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,; Baron, Ralf; Binder, Andreas; Biniek, R.; Braune, Stephan; Buerkle, Hartmut; Dall, P.; Demirakça, S.; Eckardt, Rahel; Eggers, Verena; Eichler, I.; Fietze, Ingo; Freys, Stephan M.; Fründ, Andreas; Garten, Lars; Gohrbandt, Bernhard; Harth, Irene; Hartl, Wolfgang H.; Heppner, Hans-Jürgen; Horter, Johannes; Huth, R.; Janssens, Uwe; Jungk, Christine; Kaeuper, Kristin Maria; Kessler, Paul; Kleinschmidt, S.; Kochanek, Matthias; Kumpf, Matthias; Meiser, Andreas; Mueller, Anika; Orth, M.; Putensen, Christian; Roth, B.; Schaefer, Michael J.; Schaefers, Rainhild; Schellongowski, Peter; Schindler, Monika; Schmitt, Reinhard; Scholz, Jens; Schroeder, Stefan; Schwarzmann, Gerhard; Spies, Claudia; Stingele, Robert; Tonner, Peter H.; Trieschmann, Uwe; Tryba, M.; Wappler, Frank; Waydhas, Christian; Weiss, Bjoern; Weißhaar, G.

doi:10.3205/000223

Cited by 159 publications

(40 citation statements)

References 268 publications

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“…16 There are few CPGs for management of these four conditions in the PICU, with only two for pain, 17 18 and one for pain, sedation and delirium. 19 Furthermore, some guidance documents exist, including practice/position/consensus statements/recommendations (hereafter, referred to as CPGs). 14 20 21 Although there is one position statement for the assessment of pain, sedation, delirium and iatrogenic withdrawal for paediatric critical care patients, 14 it does not include recommendations for management.…”

Section: Introductionmentioning

confidence: 99%

“…The purported benefits of CPG implementation are the standardisation of care practices; improvements in patient safety; and patient outcomes 16. There are few CPGs for management of these four conditions in the PICU, with only two for pain,17 18 and one for pain, sedation and delirium 19. Furthermore, some guidance documents exist, including practice/position/consensus statements/recommendations (hereafter, referred to as CPGs) 14 20 21.…”

Section: Introductionmentioning

confidence: 99%

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Quality of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal in pediatric intensive care: a systematic review protocol

MacDonald

Perez

Amiet

et al. 2022

bmjpo

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IntroductionInadequate management of pain and sedation in critically ill children can cause unnecessary suffering and agitation, but also delirium and iatrogenic withdrawal. It is, therefore, important to address these four interrelated conditions together. Some clinical practice guidelines (CPGs) are available for the management of pain and sedation, and a few for delirium and iatrogenic withdrawal in the paediatric intensive care unit; none address the four conditions altogether. Critical appraisal of the quality of CPGs is necessary for their recommendations to be adopted into clinical practice. The aim of this systematic review is to identify and appraise the quality of CPGs and recommendations for management of either pain, sedation, delirium and iatrogenic withdrawal.Methods and analysisResearchers will conduct a systematic review in electronic databases (Medline ALL (Ovid), Embase.com, CINAHL with Full Text (EBSCO), JBI EBP Database (Ovid)), guideline repositories and websites of professional societies to identify CPGs published from 2010 to date. They will then combine index and free terms describing CPGs with pain, sedation, delirium and withdrawal. The researchers will include CPGs if they can be applied in the paediatric intensive care population (newborns to 18 years old) and include recommendation(s) for assessment of at least one of the four conditions. Two independent reviewers will screen for eligibility, complete data extraction and quality assessments using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the AGREE Recommendation Excellence instruments. Researchers will report characteristics, content and recommendations from CPGs in tabulated forms.Ethics and disseminationEthical approval is not required for this systematic review. Results will be published in a peer-reviewed journal.PROSPERO registration numberCRD42021274364.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quality of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal in pediatric intensive care: a systematic review protocol

MacDonald

Perez

Amiet

et al. 2022

bmjpo

View full text Add to dashboard Cite

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“…In principle, both arms are observational without explicit medication advice within the two general sedation groups. Treatment will be given according to the current guidelines 10…”

Section: Methods and Analysismentioning

confidence: 99%

“…Accordingly, the use of volatile sedatives in ICUs has been included in sedation recommendations since 2015. 10 11 …”

Section: Introductionmentioning

confidence: 99%

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Evaluation of volatile sedation in the postoperative intensive care of patients recovering from heart valve surgery: protocol for a randomised, controlled, monocentre trial

et al. 2022

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IntroductionPatients undergoing heart valve surgery are predominantly transferred postoperatively to the intensive care unit (ICU) under continuous sedation. Volatile anaesthetics are an increasingly used treatment alternative to intravenous substances in the ICU. As subject to inhalational uptake and elimination, the resulting pharmacological benefits have been repeatedly demonstrated. Therefore, volatile anaesthetics appear suitable to meet the growing demands of fast-track cardiac surgery. However, their use requires special preparation at the bedside and trained medical and nursing staff, which might limit the pharmacological benefits. The aim of our work is to assess whether the temporal advantages of recovery under volatile sedation outweigh the higher effort of special preparation.Methods and analysisThe study is designed to evaluate the differences between intravenous sedatives (n=48) and volatile sedatives (n=48) in continued intensive care sedation. This study will be conducted as a prospective, randomised, controlled, single-blinded, monocentre trial at a German university hospital in consenting adult patients undergoing heart valve surgery at a university hospital. This observational study will examine the necessary preparation time, staff consultation and overall feasibility of the chosen sedation method. For this purpose, the continuation of sedation in the ICU with volatile sedatives is considered as one study arm and with intravenous sedatives as the comparison group. Due to rapid elimination and quick awakening after the termination of sedation, closer consultation between the attending physician and the ICU nursing staff is required, in addition to a prolonged setup time. Study analysis will include the required setup time, time from admission to extubation as primary outcome and neurocognitive assessability. In addition, possible operation-specific (blood loss, complications), treatment parameters (catecholamine dosages, lung function) and laboratory results (acute kidney injury, acid base balance (lactataemia), liver failure) as influencing factors will be collected. The study-relevant data will be extracted from the continuous digital records of the patient data management system after the patient has been discharged from the ICU. For statistical evaluation, 95% CIs will be calculated for the median time to extubation and neurocognitive assessability, and the association will be assessed with a Cox regression model. In addition, secondary binary outcome measures will be evaluated using Fisher’s exact tests. Further descriptive and exploratory statistical analyses are also planned.Ethics and disseminationThe study was approved by the Institutional Ethics Board of the University of Frankfurt, Germany (#20-1050). Informed consent of all individual patients will be obtained before randomisation. Results will be disseminated via publication in peer-reviewed journals.Trial registration numberClinical trials registration (NCT04958668) was completed on 1 July 2021.

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Association of Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium

Tseng²,

et al. 2019

JAMA Psychiatry

105

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

Cited by 159 publications

References 268 publications

Quality of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal in pediatric intensive care: a systematic review protocol

Quality of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal in pediatric intensive care: a systematic review protocol

Evaluation of volatile sedation in the postoperative intensive care of patients recovering from heart valve surgery: protocol for a randomised, controlled, monocentre trial

Association of Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium

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