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This book provides a concise yet comprehensive overview on the use of opioids in the ICU, offering practical, real-world recommendations on opioid utilization and alternative therapies. The text explains the physiology and assessment of pain and the need for analgesia in the ICU, details the pharmacology of opioids and their use in providing analgesia, sedation, and comfort for patients during critical illness, and summarizes advanced pharmaceutical and surgical approaches to pain management and procedural applications that can supplement, minimize, or replace opioids for the ICU patient. The book also includes algorithms and step-by-step approaches on navigating the delicate balance between the relief of suffering and the adverse effects of opioids, as well as a dedicated section on the management of critically ill patients with preexisting opioid tolerance. Written by experts in the field, Opioid Use in Critical Care: A Practical Guide is a valuable resource for ICU providers who treat and manage critically ill patients with opioids.
The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already existâ€"like evidence-based medicationsâ€"are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.
Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
The opioid overdose epidemic combined with the need to reduce the burden of acute pain poses a public health challenge. To address how evidence-based clinical practice guidelines for prescribing opioids for acute pain might help meet this challenge, Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence develops a framework to evaluate existing clinical practice guidelines for prescribing opioids for acute pain indications, recommends indications for which new evidence-based guidelines should be developed, and recommends a future research agenda to inform and enable specialty organizations to develop and disseminate evidence-based clinical practice guidelines for prescribing opioids to treat acute pain indications. The recommendations of this study will assist professional societies, health care organizations, and local, state, and national agencies to develop clinical practice guidelines for opioid prescribing for acute pain. Such a framework could inform the development of opioid prescribing guidelines and ensure systematic and standardized methods for evaluating evidence, translating knowledge, and formulating recommendations for practice.
This textbook provides an overview of pain management useful to specialists as well as non-specialists, surgeons, and nursing staff.
Like management of disease, management of pain is as old as the human race. When patients come to us with their pain, they present us with a wonderful opportunity: the chance to understand them, to understand how their pain is affecting their lives, the challenge of discovering what is causing their pain, and finally the opportunity to prescribe medications and lifestyle changes to help them gain relief from their pain. It is hoped that this book will provide the latest evidence-based updates on pain management in special circumstances and will serve as a ready reference for those embarking on pain management. Its intent is not to be a heavy book that can only be stored on a bookshelf, but a pocket-sized reference that can be carried, be easily navigated, and be available whenever a conceptual gap compromises pain physicians and their ability to treat their patients.
The fully updated second edition of this popular handbook concisely summarises all current knowledge about delirium in critically ill patients and describes simple tools the bedside clinician can use to prevent, diagnose and manage delirium. Chapters discuss new developments in assessing risk and diagnosis, crucial discoveries regarding delirium and long-term cognitive outcomes, and dangers of sedation and death. Updated management advice reflects new evidence about antipsychotics and delirium. This book explains how to minimise the risks of delirium, drugs to avoid, drugs to use and when to use them, as well as current theories regarding pathophysiology, different motoric subtypes leading to missed diagnosis, and the adverse impact of delirium on patient outcomes. While there are still unanswered questions, this edition contains all the available answers. Illustrated with real-life case reports, Delirium in Critical Care is essential reading for trainees, consultants and nurses in the ICU and emergency department.