镇静、镇痛指南-2013.pptVIP

Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit （ACCM 2013） 2013-07-26 庄海舟 Background 2002年首版PAD指南由美国重症医学院（ACCM）发布； 2012年1月发布第二版； 2013年发布最新版； 推荐方式，级别； 根据证据质量，不采信专家意见； 新的推荐意见； 1. Pain and Analgesia a. Incidence of pain i. Adult medical, surgical, and trauma ICU patients routinely experience pain, both at rest and with routine ICU care (B). ii. Pain in adult cardiac surgery patients is common and poorly treated; women experience more pain than men after cardiac surgery (B). iii. Procedural pain is common in adult ICU patients (B). b. Pain assessment i. We recommend that pain be routinely monitored in all adult ICU patients (+1B). ii. The Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) are the most valid and reliable behavioral pain scales for monitoring pain in medical, postoperative, or trauma (except for brain injury) adult ICU patients who are unable to self-report and in whom motor function is intact and behaviors are observ-able. Using these scales in other ICU patient populations and translating them into foreign languages other than French or English require further validation testing (B). iii. We do not suggest that vital signs (or observational pain scales that include vital signs) be used alone for pain assessment in adult ICU patients (–2C). iv. We suggest that vital signs may be used as a cue to begin further assessment of pain in these patients, however (+2C). c. Treatment of pain i. We recommend that preemptive analgesia and/or nonpharmacologic interventions (e.g., relaxation) be administered to alleviate pain in adult ICU patients prior to chest tube removal (+1C). ii. We suggest that for other types of invasive and potentially painful procedures in adult ICU patients, preemptive analgesic therapy and/or nonpharmaco-logic interventions may also be administered to alle-viate pain (+2C).