Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version

GMS German Medical Science — an Interdisciplinary Journal

Claudia Spies^3,34  Christian Waydhas^3,31  Frank Wappler^2,29  Michael Tryba^2,25  Tomislav Trupkovic^2,27  Rolf Detlef Treede^1,11  Philip Tränkle^3,32  Peter Tonner^1,13  Robert Stingele^1,10  Gerhard Schwarzmann⁶  Jürgen Schüttler^3,39  Dierk Schreiter^1,14  Stefan Schröder^3,38  Jens Scholz^1,17  Bernard Roth^1,15  Alexander Reske^2,26  Michael Quintel^2,28  Christian Putensen^3,36  Ulrike Neuhaus^3,33  Edmund Neugebauer^3,35  Andreas Meiser^2,20  Guenter Marggraf⁷  Heinz Laubenthal^3,37  Franz-Josef Kretz³  Wolfgang Koppert^2,21  Stefan Kleinschmidt^2,27  Paul Kessler^1,18  Ralf Huth⁴  Ulrike Haase²  Wolfgang Hartl^3,30  Lars Garten⁹  Lothar Engelmann^1,12  Ingolf Eichler¹  Verena Eggers^3,34  Christine Dictus⁵  Peter Dall^2,22  Hartmut Bürkle^1,16  Rolf Biniek^2,23  Ralf Baron⁸  Katrin Bäsell^2,24  Anja Heymann^3,33  Jörg Martin^1,19 

[1] Department of Cardiac and Vascular Surgery, Klinikum Dortmund GgmbH, Germany;Department of Anesthesiology and Intensive Care Medicine, Charité Campus Mitte, Berlin, Germany;Olgahospital, Department of Anesthesiology and Operative Intensive Care, Stuttgart, Germany;University Children's Hospital of Mainz, Germany;Department of Neurosurgery, University of Heidelberg, Germany;Anaesthesiology, Surgical Intensive Care Unit, Frankfurt, Germany;West German Heart Center Essen, Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Germany;Department of Neurology, ChristianAlbrechts University, Kiel, Germany;Department of Neonatology, Charité University Medicine Berlin, Germany;Department of Neurology, University Hospital of SchleswigHolstein, Kiel, Germany;Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Germany;Department of Internal Medicine and Intensive Care Medicine, University of Leipzig, Germany;Department of Anesthesiology and Intensive Care Medicine, Emergency Medicine Hospital Links der Weser GmbH, Bremen, Germany;Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany;Department of General Pediatrics, Cologne, Germany;Clinic for Anaesthesiology and Operative Intensive Care and Pain Clinic of Memmingen, Germany;Department of Anesthesiology and Surgical Intensive Care, University Hospital of SchleswigHolstein, Kiel, Germany;Department of Anesthesiology and Intensive Care Medicine, Orthopedic University Hospital, Frankfurt, Germany;Department of Anesthesiology and Operative Intensive Care, Klinik am Eichert, Göppingen, Germany;Department of Anesthesiology, Intensive Care and Pain, Saarland University Hospital, Homburg, Germany;Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Germany;Municipal Hospital of Lüneburg, Germany;Department of Neurology, LVRKlinik Bonn, Germany;DRK Kliniken Berlin Köpenick, Berlin, Germany;Anesthesiology and Operative Intensive Care, Klinikum Kassel, Germany;Department of Anesthesiology and Intensive Care, Universitätsklinikum Carl Gustav Carus, Dresden, Germany;Department of Anesthesiology, Intensive Care Medicine and Pain Management, BG Trauma Clinic Ludwigshafen, Germany;Surgical Intensive Care, University of Göttingen, Germany;Department of Anesthesiology and Operative Intensive Care, Hospital CologneMerheim, University of Witten/ Herdecke, Cologne, Germany;Department of Surgery Grosshadern, University of Munich, Germany;Department of Trauma Surgery, University Hospital Essen, Germany;Department of Internal Medicine, Division III, ICU 3IS, Tübingen, Germany;Department of Anesthesiology and Operative Intensive Care, Charité Campus Virchow, Berlin, Germany;Department of Anesthesiology and Intensive Care Medicine, Campus VirchowKlinikum and Campus Charité Mitte, Berlin, Germany;IFOMInstitute for Research in Operative Medicine, Institute for Surgical Research, Private University of Witten/ Herdecke GmbH, Köln, Germany;Anesthesiology and Operative Intensive Care, University of Bonn, Germany;Bochum, Germany;Department of Psychiatry and Psychotherapy, CMM Hospital Guestrow, Germany;Anaesthesiology Clinic University Hospital of Erlangen, Germany

关键词: intensive care;    treatment;    monitoring;    delirium;    sedation;    analgesia;    evidence;    guideline;   

Others  :  869191

实施日期：2009-12-04，发布日期：2010-02-10

【 摘 要 】

Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2^nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%).

Between 2006–2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) were developed into 3^rd Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU). In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade “A” (very strong recommendation), Grade “B” (strong recommendation) and Grade “0” (open recommendation) were agreed.

As a result of this process we now have an interdisciplinary and consensus-based set of 3^rd Generation Guidelines that take into account all critically illness patient populations.

The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated.These guidelines offer treatment recommendations for the ICU team.The implementation of scores and protocols into routine ICU practice is necessary for their success.

【 授权许可】

   
© 2010 Martin et al.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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• [211]Tables and schemes(GMS-Guideline-Tables-Schemes.pdf, application/pdf,922,72 kByte)