Current practice and perceptions regarding pain, agitation and delirium management in patients receiving venovenous extracorporeal membrane oxygenation

• Published in: Journal of critical care 2019-10, Vol.53, p.98-106
• Main Authors: Dzierba, Amy L., Abrams, Darryl, Madahar, Purnema, Muir, Justin, Agerstrand, Cara, Brodie, Daniel
• Format: Article
• Language: English
• Subjects: Acute respiratory failure; Anesthesia; Delirium; Extracorporeal life support; Extracorporeal membrane oxygenation; Intensive care; Narcotics; Nurse practitioners; Opioids; Pain; Patients; Perceptions; Pharmacists; Physical therapists; Prevention; Psychotropic drugs; Questionnaires; Sedation; Survey
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2019.05.014

To characterize monitoring of pain, agitation, and delirium; investigate opioid and sedative choices; and describe prevention and treatment of delirium in adults receiving venovenous extracorporeal membrane oxygenation (vv-ECMO) for respiratory failure. International, cross-sectional survey distributed January 2018 to members of the Society of Critical Care Medicine. Respondents were predominately physicians (58%) from North America (89%). Fentanyl (77%) and hydromorphone (48%) were the most common intravenous opioids used to manage pain. A deep level of sedation was targeted in the first 24-h after initiation of vv-ECMO 64% of the time. When deep sedation was targeted, propofol (70%) and benzodiazepines (41%) were the most common sedatives. The most common sedatives for light sedation were dexmedetomidine (45%) and propofol (39%). Delirium prevention included avoidance of benzodiazepines (73%), whereas the most common treatment strategy was scheduled atypical antipsychotics (83%). Centers that extubated patients during vv-ECMO used dexmedetomidine as the second preferred sedative as compared to benzodiazepines at non-extubating centers (p = 0.04). Most respondents use validated scales and protocols to assess and manage pain, agitation/sedation, and delirium. The majority of respondents reported targeting a deep level of sedation with propofol being used for both deep and light levels of sedation. •Fentanyl and hydromorphone were the most common intravenous opioids used to manage pain.•A deep level of sedation was targeted in the first 24-h after initiation of vv-ECMO more than half of the time.•When deep sedation was targeted, propofol and benzodiazepines were the most common sedatives.•The most common sedatives for light sedation were dexmedetomidine and propofol.•Most respondents use validated scales and protocols to assess and manage pain, agitation/sedation, and delirium.