Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult


Judith Jacobi, Gilles L. Fraser, Douglas B. Coursin, Richard R. Riker, Dorrie Fontaine, Eric T. Wittbrodt, Donald B. Chalfin, Michael F. Masica, H. Scott Bjerke, William M. Coplin, David W. Crippen, Barry D. Fuchs, Ruth M. Kelleher, Paul E. Marik, Stanley A. Nasraway, Jr, Michael J. Murray, William T. Peruzzi, Philip D. Lumb. Developed through the Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), in collaboration with the American Society of Health-System Pharmacists (ASHP), and in alliance with the American College of Chest Physicians; and approved by the Board of Regents of ACCM and the Council of SCCM and the ASHP Board of Directors


Crit Care Med 2002 Vol. 30, No. 1 


Maintaining an optimal level of comfort and safety for critically ill patients is a universal goal for critical care practitioners. The American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine’s (SCCM’s) practice parameters for the optimal use of sedatives and analgesics was published in 1995 and recommended a tiered approach to the use of sedatives and analgesics, largely on the basis of expert opinion (1). These clinical practice guidelines replace the previously published parameters and include an evaluation of the literature published since 1994 comparing the use of these agents. The reader should refer to the accompanying introduction for a description of the methodology used to develop these guidelines (2). This document is limited to a discussion of prolonged sedation and analgesia. Consistent with the previous practice guidelines, this document pertains to patients older than 12 years. The majority of the discussion focuses on the care of patients during mechanical ventilation. A discussion of regional techniques is not included. Appendix A summarizes the recommendations made herein.





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Gestire il dolore

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Gestire la sedazione

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Gestire il delirium

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