Anestesiología y Medicina Crítica y Cuidado Intensivo, Departamento de Medicina Crítica y Cuidado Intensivo, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad del Rosario, Universidad de Los Andes, Bogotá, Colombia.
Anestesiología, Medicina Crítica y Epidemiología, Clínica Marly JCG, Universidad del Rosario, Bogotá, Colombia.
Med Intensiva (Engl Ed). 2020 Apr;44(3):171-184. doi: 10.1016/j.medin.2019.07.013. Epub 2019 Sep 3.
Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented.
鉴于镇静、镇痛和谵妄管理在重症监护病房中的重要性，为了更新之前发布的指南，根据最新文献，提出了一个新的临床实践指南，解决了最相关的管理和干预方面的问题。来自 9 个泛美和伊比利亚危重病医学和重症治疗学会联合会国家的 24 名重症监护医生组成了一个小组，共同制定了这些指南。根据推荐评估、制定和评估工作组的标准，对证据质量和建议进行了评估。使用 MEDLINE、Cochrane 图书馆数据库（如 Cochrane 系统评价数据库和 Cochrane 中心对照试验注册库（CENTRAL）、效应摘要数据库、英国国家卫生服务经济评估数据库和拉丁美洲和加勒比健康科学文献数据库（LILACS））进行了系统的文献检索。共选择了 438 篇参考文献。经过协商一致，确定了 47 项具有高和中质量证据的强烈推荐建议、14 项具有中质量证据的条件推荐建议和 65 项具有低质量证据的条件推荐建议。最后，强调了初始和多模式疼痛管理的重要性。强调应降低镇静水平，并仅在特定情况下使用深度镇静。增加了关于右美托咪定、瑞芬太尼、氯胺酮等药物使用的证据和建议。
