title: Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients.
abstract: BACKGROUND
  Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, at the same time that lowers the incidence of complications, wich translates in better patient outcomes.
  
  
  OBJECTIVE
  To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium.
  
  
  METHODS
  A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines. Assessment of evidence quality and recommendations were made based on the Grading of Recommendations Assessment, Development and Evaluation system. Strength of recommendations was classified as 1=strong, or 2=weak, and quality of evidence as A=high, B=moderate, or C=low. Two authors searched the following databases: MEDLINE through PUBMED, The Cochrane Library and Literatura Latinoamericana y del Caribe en Ciencias de la Salud and retrieved pertinent information. Members assigned to the 11 sections of the guidelines, based on the literature review, formulated the recommendations, that were discussed in plenary sessions. Only those recommendations that achieved more than 80% of consensus were approved for the final document. The Colombian Association of Critical Medicine and Intensive Care (AMCI) supported the elaboration of this guidelines.
  
  
  RESULTS
  Four hundred sixty-seven articles were included for review. An increase in number and quality of publications was observed. This allowed to generate 64 strong recommendations with high and moderate quality of evidence in contrast to the 28 recommendations of the previous edition.
  
  
  CONCLUSIONS
  This Guidelines contains recommendations and suggestions based on the best evidence available for the management of sedation, analgesia and delirium of the critically ill patient, including a bundle of strategies that serves this purpose. We highlight the assessment of pain and agitation/sedation through validated scales, the use of opioids initially to apropiate analgesic control, associated with multimodal strategies in order to reduce opioide consumption; to promote the lowest level of sedation necessary avoiding over-sedation. Also, in case of the need of sedatives, choose the most appropiate for the patient needs, avoiding the use of benzodiazepines and identify risk factors for delirium, in order to prevent its occurrence, diagnose delirium and treat it with the most suitable pharmacological agent, whether it is haloperidol, atypical antipsychotics or dexmedetomidine, once again, avoiding the use of benzodiazepines and decreasing the use of opioids.
authors.affiliation: Departamento de Medicina Crítica y Cuidado Intensivo, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de Los Andes, Bogotá, Colombia. Electronic address: edgarcelis.md@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Celis-Rodríguez
authors.forename: C
authors.initials: C
authors.lastname: Birchenall
authors.forename: M Á
authors.initials: MÁ
authors.lastname: de la Cal
authors.forename: G
authors.initials: G
authors.lastname: Castorena Arellano
authors.forename: A
authors.initials: A
authors.lastname: Hernández
authors.forename: D
authors.initials: D
authors.lastname: Ceraso
authors.forename: J C
authors.initials: JC
authors.lastname: Díaz Cortés
authors.forename: C
authors.initials: C
authors.lastname: Dueñas Castell
authors.forename: E J
authors.initials: EJ
authors.lastname: Jimenez
authors.forename: J C
authors.initials: JC
authors.lastname: Meza
authors.forename: T
authors.initials: T
authors.lastname: Muñoz Martínez
authors.forename: J O
authors.initials: JO
authors.lastname: Sosa García
authors.forename: C
authors.initials: C
authors.lastname: Pacheco Tovar
authors.forename: F
authors.initials: F
authors.lastname: Pálizas
authors.forename: J M
authors.initials: JM
authors.lastname: Pardo Oviedo
authors.forename: D I
authors.initials: DI
authors.lastname: Pinilla
authors.forename: F
authors.initials: F
authors.lastname: Raffán-Sanabria
authors.forename: N
authors.initials: N
authors.lastname: Raimondi
authors.forename: C
authors.initials: C
authors.lastname: Righy Shinotsuka
authors.forename: M
authors.initials: M
authors.lastname: Suárez
authors.forename: S
authors.initials: S
authors.lastname: Ugarte
authors.forename: S
authors.initials: S
authors.lastname: Rubiano
mesh_terms: D000465:Algorithms; D000698:Analgesia; D006348:Cardiac Surgical Procedures; D016292:Procedural Sedation; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000628:therapy*; D054810:Deep Sedation; D003693:Delirium / Q000628:therapy; D006801:Humans; D017093:Liver Failure / Q000628:therapy; D009422:Nervous System Diseases / Q000628:therapy; D011182:Postoperative Care; D051437:Renal Insufficiency / Q000628:therapy; D012121:Respiration, Artificial; D013375:Substance Withdrawal Syndrome / Q000628:therapy; D015300:Ventilator Weaning
keywords: Agitación; Agitation; Analgesia; Bundle; Cuidado Intensivo; Delirium; Dolor; Evidence based medicine; Grading of Recommendations; Grado de Recomendación; Guía de práctica clínica; Intensive care; Medicina basada en la evidencia; Pain; Sedación; Sedation