Evaluation and treatment of pain in critically ill adults.

Pain is experienced by the overwhelming majority of patients during their intensive care unit stay, but it remains an underappreciated problem. To effectively treat pain, it must be detected and quantified using a validated assessment tool. It is acknowledged that optimal pain relief may be difficult to achieve given the complex interplay of coexisting medical conditions and the environment in which care is provided. Nonetheless, by following structured approaches to pain, resource consumption may be reduced, and even improved survival may be realized. This review covers practices and techniques specific to addressing and treating pain in the adult intensive care environment. Traditional pharmacological approaches including opiate and nonopiate medications are reviewed, as are regional anesthetic techniques and nonpharmacological approaches used for controlling pain.

A national survey of airway management training in United States internal medicine-based critical care fellowship programs.

BACKGROUND: Intensivists may be primarily responsible for airway management in non-operating room locations. Little is known of airway management training provided during fellowship.Our primary aim was to describe the current state of airway education in internal medicine-based critical care fellowship programs. METHODS: Between February 1 and April 30, 2011, program directors of all 3-year combined pulmonary/critical care and 2-year multidisciplinary critical care medicine programs in the United States were invited to complete an online survey. Contact information was obtained via FRIEDA Online (https://freida.ama-assn.org). Non-responders were sent automated reminders, were contacted by e-mail, or by telephone. RESULTS: The overall response proportion was 66% (111/168 programs). Sixty-four (58%) programs reported a designated airway rotation, chiefly occurring for 1 month during the first year of training. Thirty-five programs (32%)reported having a director of airway education and 78 (70%) reported incorporating simulation based airway education. Nearly all programs (95%) reported provision of supervised airway experience during fellowship. Commonly used airway management devices, including video laryngoscopes,intubating stylets, supraglottic airway devices, and fiberoptic bronchoscopes, were reportedly available to trainees. However, 73% reported < 10 uses of a supraglottic airway device, 60% < 25 uses of intubating stylets, 73% < 30 uses of a video laryngoscope, and 65% reported < 10 flexible fiberoptic intubations. Estimates of the required number of procedures to ensure competence varied widely. CONCLUSIONS: The majority of programs have a formal airway management program incorporating a variety of intubation techniques. Overall experience varies widely, however.