Martin Jörg, Heymann Anja, Bäsell Katrin, Baron Ralf, Biniek Rolf, Bürkle Hartmut, Dall Peter, Dictus Christine, Eggers Verena, Eichler Ingolf, Engelmann Lothar, Garten Lars, Hartl Wolfgang, Haase Ulrike, Huth Ralf, Kessler Paul, Kleinschmidt Stefan, Koppert Wolfgang, Kretz Franz-Josef, Laubenthal Heinz, Marggraf Guenter, Meiser Andreas, Neugebauer Edmund, Neuhaus Ulrike, Putensen Christian, Quintel Michael, Reske Alexander, Roth Bernard, Scholz Jens, Schröder Stefan, Schreiter Dierk, Schüttler Jürgen, Schwarzmann Gerhard, Stingele Robert, Tonner Peter, Tränkle Philip, Treede Rolf Detlef, Trupkovic Tomislav, Tryba Michael, Wappler Frank, Waydhas Christian, Spies Claudia
Department of Anesthesiology and Operative Intensive Care, Klinik am Eichert, Göppingen, Germany.
Ger Med Sci. 2010 Feb 2;8:Doc02. doi: 10.3205/000091.
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.
对重症患者的镇痛、镇静和谵妄进行针对性监测，并对其进行适当管理是重症监护医学的一项护理标准。鉴于目标导向治疗已被公认的优势，德国有必要制定我们自己的重症监护镇痛和镇静指南，这些指南于2005年作为第二代指南发布。通过2006年对这些指南的传播，监测的使用率从8%提高到了51%，基于方案的方法的使用率从21%提高到了46%。在2006 - 2009年期间，德国麻醉和重症医学学会（DGAI）和德国重症与急诊医学跨学科协会（DIVI）的现有指南被制定为第三代指南，以确保和优化重症监护病房（ICU）镇痛、镇静和谵妄管理的质量。与另外10个专业协会合作，使用牛津循证医学中心的标准对文献进行了综述。利用671篇参考文献的数据，制定了文本、图表和建议。在这些建议中，确定了“A”级（非常强烈的建议）、“B”级（强烈的建议）和“0”级（开放性建议）。经过这一过程，我们现在有了一套跨学科且基于共识的第三代指南，该指南考虑了所有重症患者群体。反复证明了使用镇痛、镇静和谵妄治疗方案的有效性。这些指南为ICU团队提供了治疗建议。要使这些指南取得成功，将评分和方案纳入ICU常规实践是必要的。
