Evidenceandconsensusbasedguidelineforthe ...

1 OPEN ACCESS This is the original (English) version. Intensive Care Medicine The translated (German) version starts at p. 22. Guideline Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) short version Abstract In 2010, under the guidance of the DGAI (German Society of Anaesthesi- DAS-Taskforce 2015: ology and Intensive Care Medicine) and DIVI (German Interdisciplinary Ralf Baron1. Association for Intensive Care and Emergency Medicine), twelve German medical societies published the Evidence- and Consensus-based Andreas Binder1.

2 Guidelines on the Management of Analgesia, Sedation and Delirium in Rolf Biniek1. Intensive Care . Since then, several new studies and publications have Stephan Braune2. considerably increased the body of evidence, including the new recom- mendations from the American College of Critical Care Medicine (ACCM) Hartmut Buerkle3. in conjunction with Society of Critical Care Medicine (SCCM) and Peter Dall4. American Society of Health-System Pharmacists (ASHP) from 2013. For Sueha Demirakca5. this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and Rahel Eckardt6.

3 Anxiety management. The literature was systematically searched and Verena Eggers3. evaluated using the criteria of the Oxford Center of Evidence Based Ingolf Eichler7. Medicine. The body of evidence used to formulate these recommenda- tions was reviewed and approved by representatives of 17 national Ingo Fietze8. societies. Three grades of recommendation were used as follows: Grade Stephan Freys9. A (strong recommendation), Grade B (recommendation) and Grade Andreas Fr nd10. 0 (open recommendation). The result is a comprehensive, interdiscip- linary, evidence and consensus-based set of level 3 guidelines.

4 This Lars Garten5. publication was designed for all ICU professionals, and takes into ac- Bernhard Gohrbandt7. count all critically ill patient populations. It represents a guide to symp- Irene Harth5. tom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management Wolfgang Hartl9. in intensive care medicine. Hans-J rgen Heppner6. Keywords: guideline, evidence, analgesia, sedation, delirium, anxiety, Johannes Horter3. stress, sleep, monitoring, treatment, intensive care, critical care, Ralf Huth5.

5 Germany Uwe Janssens2. Christine Jungk11. Kristin Maria Kaeuper12. Paul Kessler3. Stefan Kleinschmidt3. Matthias Kochanek13. Matthias Kumpf5. Andreas Meiser3. Anika Mueller3. Maritta Orth8. Christian Putensen3. Bernd Roth5. Michael Schaefer14. Rainhild Schaefers12. GMS German Medical Science 2015, Vol. 13, ISSN 1612-3174 1/42. DAS-Taskforce 2015 et al.: Evidence and consensus based guideline for the management .. Peter Schellongowski13. Monika Schindler5. Reinhard Schmitt15. Jens Scholz3. Stefan Schroeder16. Gerhard Schwarzmann15. Claudia Spies3. Robert Stingele1.

6 Peter Tonner3. Uwe Trieschmann3. Michael Tryba3. Frank Wappler3. Christian Waydhas17. Bjoern Weiss3. Guido Weisshaar5. 1 German Society of Neurology (DGN). 2 German Society of Internal Medicine Intensive Care (DGIIN). 3 German Society of Anaesthesiology and Intensive Care Medicine (DGAI). 4 German Society of Gynecology & Obstetrics (DGGG). 5 German Society of Neonatology and Pediatric Intensive Care (GNPI). 6 German Society of Geriatrics (DGG). 7 German Society for Thoracic and Cardiovascular Surgery (DGTHG). 8 German Sleep Society (DGSM). 9 German Society of Surgery (DGCH).

7 10 German Association for Physiotherapy (ZVK). 11 German Society of Neurosurgery (DGNC). 12 German Society of Midwifery Science (DGHWi). 13 German Society of Haematology and Oncology (DGHO). GMS German Medical Science 2015, Vol. 13, ISSN 1612-3174 2/42. DAS-Taskforce 2015 et al.: Evidence and consensus based guideline for the management .. 14 German Pain Society (DGSS). 15 German Society for Specialised Nursing and Allied Health Professions (DGF). 16 German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). 17 German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI).

8 Introduction and evidence-based targets for treatment, the assess- ment of the clinical situation with validated instruments, In 2010, twelve German medical societies published the and the goal-directed pharmacological therapy. These Evidence- and Consensus-based Guidelines on the measures are to be accompanied by non-pharmacological Management of Analgesia, Sedation and Delirium. Since interventions aimed at prevention and treatment. this publication, the body of evidence in the field has in- The critically ill patient should be awake and alert, creased considerably.

9 Several new studies and publica- without pain, anxiety, or delirium. Ultimately, this allows tions, including the new recommendations from the the patient to actively participate in their treatment and American College of Critical Care Medicine (ACCM) in recovery. conjunction with Society of Critical Care Medicine (SCCM) The term sedation was left in the title intentionally: the and American Society of Health-System Pharmacists indication and conduction of sedation require special at- (ASHP) in 2013, make a substantial actualization of the tention in order not to harm the patient through oversed- German guidelines necessary.

10 This update not only ac- ation, as this has been proven to negatively affect patient counts for new evidence, but also contains a major re- outcome. In the interest of the patients, the use of seda- structuring and extension of the guidelines to cover new tives and analgesics must therefore be very carefully aspects of treatment, such as sleep and anxiety manage- considered. The patient must be allowed to be as alert ment. and oriented as possible, so that they may partake in the This new version aims to provide practical guidance for therapy and convalescence process, as evidence shows the symptom-based prevention, diagnostics and therapy is feasible, practical, and safe.