This is the podcast surgery I see Browns. My name is Dr. Jeffrey Guy. I'm an associate professor of surgery and director of the burning unit of Vanderbilt Regional Medical Center.

The topic that we're going to talk about today is the role of pain in the intensive care unit.

And this will be somewhat of a generalized conversation as this and the idea of sedation and delirium have all become very

intermingled in the intensive care unit.

We've learned from studies which we've quoted in the previous podcast, such as the ABC trial

that Wes Ely and his colleagues published recently in Lancet, that the effect of sedation and delirium in the intensive care

unit can have profound implications in the role of weaning people from mechanical ventilators

as well as prolonged, as well as 60-day survival. But what I want to focus on is more of a

generalized discussion of pain and how we should manage

it, particularly in a surgical ICU, and being mindful that where I spend the majority of my

time is managing pain in a burn intensive care unit.

Albert Schweitzer said, and I quote, we must all die, but that I can save him from days of torture.

That is what I feel is my great and ever new privilege.

Pain is more terrible Lord of mankind than even death itself.

And I think Albert Schweitzer really put this into focus,

that people really do fear pain more than they do death. The problem with pain is the obvious.

Pain hurts, surgery hurts, fracture hurts, and procedures hurt. And ICUs are very scary patients for patients.

ICUs are very scary places for patients. And this would seem relatively obvious. But those of us who live in these

environments, I think often become saturated, that the intensive care unit, which may be a very

scary place for a family member of our patient, is where we spend the vast majority of our time,

and certainly where we work. Remember the first time you walked in the intensive care unit. You saw patients laying there within the tracheal tubes and the sound of ventilators

and alarms. Keep in mind that that is the environment that many of our patients and certainly

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