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重症医学中谵妄、镇痛与镇静管理的循证及共识指南。2015年修订版（DAS指南2015）-简版

Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version.

作者信息

Baron Ralf, Binder Andreas, Biniek Rolf, Braune Stephan, Buerkle Hartmut, Dall Peter, Demirakca Sueha, Eckardt Rahel, Eggers Verena, Eichler Ingolf, Fietze Ingo, Freys Stephan, Fründ Andreas, Garten Lars, Gohrbandt Bernhard, Harth Irene, Hartl Wolfgang, Heppner Hans-Jürgen, Horter Johannes, Huth Ralf, Janssens Uwe, Jungk Christine, Kaeuper Kristin Maria, Kessler Paul, Kleinschmidt Stefan, Kochanek Matthias, Kumpf Matthias, Meiser Andreas, Mueller Anika, Orth Maritta, Putensen Christian, Roth Bernd, Schaefer Michael, Schaefers Rainhild, Schellongowski Peter, Schindler Monika, Schmitt Reinhard, Scholz Jens, Schroeder Stefan, Schwarzmann Gerhard, Spies Claudia, Stingele Robert, Tonner Peter, Trieschmann Uwe, Tryba Michael, Wappler Frank, Waydhas Christian, Weiss Bjoern, Weisshaar Guido

机构信息

German Society of Neurology (DGN).

German Society of Internal Medicine Intensive Care (DGIIN).

出版信息

Ger Med Sci. 2015 Nov 12;13:Doc19. doi: 10.3205/000223. eCollection 2015.

DOI:10.3205/000223
PMID:26609286
原文链接:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4645746/
Abstract

In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade "A" (strong recommendation), Grade "B" (recommendation) and Grade "0" (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

摘要

2010年，在德国麻醉与重症医学学会（DGAI）和德国重症与急诊医学跨学科协会（DIVI）的指导下，德国12个医学协会发表了《重症监护中镇痛、镇静和谵妄管理的循证与共识指南》。自那时以来，多项新研究和出版物大幅增加了证据量，包括美国危重病医学会（ACCM）联合危重病医学学会（SCCM）及美国卫生系统药师协会（ASHP）于2013年提出的新建议。为了此次更新，需要对指南进行重大重组和扩充，以涵盖治疗的新方面，如睡眠和焦虑管理。使用牛津循证医学中心的标准对文献进行了系统检索和评估。用于制定这些建议的证据由17个国家协会的代表进行了审查和批准。采用了以下三个推荐等级：“A”级（强烈推荐）、“B”级（推荐）和“0”级（开放性推荐）。结果是一套全面、跨学科、基于证据和共识的3级指南。本出版物是为所有重症监护专业人员设计的，并考虑了所有重症患者群体。它代表了重症医学中以症状为导向的谵妄、焦虑、应激预防、诊断和治疗以及基于方案的镇痛、镇静和睡眠管理指南。

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Effect of occupational therapy on the occurrence of delirium in critically ill patients: a systematic review and meta-analysis.职业治疗对危重症患者谵妄发生的影响：一项系统评价和荟萃分析。
Front Neurol. 2024 Jul 22;15:1391993. doi: 10.3389/fneur.2024.1391993. eCollection 2024.
氯胺酮用于机械通气患者的持续镇静。
J Emerg Trauma Shock. 2015 Jan-Mar;8(1):11-5. doi: 10.4103/0974-2700.145414.
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Under-recognition of delirium in older adults by nurses in the intensive care unit setting.重症监护病房的护士对老年患者谵妄的识别不足。
Aging Clin Exp Res. 2015 Oct;27(5):735-40. doi: 10.1007/s40520-015-0323-6. Epub 2015 Feb 12.
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Cardiac awake extracorporeal life support-bridge to decision?心脏清醒体外生命支持——通向决策的桥梁？
Artif Organs. 2015 May;39(5):400-8. doi: 10.1111/aor.12396. Epub 2015 Jan 16.
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Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.在危重症患者中，依托咪酯单次诱导剂量与其他诱导剂用于气管插管的比较。
Cochrane Database Syst Rev. 2015 Jan 8;1(1):CD010225. doi: 10.1002/14651858.CD010225.pub2.
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Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults.机械通气成年患者谵妄的患病率、危险因素及转归
Crit Care Med. 2015 Mar;43(3):557-66. doi: 10.1097/CCM.0000000000000727.
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Baseline EEG pattern on continuous ICU EEG monitoring and incidence of seizures.重症监护病房（ICU）持续脑电图（EEG）监测的基线脑电图模式及癫痫发作发生率。
J Clin Neurophysiol. 2015 Apr;32(2):147-51. doi: 10.1097/WNP.0000000000000157.
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Extracorporeal CO2 removal as bridge to lung transplantation in life-threatening hypercapnia.体外二氧化碳清除作为危及生命的高碳酸血症患者肺移植的桥梁。
Transpl Int. 2015 Mar;28(3):297-304. doi: 10.1111/tri.12486. Epub 2014 Dec 5.
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Extracorporeal Co2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control.高碳酸血症患者无创通气失败风险的体外二氧化碳清除：一项采用历史对照的匹配队列研究
Crit Care Med. 2015 Jan;43(1):120-7. doi: 10.1097/CCM.0000000000000607.