2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit

Abstract

Background: To revise and expand the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).”Methods: We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding.Results: The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). Conclusions: The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.

The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea

“…Sedation is an important procedure of intensive care practice at the time of intubation to minimize oxygen consumption and facilitate mechanical ventilation comfortably. 1 2 Over the past two decades, deep sedation has been reported to be associated with adverse outcomes, such as delayed weaning, increased lengths of intensive care unit (ICU) stay, and increased hospital mortality. 3 4 Especially, early deep sedation during the initial mechanical ventilation period worsens the outcomes.…”

Non-steroidal anti-inflammatories for analgesia in critically ill patients: a systematic review and meta-analysis of randomized control trials

“…In essence, short-term NSAID use with consideration of patient risk factors and close monitoring can reduce the risk of adverse events. This paradigm is reflected in recent guidelines, which have suggested that IV ketorolac can be used as an analgesic adjunct in the ICU for up to 5 days [70]. This recommendation was based on level C quality evidence where expert opinion supported the recommendation but acknowledged a paucity of specific evidence.…”

End‐of‐life care in the intensive care unit

“…Two systematic reviews have identified that a combination of morphine and midazolam is most commonly used during withholding and withdrawing of life‐sustaining treatment in critically ill ICU patients [25, 45]. A continuous intravenous infusion is commonly used, as this mode can maintain a consistent blood concentration that can be adjusted according to the infusion rate [46]. For end‐of‐life patients, morphine, midazolam and haloperidol are the most prescribed drugs in non‐ICU palliative care settings, where the subcutaneous route is preferred [47].…”