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Review
. 2015 Nov 12:13:Doc19.
doi: 10.3205/000223. eCollection 2015.

Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version

DAS-Taskforce 2015; Ralf Baron  1 , Andreas Binder  1 , Rolf Biniek  1 , Stephan Braune  2 , Hartmut Buerkle  3 , Peter Dall  4 , Sueha Demirakca  5 , Rahel Eckardt  6 , Verena Eggers  3 , Ingolf Eichler  7 , Ingo Fietze  8 , Stephan Freys  9 , Andreas Fründ  10 , Lars Garten  5 , Bernhard Gohrbandt  7 , Irene Harth  5 , Wolfgang Hartl  9 , Hans-Jürgen Heppner  6 , Johannes Horter  3 , Ralf Huth  5 , Uwe Janssens  2 , Christine Jungk  11 , Kristin Maria Kaeuper  12 , Paul Kessler  3 , Stefan Kleinschmidt  3 , Matthias Kochanek  13 , Matthias Kumpf  5 , Andreas Meiser  3 , Anika Mueller  3 , Maritta Orth  8 , Christian Putensen  3 , Bernd Roth  5 , Michael Schaefer  14 , Rainhild Schaefers  12 , Peter Schellongowski  13 , Monika Schindler  5 , Reinhard Schmitt  15 , Jens Scholz  3 , Stefan Schroeder  16 , Gerhard Schwarzmann  15 , Claudia Spies  3 , Robert Stingele  1 , Peter Tonner  3 , Uwe Trieschmann  3 , Michael Tryba  3 , Frank Wappler  3 , Christian Waydhas  17 , Bjoern Weiss  3 , Guido Weisshaar  5
Affiliations
Review

Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version

DAS-Taskforce 2015 et al. Ger Med Sci. .

Abstract
in English, German

In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade "A" (strong recommendation), Grade "B" (recommendation) and Grade "0" (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

Die vorherige Version der S3-Leitlinie „Analgesie, Sedierung und Delirmanagement in der Intensivmedizin“ wurde 2010 unter der Federführung der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI) publiziert. Neue Evidenz aus Studien ebenso wie neue Leitlinien, u.a. die 2013 erschienene Leitlinie der U.S.-amerikanischen Society of Critical Care Medicine (SCCM), des American College of Critical Care Medicine (ACCM) und der American Society of Health-System Pharmacists (ASHP), gaben nicht nur Anlass zu einem Update der deutschen Empfehlungen von 2010. Für die Fortschreibung der S3-Leitlinie wurden eine Neuformulierung von klinisch relevanten Schlüsselfragen und die signifikante Erweiterung der Leitlinie um neue Facetten der Behandlung, wie zum Beispiel das Schlafmanagement, notwendig. Dazu wurde die systematisch gesuchte Literatur nach Kriterien des Oxford Centre of Evidence Based Medicine bewertet. Der enorme Evidenzkörper bildete die Grundlage für die Empfehlungen, die von Mandatsträgern aus 17 Fachgesellschaften konsentiert wurden. In den Empfehlungen wurden die Grade „A“ (starke Empfehlung), „B“ (Empfehlung) und „0“ (offene Empfehlung) gewählt. Als Ergebnis dieses Prozesses liegt nun die weltweit umfassendste, interdisziplinär erarbeitete evidenz- und konsensbasierte Stufe 3 Leitlinie vor. Die Leitlinie richtet sich an alle auf der Intensivstation tätigen Berufsgruppen, die Empfehlungen berücksichtigen alle intensivmedizinisch-behandelten Patientengruppen. Sie stellt einen Leitfaden zur symptomorientierten Prävention, Diagnostik und Therapie von Delir, Angst, Stress und der protokollbasierten Analgesie, Sedierung und dem Schlafmanagement in der Intensivmedizin für Erwachsene und Kinder dar.

Keywords: Germany; analgesia; anxiety; critical care; delirium; evidence; guideline; intensive care; monitoring; sedation; sleep; stress; treatment.

