Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

被引：1200

作者：

Devlin, John W. ^{[1
,2
]}

Skrobik, Yoanna ^{[3
,4
]}

Gelinas, Celine ^{[5
]}

Needham, Dale M. ^{[6
]}

Slooter, Arjen J. C. ^{[7
]}

Pandharipande, Pratik P. ^{[8
]}

Watson, Paula L. ^{[9
]}

Weinhouse, Gerald L. ^{[10
,11
]}

Nunnally, Mark E. ^{[12
,13
,14
,15
]}

Rochwerg, Bram ^{[16
,17
]}

Balas, Michele C. ^{[18
,19
]}

van den Boogaard, Mark ^{[20
]}

Bosma, Karen J. ^{[21
,22
]}

Brummel, Nathaniel E. ^{[23
,24
]}

Chanques, Gerald ^{[25
,26
]}

Denehy, Linda ^{[27
]}

Drouot, Xavier ^{[28
,29
]}

Fraser, Gilles L. ^{[30
,31
]}

Harris, Jocelyn E. ^{[32
]}

Joffe, Aaron M. ^{[33
]}

Kho, Michelle E. ^{[32
]}

Kress, John P. ^{[34
]}

Lanphere, Julie A. ^{[35
]}

McKinley, Sharon ^{[36
]}

Neufeld, Karin J. ^{[37
]}

Pisani, Margaret A. ^{[38
]}

Payen, Jean-Francois ^{[39
]}

Pun, Brenda T. ^{[24
]}

Puntillo, Kathleen A. ^{[40
]}

Riker, Richard R. ^{[30
,31
]}

Robinson, Bryce R. H. ^{[41
]}

Shehabi, Yahya ^{[42
]}

Szumita, Paul M. ^{[43
]}

Winkelman, Chris ^{[44
]}

Centofanti, John E. ^{[45
]}

Price, Carrie ^{[46
]}

Nikayin, Sina ^{[47
]}

Misak, Cheryl J. ^{[48
]}

Flood, Pamela D. ^{[49
]}

Kiedrowski, Ken ^{[50
]}

Alhazzani, Waleed ^{[17
,51
]}

机构：

[1] Northeastern Univ, Sch Pharm, Boston, MA 02115 USA

[2] Tufts Med Ctr, Div Pulm Crit Care & Sleep Med, Boston, MA USA

[3] McGill Univ, Fac Med, Montreal, PQ, Canada

[4] Reseau Sante Resp, Regrp Soins Crit Resp, Montreal, PQ, Canada

[5] McGill Univ, Ingram Sch Nursing, Montreal, PQ, Canada

[6] Johns Hopkins Univ, Sch Med, Dept Phys Med & Rehabil, Div Pulm & Crit Care Med, Baltimore, MD USA

[7] Univ Utrecht, Univ Med Ctr, Dept Intens Care Med, Brain Ctr Rudolf Magnus, Utrecht, Netherlands

[8] Vanderbilt Univ, Med Ctr, Dept Anesthesiol, Div Anesthesiol Crit Care Med, Nashville, TN USA

[9] Vanderbilt Univ, Med Ctr, Div Sleep Med, Nashville, TN USA

[10] Brigham & Womens Hosp, Div Pulm & Crit Care, 75 Francis St, Boston, MA 02115 USA

[11] Harvard Univ, Sch Med, Boston, MA USA

[12] NYU, Langone Hlth, Div Anesthesiol Perioperat Care & Pain Med, New York, NY USA

[13] NYU, Langone Hlth, Div Med, New York, NY USA

[14] NYU, Langone Hlth, Div Neurol, New York, NY USA

[15] NYU, Langone Hlth, Div Surg, New York, NY USA

[16] McMaster Univ, Dept Med Crit Care, Hamilton, ON, Canada

[17] McMaster Univ, Dept Hlth Res Methods Impact & Evidence, Hamilton, ON, Canada

[18] Ohio State Univ, Coll Nursing, Ctr Excellence Crit & Complex Care, Columbus, OH 43210 USA

