Executive Summary: 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：11

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
]}

van den Boogaard, Mark ^{[19
]}

Bosma, Karen J. ^{[20
,21
]}

Brummel, Nathaniel E. ^{[22
,23
]}

Chanques, Gerald ^{[24
,25
]}

Denehy, Linda ^{[26
]}

Drouot, Xavier ^{[27
,28
]}

Fraser, Gilles L. ^{[29
,30
]}

Harris, Jocelyn E. ^{[31
]}

Joffe, Aaron M. ^{[32
]}

Kho, Michelle E. ^{[31
]}

Kress, John P. ^{[33
]}

Lanphere, Julie A. ^{[34
]}

McKinley, Sharon ^{[35
]}

Neufeld, Karin J. ^{[36
]}

Pisani, Margaret A. ^{[37
]}

Payen, Jean-Francois ^{[38
]}

Pun, Brenda T. ^{[39
]}

Puntillo, Kathleen A. ^{[40
]}

Riker, Richard R. ^{[29
,30
]}

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 02111 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, Div Pulm & Crit Care Med, Dept Phys Med & Rehabil, 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] New York Univ Langone Hlth, Div Anesthesiol Perioperat Care & Pain Med, New York, NY USA

[13] New York Univ Langone Hlth, Med, New York, NY USA

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

[15] New York Univ 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, Wexner Med Ctr, Columbus, OH 43210 USA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[34] Intermt Hlth, Dept Phys Med & Rehabil, Salt Lake City, UT USA

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

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

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

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

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

[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, CA USA

[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：

美国国家卫生研究院; 加拿大健康研究院;

关键词：

delirium; guidelines; intensive care; mobilization; pain; sedation; sleep; INTENSIVE-CARE-UNIT; CRITICALLY-ILL PATIENTS; MECHANICALLY VENTILATED PATIENTS; ANALGESIA-BASED SEDATION; LONG-TERM SEDATION; RESPIRATORY-DISTRESS-SYNDROME; GUILLAIN-BARRE-SYNDROME; ACUTE LUNG INJURY; CARDIAC-SURGERY; DOUBLE-BLIND;

D O I：

10.1097/CCM.0000000000003259

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：1532 / 1548

页数：17

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