedatives in intensive care units (ICUs) but may have negative consequences for patients and families. This study aimed to identify key patient-important outcomes related to opioid reduction and the use of analgesic adjuncts (e.g., non-steroidal anti-inflammatory drugs [NSAIDs]) in critically ill adult patients through a modified Delphi study involving patients, families, and healthcare providers.
Methods:
A modified Delphi process, including two survey rounds and one discussion round among stakeholders (patients, family members, and healthcare providers), was used to identify and rate key patient-important outcomes, evaluation time-points, and suitable tools/definitions for a potential randomized controlled trial.
Results:
Opioid reduction was identified as a key patient-important outcome by 82% of participants across both survey rounds. Various themes emerged from surveys and stakeholder meetings, showing a preference for both pharmacological and non-pharmacological adjunctive therapies for ICU pain management. Opinions varied based on clinical or non-clinical backgrounds.
Conclusions:
Participants agreed that reducing opioid exposure and using adjunctive pain management strategies are crucial patient-important outcomes. Further research is needed to explore the efficacy and safety of opioid alternatives and both pharmacologic and non-pharmacologic interventions.
Implications For Clinical Practice:
This study highlights that both patients and families value reducing opioid exposure and exploring alternatives, aligning with healthcare providers' goals. Improved communication and education about opioid use can enhance patient-centered care. These findings support the need for future trials on adjunctive analgesics to reduce opioid exposure and improve outcomes, addressing both clinical and patient-family perspectives.
Insights
Patients and families prioritize reducing opioid exposure in intensive care units (ICUs). This study identified key outcomes for opioid reduction and adjunctive pain management, supporting future research into alternatives.
Area of Science:
- Critical Care Medicine
- Pain Management
- Pharmacology
Background:
- The global opioid epidemic necessitates re-evaluation of pain management strategies.
- Opioids are standard in intensive care units (ICUs) but carry risks for patients and families.
- There is a critical need for alternatives to minimize opioid exposure in critically ill adults.
Purpose of the Study:
- To identify patient-important outcomes for opioid reduction in ICUs.
- To explore the use of analgesic adjuncts as alternatives to opioids.
- To involve patients, families, and healthcare providers in defining research priorities.
Main Methods:
- A modified Delphi process was employed.
- Two survey rounds and one discussion round were conducted with diverse stakeholders.
- Key patient-important outcomes, evaluation time-points, and tools for a potential randomized controlled trial were identified and rated.
Main Results:
- Opioid reduction was identified as a key patient-important outcome by 82% of participants.
- Stakeholders expressed a preference for both pharmacological and non-pharmacological adjunctive therapies.
- Opinions on pain management strategies varied between clinical and non-clinical backgrounds.
Conclusions:
- Reducing opioid exposure and utilizing adjunctive pain management are critical patient-important outcomes.
- Further research is essential to evaluate the efficacy and safety of opioid alternatives.
- Patient and family perspectives align with healthcare providers' goals, emphasizing patient-centered care and the need for trials on adjunctive analgesics.
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