[19] Ohio State Univ, Wexner Med Ctr, Columbus, OH 43210 USA

[20] Radboud Univ Nijmegen, Med Ctr, Dept Intens Care Med, Nijmegen, Netherlands

[21] London Hlth Sci Ctr, Div Crit Care, London, ON, Canada

[22] Univ Western Ontario, Schulich Sch Med & Dent, London, ON, Canada

[23] Vanderbilt Univ, Med Ctr, Dept Med, Ctr Qual Aging,Div Allergy Pulm & Crit Care Med, Nashville, TN USA

[24] Vanderbilt Univ, Med Ctr, Ctr Hlth Serv Res, Nashville, TN USA

[25] Montpellier Univ, St Eloi Hosp, Dept Anesthesia & Intens Care, Montpellier, France

[26] Univ Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France

[27] Univ Melbourne, Melbourne Sch Hlth Sci, Melbourne, Vic, Australia

[28] Univ Poitiers, Fac Med Pharm, Poitiers, France

[29] CHU Poitiers, Serv Neurophysiol, Poitiers, France

[30] Maine Med Ctr, Dept Crit Care, Portland, ME 04102 USA

[31] Tufts Univ, Sch Med, Portland, ME USA

[32] McMaster Univ, Sch Rehabil Sci, Hamilton, ON, Canada

[33] Univ Washington, Harborview Med Ctr, Dept Anesthesiol & Pain Med, 325 9Th Ave, Seattle, WA 98104 USA

[34] Univ Chicago, Div Pulm & Crit Care Med, Chicago, IL 60637 USA

[35] Intermt Healthcare, Dept Phys Med & Rehabil, Salt Lake City, UT USA

[36] Deakin Univ, Sch Nursing & Midwifery, Geelong, Vic 3217, Australia

[37] Johns Hopkins Univ, Sch Med, Dept Psychiat & Behav Sci, Baltimore, MD 21205 USA

[38] Yale Univ, Sch Med, Div Pulm Crit Care & Sleep Med, New Haven, CT USA

[39] Grenoble Alpes Univ Hosp, Dept Anesthesiol & Crit Care, Grenoble, France

[40] Univ Calif San Francisco, Sch Nursing, San Francisco, CA 94143 USA

[41] Univ Washington, Dept Surg, Seattle, WA 98195 USA

[42] Monash Univ, Sch Clin Sci, Dept Crit Care & Perioperat Med, Melbourne, Vic, Australia

[43] Brigham & Womens Hosp, Dept Pharm, 75 Francis St, Boston, MA 02115 USA

[44] Case Western Reserve Univ, Frances Payne Bolton Sch Nursing, Cleveland, OH 44106 USA

[45] McMaster Univ, Dept Anesthesia & Crit Care, Hamilton, ON, Canada

[46] Johns Hopkins Univ, Welch Med Lib, Baltimore, MD USA

[47] New York Med Coll, Dept Psychiat & Behav Sci, Valhalla, NY 10595 USA

[48] Univ Toronto, Dept Philosophy, Toronto, ON, Canada

[49] Stanford Univ Hosp, Div Anesthesiol, Palo Alto, CA USA

[50] Johns Hopkins Univ Hosp, Patient & Family Advisory Comm, Baltimore, MD 21287 USA

来源：

CRITICAL CARE MEDICINE | 2018年 / 46卷 / 09期

基金：

加拿大健康研究院; 美国国家卫生研究院;

关键词：

delirium; guidelines; immobility; intensive care; mobilization; pain; sedation; sleep; INTENSIVE-CARE-UNIT; CRITICALLY-ILL PATIENTS; MECHANICALLY VENTILATED PATIENTS; CONFUSION ASSESSMENT METHOD; QUALITY-OF-LIFE; POSTTRAUMATIC-STRESS-DISORDER; TERM COGNITIVE IMPAIRMENT; ACUTE POSTOPERATIVE PAIN; ANALGESIA-BASED SEDATION; PHYSICAL RESTRAINT USE;

D O I：

10.1097/CCM.0000000000003299

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. Design: Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic discussions among subgroups and whole panel were part of the guidelines' development. A general content review was completed face-to-face by all panel members in January 2017. Methods: Content experts, methodologists, and ICU survivors were represented in each of the five sections of the guidelines: Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as strong, conditional, or good practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. Results: The Pain, Agitation/Sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered prioritized question list remained without recommendation. Conclusions: We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.

引用

页码：E825 / E873

页数：49

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