The Effect of Implementing Pain, Agitation, and Delirium Control Protocol on Outcomes of Critically Ill Patients with a History of Drug Abuse in Intensive Care Units

Drug abuse is a major concern, leading to inappropriate control of pain, agitation, and delirium. In the current study, we aimed to evaluate the effect of implementing Pain, Agitation, and Delirium (PAD) control protocol on the outcomes of critically ill patients with a history of drug abuse in the intensive care unit (ICU).

In this experimental study, 44 opioid-dependent patients (18 years and older) were included. The pain was assessed by the Behavioral Pain Scale (BPS) per hour, the level of sedation was evaluated by the Richmond Agitation Sedation (RASS) per hour, and Delirium was measured every 8 hours by the Confusion Assessment Method (CAM-ICU). Based on the type and dose of the consumed drug and the way it was used, the dose of methadone was calculated. In addition, possible symptoms of withdrawal syndrome and excessive use were assessed every hour by the intensive care unit nurse.

The ICU stay length was 17 days in the control group and seven days in the intervention group. Patients in the intervention group received lower doses of Methadone and Propofol compared to the control group during 72 hours and lower doses of fentanyl after 48 and 72 hours (p<0.05). In addition, patients with acceptable limits of pain and sedation were significantly more in quantity in the intervention group compared to the control group (p=0.001 and p=0.05, respectively).

Implementing PAD protocol, along with appropriate medical therapy, can greatly help improve the medical care provided by the ICU team.