Opioid Use in Critical Care: A Practical Guide

This book provides a concise yet comprehensive overview on the use of opioids in the ICU, offering practical, real-world recommendations on opioid utilization and alternative therapies. The text explains the physiology and assessment of pain and the need for analgesia in the ICU, details the pharmacology of opioids and their use in providing analgesia, sedation, and comfort for patients during critical illness, and summarizes advanced pharmaceutical and surgical approaches to pain management and procedural applications that can supplement, minimize, or replace opioids for the ICU patient. The book also includes algorithms and step-by-step approaches on navigating the delicate balance between the relief of suffering and the adverse effects of opioids, as well as a dedicated section on the management of critically ill patients with preexisting opioid tolerance. 

Written by experts in the field, Opioid Use in Critical Care: A Practical Guide is a valuable resource for ICU providers who treat and manage critically ill patients with opioids.

Jose L. Pascual, MD, PhD, FRCS(C), FACS, FCCM

Associate Professor of Surgery and Neurosurgery

Perelman School of Medicine

Clinical Associate, School of Nursing

University of Pennsylvania

Philadelphia, PA, 1904

USA

Timothy G. Gaulton, MD, MSc

Assistant Professor of Anesthesiology and Critical Care

Perelman School of Medicine

University of Pennsylvania

Philadelphia, PA, 1904 

USA

Jose Pascual is an intensivist/surgeon at the University of Pennsylvania, board certified in the US and Canada. He finished his fellowship in 2007 and his basic science PhD in resuscitation immunobiology, at McGill University, in 2005. His thesis investigated the salutary effects of immunemodulating fluids in shock.

As faculty of Medical and Nursing Schools, Dr. Pascual teaches students, residents, fellows and advance practice providers in several didactic and skills courses. However, most notable is his role as research mentor for medical, nursing and undergraduate students raising questions at the bedside and attempting to answer them through clinical or basic science research projects. In the last 5 years, Dr. Pascual has mentored 23 research trainees, several of whom have won awards at national/international scientific meetings.

Jose Pascual’s research interests include Traumatic Brain Injury, shock and ICU education through simulation and patient safety initiatives. His TBI laboratory studies immune responses to injury through intravital microscopy of the cerebral microcirculation investigating the role of the neutrophil in injury and shock. 

Dr. Pascual has launched several ICU educational initiatives using simulation integrated within the ICU to teach day-to-day emergent event management by the multidisciplinary team (NPs, MDs, nurses, pharmacists) through learning from errors or near misses. Initiatives relating to videorecorded simulator-generated or real emergent events have been integrated in ICU Quality Improvement efforts and also published.

Timothy Gaulton is an board certified intensivist/anesthesiologist at the University of Pennsylvania.  He completed residency in anesthesiology at Brigham and Women’s Hospital in 2016 and fellowship in critical care medicine at the University of Pennsylvania in 2018.  Dr. Gaulton works clinically in neurologic/neurosurgical and trauma ICUs.  Dr. Gaulton’s academic focus is on perioperative outcomes research and optimizing functional and cognitive recovery after acute illness and trauma, particularly in older adults and the obese.