Shapiro B A, Warren J, Egol A B, Greenbaum D M, Jacobi J, Nasraway S A, Schein R M, Spevetz A, Stone J R
Crit Care Med. 1995 Sep;23(9):1596-600. doi: 10.1097/00003246-199509000-00021.
The development of practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit (ICU) setting for the purpose of guiding clinical practice.
A task force of more than 40 experts in disciplines related to the use of analgesic and sedative agents in the ICU was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM).
The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, pharmacopeias, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four predetermined categories, according to study design and scientific value.
The task force met several times as a whole, and numerous times in smaller groups by teleconference, over a 1-yr period to identify the pertinent literature and arrive at consensus recommendations for the whole task force to discuss. Consideration was given to the relationship between the weight of scientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council.
To facilitate rapid communication of the six recommendations contained within the complete and unabridged practice parameter document, an executive summary was prepared for publication by the ACCM Board of Regents, and this executive summary was approved by the task force steering committee and the SCCM Executive Council.
A consensus of experts provided six recommendations with supporting data for intravenous analgesia and sedation in the ICU setting: a) morphine sulfate is the preferred analgesic agent for critically ill patients; b) fentanyl is the preferred analgesic agent for critically ill patients with hemodynamic instability, for patients manifesting symptoms of histamine release with morphine, or morphine allergy; c) hydromorphone can serve as an acceptable alternative to morphine; d) midazolam or propofol are the preferred agents only for the short-term (< 24 hrs) treatment of anxiety in the critically ill adult; e) lorazepam is the preferred agent for the prolonged treatment of anxiety in the critically ill adult; f) haloperidol is the preferred agent for the treatment of delirium in the critically ill adult. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.
制定重症监护病房（ICU）成年患者静脉镇痛和镇静的实践参数，以指导临床实践。
从美国危重病医学会（ACCM）和危重病医学会（SCCM）的成员中召集了一个由40多名与ICU中使用镇痛和镇静药物相关学科的专家组成的特别工作组。
特别工作组成员提供个人经验，并确定将从中寻求共识的已发表文献（MEDLINE文章、教科书、药典等）。根据研究设计和科学价值，对已发表文献进行审查并分类到四个预定类别之一。
特别工作组作为一个整体召开了几次会议，并在1年的时间里通过电话会议以小组形式召开了多次会议，以确定相关文献，并达成共识建议供整个特别工作组讨论。考虑了科学信息的权重与专家观点之间的关系。在接下来的一年里，由特别工作组指导委员会撰写文件草案，并由特别工作组成员进行辩论，直到通过名义小组程序达成共识。然后，ACCM董事会对特别工作组草案进行审查、评估和编辑。在指导委员会批准后，文件草案由SCCM理事会审查并批准。
为便于快速传达完整且未删节的实践参数文件中包含的六项建议，ACCM董事会编写了一份执行摘要以供发表，该执行摘要得到了特别工作组指导委员会和SCCM执行委员会的批准。
专家共识提供了六项关于ICU环境中静脉镇痛和镇静的建议及支持数据：a）硫酸吗啡是重症患者的首选镇痛剂；b）芬太尼是血流动力学不稳定的重症患者、表现出吗啡组胺释放症状的患者或吗啡过敏患者的首选镇痛剂；c）氢吗啡酮可作为吗啡的可接受替代药物；d）咪达唑仑或丙泊酚仅用于成年重症患者焦虑的短期（<24小时）治疗；e）劳拉西泮是成年重症患者焦虑长期治疗的首选药物；f）氟哌啶醇是成年重症患者谵妄治疗的首选药物。本执行摘要有选择地提供了支持信息，并非完整文件的替代品。
