Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo

Edgar Celis Rodríguez, Juan Mauricio Pardo Oviedo, MA De la Cal, G Castorena Arellano, A Hernandez, D Ceraso, JC Diaz Cortés, C Duenas Castell, EJ Jimenez, JC Meza, t Muñoz Martinez, JO Sosa Garcia, C Pacheco Tovar, F Palizas, Juan Mauricio Pardo Oviedo, DI Pinilla, F Raffan-Sanabria, Raimondi N, C Righy Shinotsuka, Suarez MS Ugarte, S Rubiano, Claudia Birchenall

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

INTRODUCTION:
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.

METHODOLOGY:
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.
Original languageEnglish (US)
Pages (from-to)519 - 574
Number of pages55
JournalMedicina Intensiva
Volume37
Issue number8
DOIs
StatePublished - Nov 1 2013

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Delirium
Practice Guidelines
Critical Illness
Critical Care
Guidelines
Analgesia
Benzodiazepines
Opioid Analgesics
Dexmedetomidine
Haloperidol
Pain Measurement
Hypnotics and Sedatives
MEDLINE
Antipsychotic Agents
Libraries
Analgesics
Publications
Consensus
Epidemiology
Medicine

Cite this

Celis Rodríguez, Edgar ; Pardo Oviedo, Juan Mauricio ; De la Cal, MA ; Arellano, G Castorena ; Hernandez, A ; Ceraso, D ; Cortés, JC Diaz ; Castell, C Duenas ; Jimenez, EJ ; Meza, JC ; Muñoz Martinez, t ; Sosa Garcia, JO ; Pacheco Tovar, C ; Palizas, F ; Pardo Oviedo, Juan Mauricio ; Pinilla, DI ; Raffan-Sanabria, F ; N, Raimondi ; Righy Shinotsuka, C ; M, Suarez ; Ugarte, S ; Rubiano, S ; Birchenall, Claudia. / Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo. In: Medicina Intensiva. 2013 ; Vol. 37, No. 8. pp. 519 - 574.
@article{3ed0b8368a7e463395dd2b8a1574c90f,
title = "Gu{\'i}a de pr{\'a}ctica cl{\'i}nica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto cr{\'i}ticamente enfermo",
abstract = "INTRODUCTION: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 Gu{\'i}a de pr{\'a}ctica cl{\'i}nica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto cr{\'i}ticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium.METHODOLOGY:A group of 21 intensivists from 9 countries of the Federaci{\'o}n Panamericana e Ib{\'e}rica de Sociedades de Medicina Cr{\'i}tica 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.",
author = "{Celis Rodr{\'i}guez}, Edgar and {Pardo Oviedo}, {Juan Mauricio} and {De la Cal}, MA and Arellano, {G Castorena} and A Hernandez and D Ceraso and Cort{\'e}s, {JC Diaz} and Castell, {C Duenas} and EJ Jimenez and JC Meza and {Mu{\~n}oz Martinez}, t and {Sosa Garcia}, JO and {Pacheco Tovar}, C and F Palizas and {Pardo Oviedo}, {Juan Mauricio} and DI Pinilla and F Raffan-Sanabria and Raimondi N and {Righy Shinotsuka}, C and Suarez M and S Ugarte and S Rubiano and Claudia Birchenall",
year = "2013",
month = "11",
day = "1",
doi = "10.1016/j.medin.2013.04.001",
language = "English (US)",
volume = "37",
pages = "519 -- 574",
journal = "Medicina Intensiva",
issn = "0210-5691",
publisher = "Elsevier Doyma",
number = "8",

}

Celis Rodríguez, E, Pardo Oviedo, JM, De la Cal, MA, Arellano, GC, Hernandez, A, Ceraso, D, Cortés, JCD, Castell, CD, Jimenez, EJ, Meza, JC, Muñoz Martinez, T, Sosa Garcia, JO, Pacheco Tovar, C, Palizas, F, Pardo Oviedo, JM, Pinilla, DI, Raffan-Sanabria, F, N, R, Righy Shinotsuka, C, M, S, Ugarte, S, Rubiano, S & Birchenall, C 2013, 'Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo', Medicina Intensiva, vol. 37, no. 8, pp. 519 - 574. https://doi.org/10.1016/j.medin.2013.04.001

Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo. / Celis Rodríguez, Edgar; Pardo Oviedo, Juan Mauricio; De la Cal, MA; Arellano, G Castorena; Hernandez, A; Ceraso, D; Cortés, JC Diaz; Castell, C Duenas; Jimenez, EJ; Meza, JC; Muñoz Martinez, t; Sosa Garcia, JO; Pacheco Tovar, C; Palizas, F; Pardo Oviedo, Juan Mauricio; Pinilla, DI; Raffan-Sanabria, F; N, Raimondi; Righy Shinotsuka, C; M, Suarez; Ugarte, S; Rubiano, S; Birchenall, Claudia.

In: Medicina Intensiva, Vol. 37, No. 8, 01.11.2013, p. 519 - 574.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo

AU - Celis Rodríguez, Edgar

AU - Pardo Oviedo, Juan Mauricio

AU - De la Cal, MA

AU - Arellano, G Castorena

AU - Hernandez, A

AU - Ceraso, D

AU - Cortés, JC Diaz

AU - Castell, C Duenas

AU - Jimenez, EJ

AU - Meza, JC

AU - Muñoz Martinez, t

AU - Sosa Garcia, JO

AU - Pacheco Tovar, C

AU - Palizas, F

AU - Pardo Oviedo, Juan Mauricio

AU - Pinilla, DI

AU - Raffan-Sanabria, F

AU - N, Raimondi

AU - Righy Shinotsuka, C

AU - M, Suarez

AU - Ugarte, S

AU - Rubiano, S

AU - Birchenall, Claudia

PY - 2013/11/1

Y1 - 2013/11/1

N2 - INTRODUCTION: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.METHODOLOGY: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.

AB - INTRODUCTION: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.METHODOLOGY: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.

U2 - 10.1016/j.medin.2013.04.001

DO - 10.1016/j.medin.2013.04.001

M3 - Article

VL - 37

SP - 519

EP - 574

JO - Medicina Intensiva

JF - Medicina Intensiva

SN - 0210-5691

IS - 8

ER -