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中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (04) : 241 -244. doi: 10.3877/cma.j.issn.2096-1537.2017.04.001

所属专题: 镇痛镇静 重症医学 文献 指南共识

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ICU机械通气患者的镇静与镇痛:指南vs现实
刘京涛1, 马朋林1,()   
  1. 1. 100091 北京,解放军第309医院重症医学科
  • 收稿日期:2017-06-12 出版日期:2017-11-28
  • 通信作者: 马朋林

Analgesia and sedation for mechanically ventilated patients in ICU: guidelines vs. reality

Jingtao Liu1, Penglin Ma1,()   

  1. 1. Department of Critical Care Medicine, the 309th Hospital of Chinese Peoples′ Liberation Army, Beijing 100091, China
  • Received:2017-06-12 Published:2017-11-28
  • Corresponding author: Penglin Ma
  • About author:
    Corresponding author: Ma Penglin, Email:
引用本文:

刘京涛, 马朋林. ICU机械通气患者的镇静与镇痛:指南vs现实[J/OL]. 中华重症医学电子杂志, 2017, 03(04): 241-244.

Jingtao Liu, Penglin Ma. Analgesia and sedation for mechanically ventilated patients in ICU: guidelines vs. reality[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(04): 241-244.

2002年ICU成人重症患者镇痛、镇静剂临床应用指南改变了ICU医护人员对机械通气患者实施镇痛、镇静治疗重要性的认识,2013年更新的PAD指南以及2016年eCASH理念进一步提出以充分镇痛为基础的浅镇静为导向的镇痛、镇静策略有益于改善临床预后。由此可见,指南对规范并改进临床实践具有普遍意义。然而,现实情况是更新的指南当今临床依从性并不乐观。在众多原因中,广大临床医师镇痛、镇静认识提高后,新理念在临床实施中尚存在诸多障碍可能是重要因素,如疼痛的客观评价、浅镇静的安全风险以及eCASH的适应群体等。因此,进一步研究解决上述问题是新理念有效推广的关键。

2002 published guidelines greatly promoted knowledge of intensive caring providers on analgesia and sedation for mechanically ventilated patients. Updated PAD guidelines in 2013 and eCASH concept in 2016 further suggested that adequate analgesia based light sedation-directed strategy be beneficial to outcomes. Accordingly, guidelines were valuable for standardizing as well as improving clinical practices extensively. However, it is the fact that compliance was significantly low to updated guidelines nowadays. Barriers happened in implementation of new approaches, such objective assessment of pain intensity, risk of light sedation on safety and right populations for eCASH as well, might be important one of the multiple impacting factors since knowledge of analgesia and sedation was widely promoted. Therefore, it is crucial for well implement of these new approaches to solve these problems.

1
Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult [J]. Crit Care Med, 2002, 30(1):119-141.
2
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit [J]. Crit Care Med, 2013, 41(1):263-306.
3
Vincent JL, Shehabi Y, Walsh, TS,et al. Comfort and patient-centred care without excessive sedation: the eCASH concept [J]. Intensive Care Med, 2016, 42(6):962-971.
4
Shehabi Y, Chan L, Kadiman S, et al. Sedation Practice in Intensive Care Evaluation (SPICE) Study Group investigators. Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study [J]. Intensive Care Med, 2013, 39(5):910-918.
5
Guldbrand P, Berggren L, Brattebö G, et al. Survey of routines for sedation of patients on controlled ventilation in Nordic intensive care units. Acta Anaesthesiol Scand [J]. 2004, 48(8):944-950.
6
Payen JF, Chanques G, Mantz J, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study [J]. Anesthesiology, 2007, 106(4):687-695.
7
Martin J, Franck M, Sigel S, et al. Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey [J]. 2007, 11(6):R124.
8
Ma P, Liu J, Xi X, et al. Practice of sedation and the perception of discomfort during mechanical ventilation in Chinese intensive care units [J]. J Crit Care, 2010, 25(3):451-457.
9
Shapiro MB, West MA, Nathens AB, et al. V. Guidelines for sedation and analgesia during mechanical ventilation general overview [J]. J Trauma, 2007, 63(4):945-950.
10
Pun BT, Balas MC, Davidson J. Implementing the 2013 PAD guidelines: top ten points to consider [J]. Semin Respir Crit Care Med, 2013, 34(2):223-235.
11
Riker RR, Fraser GL. The new practice guidelines for pain, agitation, and delirium [J]. Am J Crit Care, 2013, 22(2):153-157.
12
Jackson DL, Proudfoot CW, Cann KF, et al. The incidence of sub-optimal sedation in the ICU: a systematic review [J]. Crit Care, 2009, 13(6):R204.
13
Tanaka LM, Azevedo LC, Park M, et al. Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study [J]. Crit Care, 2014, 18(4):R156.
14
Balzer F, Weiß B, Kumpf O, et al. Early deep sedation is associated with decreased in -hospital and two-year follow-up survival [J]. Crit Care, 2015, 19:197.
15
Sneyers B, Laterre PF, Perreault MM, et al. Current practices and barriers impairing physicians′ and nurses′ adherence to analgo-sedation recommendations in the intensive care unit-a national survey [J]. Crit Care, 2014, 18(6):655.
16
Samuelson KA, Lundberg D, Fridlund B. Stressful experiences in relation to depth of sedation in mechanically ventilated patients [J]. Nurs Crit Care, 2007, 12(2):93-104.
17
Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial [J]. Lancet, 2010, 375(9713):475-480.
18
Shehabi Y, Bellomo R, Reade MC, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients [J]. Am J Respir Crit Care Med, 2012, 186(8):724-731.
19
DAS-Taskforce 2015, Baron R, Binder A, et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015(DAS-Guideline 2015)-short version [J]. Ger Med Sci, 2015, 13:Doc19.
20
Rijkenberg S, Stilma W, Endeman H, et al. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool [J]. J Crit Care. 2015, 30(1):167-172.
21
Gong Y, Ma P. Questions on the pain, agitation, and delirium practice guidelines for adult critically ill patients [J]. Chin Med J(Engl), 2014, 127 (24):4283-4286.
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