Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption, and Neuromuscular Blockade

Patients admitted to a hospital with an ICU stay were also more likely to have medications discontinued

among all five of the medication groups than were control patients. Except for respiratory inhalers,

there was a higher risk of medication discontinuation in all medication groups in patients hospitalized

with an ICU admission than in patients hospitalized without an ICU admission. The composite outcome

of death, hospitalization, and emergency department visit up to 1 year after hospital discharge in all

study patients was higher in patients in whom a statin or antiplatelet or anticoagulant was discontinued

A prospective, observational cohort study was conducted of all outpatient appointments of a tertiary

care hospital’s post-ICU clinic between July 2012 and December 2015. The pharmacist completed

medication reconciliation, interview, counseling, and resultant interventions during the post-ICU clinic

appointment. The pharmacist did a full medication review in 56 of the patients (90%). All 56 patients

had at least one pharmacy intervention. Medications were discontinued at the clinic appointment for 22

of the patients (39%). New medications were initiated in 18 of the patients (32%). An adverse drug event

was identified in nine of the patients (18%). Adverse drug event preventive measures were implemented

in 18 patients (32%). Thirteen patients (23%) had an influenza vaccination administered. Two patients

A prospective, observational study was conducted in 12 ICUs/post-ICU clinics between September

2019 and July 2021. A full medication review was performed in 472 patients by a pharmacist at the

post-ICU clinic.. In 397 (84%) patients, pharmacy interventions were made. Medications were stopped

in 124 (26%) and started in 91 (19%) patients. The number of patients that had a dose decreased was

51 (11%). The number of patients that had a dose increased was 43 (9%). Adverse drug event (ADE)

preventive measures were initiated in 115 (24%) patients. Identification of ADEs occurred in 69 (15%)

patients. In 30 (6%) patients, medication interactions were identified.

Patient Cases

T.L. (from question 4) was extubated 24 hours ago, is currently receiving dexmedetomidine 0.2 mcg/kg/

hour, and has received two doses of fentanyl 25 mcg over 24 hours for pain. She is alert and calm with

intermittent periods of agitation. Her pain score is now negative, and she is newly positive for delirium by

CAM-ICU. Her laboratory values and vital signs are normal. Which would best be recommended for the

management of delirium?

P.V. is a 70-year-old woman intubated for severe respiratory failure (Fio2 80%) and refractory shock from

methicillin-resistant Staphylococcus aureus pneumonia, for which she was administered antibiotics, vaso-

pressors, and steroids. She is on day 5 of mechanical ventilation (Fio2 50%) and has been off vasopressors for

48 hours. The nurse describes PAD, but the patient denies pain. Medications include vancomycin 1000 mg

daily, heparin 5000 units subcutaneously every 12 hours, hydrocortisone 50 mg every 6 hours, and fentanyl

75 mcg/hour. Which is the most appropriate recommendation at this time?