Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
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DOI：
10.1097/ccm.0000000000003299
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发表时间：
2018-09-01
影响因子：
8.8
通讯作者：
Alhazzani, Waleed
中科院分区：
文献类型：
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作者：
Devlin, John W.;Skrobik, Yoanna;Alhazzani, Waleed
目的：为了更新和扩展2013年临床实践指南的疼痛，躁动，谵妄在成人患者在ICU.Design的管理：32个国际专家，4个方法学家，和4个危重病幸存者几乎每月至少见面。所有部门的小组都在每年一度的重症监护医学会大会上面对面地聚集在一起;虚拟连接包括那些无法参加的人。事先制定了正式的利益冲突政策，并在整个过程中予以执行。小组和整个小组之间的会议和电子讨论是制定准则的一部分。2017年1月，所有专家组成员面对面完成了一般内容审查。方法：内容专家、方法学家和ICU幸存者在指南的五个部分中均有代表：疼痛、躁动/镇静、谵妄、不动（活动/康复）和睡眠（中断）。每个部分都创建了人群、干预、比较和结局，以及基于感知的临床相关性的不可操作的描述性问题。然后，指南小组投票决定他们的排名，患者优先考虑他们的重要性。对于每个人群、干预措施、比较和结局问题，各章节搜索了现有的最佳证据，确定了其质量，并根据建议评估、制定和评价原则的分级，将建议制定为强有力的、有条件的或良好的实践声明。此外，证据差距和临床注意事项明确identified.Results：疼痛，躁动/镇静，谵妄，不动（动员/康复），睡眠（中断）小组发出37条建议（三个强和34个条件），两个良好的做法声明，和32个未分级，不可诉的声明。三个问题从以患者为中心的优先问题列表仍然没有recommendation.Conclusions：我们发现大量的，跨学科的国际专家队列之间的证据支持的建议，以及在评估，预防和治疗的疼痛，躁动/镇静，谵妄，不动（动员/康复），睡眠（中断）在重症成人的剩余文献差距的协议。强调这一证据和研究需求将改善疼痛、躁动/镇静、谵妄、不动（活动/康复）和睡眠（中断）管理，并为改善这一弱势人群的结局和科学提供基础。
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.