Kronik Ağrı Sendromlu Hastanın Yoğun Bakım Ünitesinde Takibi
Özet
Kronik ağrı, yoğun bakım ünitelerinde sık karşılaşılan ve yönetimi zor bir sorundur. Yoğun bakım hastalarının büyük bir kısmı, yatış sırasında akut veya kronik ağrı deneyimlemekte ve bu durum fizyolojik, psikolojik ve bilişsel komplikasyonlara yol açmaktadır. Yetersiz ağrı yönetimi; iyileşme sürecini uzatabilir, morbidite ve mortalite oranlarını artırabilir. Kronik ağrı; sinir, endokrin ve bağışıklık sistemlerinde adaptasyonlara yol açan bir hastalık olarak tanımlanır ve yoğun bakım sonrası hastaların %28-77’sinde devam etmektedir. Yoğun bakımda ağrı değerlendirmesi zorludur; hastaların bilinç durumu, mekanik ventilasyon ve sedasyon gereksinimleri iletişimde engel oluşturur. Bu nedenle davranışsal ölçekler (BPS, CPOT..) kullanılmaktadır. Ağrının yönetiminde farmakolojik yaklaşımlar (opioidler, non-opioidler) ve farmakolojik olmayan yöntemler (masaj, soğuk terapi, müzik terapisi..) birleştirilerek multidisipliner bir yaklaşım önerilir. Kronik ağrının önlenmesi ve yönetimi için ağrıyı erken teşhis etmek, etkili tedavi uygulamak ve bireyselleştirilmiş analjezik stratejiler geliştirmek esastır.
Chronic pain is a prevalent and challenging issue in intensive care units (ICUs). A significant proportion of ICU patients experience acute or chronic pain during hospitalization, leading to physiological, psychological, and cognitive complications. Inadequate pain management may prolong recovery, increase morbidity and mortality rates. Chronic pain is defined as a condition associated with adaptations in the nervous, endocrine, and immune systems, and persists in 28-77% of ICU survivors. Pain assessment in ICUs is complex due to factors such as patients’ altered consciousness, mechanical ventilation, and sedation requirements, which hinder communication. Therefore, behavioral scales (e.g., BPS, CPOT..) are commonly utilized. Pain management emphasizes a multidisciplinary approach, combining pharmacological treatments (opioids, non-opioids) with non-pharmacological methods (e.g., massage, cold therapy, music therapy). Effective prevention and management of chronic pain require early detection, implementation of appropriate treatments, and individualized analgesic strategies.
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