Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version.
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.
Martin
Jörg
J
Department of Anesthesiology and Operative Intensive Care, Klinik am Eichert, Göppingen, Germany.
Heymann
Anja
A
Bäsell
Katrin
K
Baron
Ralf
R
Biniek
Rolf
R
Bürkle
Hartmut
H
Dall
Peter
P
Dictus
Christine
C
Eggers
Verena
V
Eichler
Ingolf
I
Engelmann
Lothar
L
Garten
Lars
L
Hartl
Wolfgang
W
Haase
Ulrike
U
Huth
Ralf
R
Kessler
Paul
P
Kleinschmidt
Stefan
S
Koppert
Wolfgang
W
Kretz
Franz-Josef
FJ
Laubenthal
Heinz
H
Marggraf
Guenter
G
Meiser
Andreas
A
Neugebauer
Edmund
E
Neuhaus
Ulrike
U
Putensen
Christian
C
Quintel
Michael
M
Reske
Alexander
A
Roth
Bernard
B
Scholz
Jens
J
Schröder
Stefan
S
Schreiter
Dierk
D
Schüttler
Jürgen
J
Schwarzmann
Gerhard
G
Stingele
Robert
R
Tonner
Peter
P
Tränkle
Philip
P
Treede
Rolf Detlef
RD
Trupkovic
Tomislav
T
Tryba
Michael
M
Wappler
Frank
F
Waydhas
Christian
C
Spies
Claudia
C
D000698:Analgesia / Q000592:standards*; D016292:Procedural Sedation / Q000592:standards*; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000628:therapy; D003693:Delirium / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D017410:Practice Guidelines as Topic