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Force, Velocity, Length, Rate of Shortening
Youssef A. Daklallah and Larry Manders
Publication Date: 6-7-2024
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The Critical Conundrum: Balancing Pain and Opioid Use in Critical Illness
Mary L. Jarzebowski and Morgan Laney
Publication Date: 10-25-2024
Opioid use is widespread throughout the intensive care unit. Opioids are prescribed for analgesia and/or sedation to tolerate mechanical ventilation, but both undertreating pain and overusing opioids can lead to considerable adverse effects in critically ill patients. Clinicians must consider many factors when administering opioids in critical illness, including patients’ history of chronic pain and outpatient opioid use, pain associated with their acute diagnoses, surgery, and invasive procedures, as well as tolerance of mechanical ventilation. Underutilization of opioids may yield unmanaged pain, which may manifest as post-traumatic stress disorder in ICU survivors. Aggressive weaning of opioids may risk iatrogenic opioid withdrawal. Conversely, evidence is growing that supports potential harms from opioid use in critical illness, including new persistent opioid use and new chronic pain diagnoses after discharge. This chapter provides a comprehensive review of the risks and benefits of opioid use in the ICU.
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