Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit
Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit
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DOI：
10.1097/ccm.0b013e3182783b72
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发表时间：
2013-01-01
影响因子：
8.8
通讯作者：
Jaeschke, Roman
中科院分区：
文献类型：
--
作者：
Barr, Juliana;Fraser, Gilles L.;Jaeschke, Roman
目的：修订2002年《重症监护医学》杂志上发表的《危重III期成人持续使用镇静剂和镇痛剂的临床实践指南》。方法：美国重症监护医学院组建了一个20人的多学科、多机构工作组，他们在指南制定、疼痛、躁动和镇静、谵妄管理以及成人危重患者的相关结局方面具有专业知识。该工作组，分为四个小组委员会，合作超过6年的人，通过电话会议，并通过电子通信。小组委员会负责开发相关临床问题，使用建议评估分级、开发和评估方法（http：www.gradeworkinggroup.org）来审查、评估和总结文献，并开发临床声明（描述性）和建议（可操作）。在专业图书管理员和Refworks（R）数据库软件的帮助下，他们开发了一个基于Web的电子数据库，其中包含从8个临床搜索引擎中提取的19，000多篇参考文献，这些参考文献与疼痛和镇痛、激动和镇静、谵妄以及成人ICU患者的相关临床结果有关。该小组还使用心理测量分析来评估和比较疼痛，激动/镇静和谵妄评估工具。所有工作队成员都被允许审查支持每项声明和建议的文献，并向小组委员会提供反馈。所有声明和建议均采用名义小组技术和改良的德尔菲法达成小组共识，所有工作队成员使用电子调查（http：//www.example.com）进行匿名投票。www.esurvey.com所有投票于2010年12月完成。本文引用了在此日期之后和这些指南出版之前出版的相关研究。每个陈述和建议的证据质量被评为高（A）、中等（B）或低/非常低（C）。建议的强度分为强（1）或弱（2），支持（+）或反对（-）干预。一项强有力的建议（无论是赞成还是反对）表明，干预的理想效果要么明显超过其不良效果（风险、负担和成本），要么没有。对于所有强烈建议，短语“我们建议.”贯穿始终。一项支持或反对干预措施的微弱建议表明，可取和不可取的效果之间的权衡不太清楚。对于所有薄弱的建议，短语“我们建议.”贯穿始终。在缺乏足够证据或无法达成小组共识的情况下，未提出建议（0）。基于专家意见的协商一致意见不能用来代替缺乏证据。如果工作队成员是相关研究的共同作者，则遵循一致的方法来解决潜在的利益冲突。该指南的制定独立于任何行业资金。结论：这些指南为制定综合的、基于证据的、以患者为中心的方案提供了路线图，用于预防和治疗重症患者的疼痛、激越和谵妄。(Crit Care Med 2013; 41：263-306）
Objective: To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically III Adult" published in Critical Care Medicine in 2002.Methods: The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients. The task force, divided into four subcommittees, collaborated over 6 yr in person, via teleconferences, and via electronic communication. Subcommittees were responsible for developing relevant clinical questions, using the Grading of Recommendations Assessment, Development and Evaluation method (http://www.gradeworkinggroup.org) to review, evaluate, and summarize the literature, and to develop clinical statements (descriptive) and recommendations (actionable). With the help of a professional librarian and Refworks(R) database software, they developed a Web-based electronic database of over 19,000 references extracted from eight clinical search engines, related to pain and analgesia, agitation and sedation, delirium, and related clinical outcomes in adult ICU patients. The group also used psychometric analyses to evaluate and compare pain, agitation/sedation, and delirium assessment tools. All task force members were allowed to review the literature supporting each statement and recommendation and provided feedback to the subcommittees. Group consensus was achieved for all statements and recommendations using the nominal group technique and the modified Delphi method, with anonymous voting by all task force members using E-Survey (http://www.esurvey.com). All voting was completed in December 2010. Relevant studies published after this date and prior to publication of these guidelines were referenced in the text. The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2), and either in favor of (+) or against (-) an intervention. A strong recommendation (either for or against) indicated that the intervention's desirable effects either clearly outweighed its undesirable effects (risks, burdens, and costs) or it did not. For all strong recommendations, the phrase "We recommend ..." is used throughout. A weak recommendation, either for or against an intervention, indicated that the tradeoff between desirable and undesirable effects was less clear. For all weak recommendations, the phrase "We suggest ..." is used throughout. In the absence of sufficient evidence, or when group consensus could not be achieved, no recommendation (0) was made. Consensus based on expert opinion was not used as a substitute for a lack of evidence. A consistent method for addressing potential conflict of interest was followed if task force members were coauthors of related research. The development of this guideline was independent of any industry funding.Conclusion: These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients. (Crit Care Med 2013; 41:263-306)