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Figures

Table 1
Table 1. Risk factors for ICU-delirium
Table 2
Table 2. Prevention and risk reduction
Table 3
Table 3. Long-term consequences
Table 4
Table 4. Monitoring – general aspects
Table 5
Table 5. Monitoring of analgesia
Table 6
Table 6. Monitoring of sedation
Table 7
Table 7. Monitoring of delirium
Table 8
Table 8. Monitoring of anxiety
Table 9
Table 9. Monitoring of sleep
Table 10
Table 10. Treatment concepts – non-pharmacological concepts
Table 11
Table 11. Analgesia and regional analgesia
Table 12
Table 12. Sedation
Table 13
Table 13. Moderate/deep sedation
Table 14
Table 14. Symptom oriented sedative therapy (target RASS 0/–1)
Table 15
Table 15. Therapy of delirium
Table 16
Table 16. Weaning from mechanical ventilation
Table 17
Table 17. Treatment with neuromuscular blocking agents (NMBA)
Table 18
Table 18. Intra- and inter-hospital transports
Table 19
Table 19. Pregnant and breastfeeding patients in the ICU
Table 20
Table 20. End-of-life care
Table 21
Table 21. Patients with severe burn injuries
Table 22
Table 22. Burn-injured children
Table 23
Table 23. Multiple trauma patients
Table 24
Table 24. Patients with intracranial hypertension
Table 25
Table 25. Cardiac surgery
Table 26
Table 26. Patients on extracorporeal life support systems (ECLS)
Table 27
Table 27. Monitoring of analgesia in children
Table 28
Table 28. Monitoring of sedation in children
Table 29
Table 29. Monitoring of delirium in children
Table 30
Table 30. Analgesia in children
Table 31
Table 31. Non-pharmacological procedures in children
Table 32
Table 32. Sedation in children
Table 33
Table 33. Therapy of delirium in children
Table 34
Table 34. Monitoring in the elderly
Table 35
Table 35. Treatment strategies in the elderly
Table 36
Table 36. Economy, quality assurance, and implementation of the guideline
Figure 1
Figure 1. Algorithm for monitoring of sedation, delirium, and pain in adult patients
RASS: Richmond Agitation, Sedation Scale; CAM-ICU: Confusion Assessment Method for the Intensive Care Unit; ICDSC: Intensive Care Delirium Screening Checklist; BPS: Behavioral Pain Scale; BPS-NI: Behavioral Pain Scale, not intubated; CPOT: Critical Care Pain Observation Tool; FPS-R: Faces Pain Scale, revised
Figure 2
Figure 2. Symptom-based therapy and reduction of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine
Algorithm that focuses on a possible holistic management for adult critically ill patients. RASS: Richmond Agitation-Sedation Scale. Other scores (delirium, analgesia: observational/self-assessment), please, s.f. addendum at http://www.awmf.org/leitlinien/detail/ll/001-012.html.
See this image and copyright information in PMC

References

    1. OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine; Available from: http://www.cebm.net/index.aspx?o=5653.
    1. The ADAPTE Collaboration. The ADAPTE Process: Toolkit for Guideline Adaptation. Version 2.0. 2009. Available from: http://www.g-i-n.net/document-store/working-groups-documents/adaptation/....
    1. Mehta S, Cook D, Devlin JW, Skrobik Y, Meade M, Fergusson D, Herridge M, Steinberg M, Granton J, Ferguson N, Tanios M, Dodek P, Fowler R, Burns K, Jacka M, Olafson K, Mallick R, Reynolds S, Keenan S, Burry L SLEAP Investigators; Canadian Critical Care Trials Group. Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2015 Mar;43(3):557–566. doi: 10.1097/CCM.0000000000000727. Available from: http://dx.doi.org/10.1097/CCM.0000000000000727. - DOI - DOI - PubMed
    1. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, Jr, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004 Apr;291(14):1753–1762. doi: 10.1001/jama.291.14.1753. Available from: http://dx.doi.org/10.1001/jama.291.14.1753. - DOI - DOI - PubMed
    1. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med. 2007 Jan;33(1):66–73. doi: 10.1007/s00134-006-0399-8. Available from: http://dx.doi.org/10.1007/s00134-006-0399-8. - DOI - DOI - PubMed

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