浅镇静 ,要多浅济宁1018.pptVIP

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浅镇静 ,要多浅济宁1018.ppt

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内容提要为何要浅镇静？浅镇静不能过浅！正确看待PAD指南倡导的浅镇静。正确看待PAD指南倡导的浅镇静！ Uncovered the big gap between our knowledge and clinical practice Pain and Analgesia Light sedation: Contribution of PAD 2013 Shehabi et al. Critical Care 2013, 17:322 Uncovered the big gap between our knowledge and clinical practice (questions) 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). b. Pain assessment i. We recommend that pain be routinely monitored in all adult ICU patients (+1B). Crit Care Med 2013; 41:263–306 Uncovered the big gap between our knowledge and clinical practice (questions) Agitation and Sedation a. Depth of sedation vs. clinical outcomes i. Maintaining light levels of sedation in adult ICU patients is associated with improved clinical outcomes (shorter duration of MV and a shorter ICU LOS) (B). iv. We recommend that sedative medications be titrated to maintain a light rather than a deep level of sedation in adult ICU pts, unless clinically contraindicated (+1B). Crit Care Med 2013; 41:263–306 Uncovered the big gap between our knowledge and clinical practice (questions) Delirium Outcomes associated with delirium i. increased mortality (A). ii. prolonged ICU and hospital LOS (A). iii. development of post-ICU cognitive impairment in adult ICU patients (B). b. Detecting and monitoring delirium i. We recommend routine monitoring of delirium in adult ICU patients (+1B). Crit Care Med 2013; 41:263–306 Uncovered the big gap between our knowledge and clinical practice(Answers) 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). b. Pain assessment i. We recommend that pain be routinely monitored in all adult ICU patients (+1B). Crit Care Med 2013; 41:263–306 c. Treatment of pain from i to xi, … 2X0; 3XC; 5XB;1XA (neuropathic pain ) Uncovered the b