ICUにおける 鎮痛・鎮静・せん妄管理

1 ICU .. SCCM CCM 2002; 30: 119-41 2012 SCCM !? 2013 SCCM Clinnical practice guidelines for the management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit CCM 2013; 41: 263-306 ACCM American College of Critical Care Medicine SCCM Society of Critical Care Medicine ASGP American Society of Health- System Phermacists 2006 Dr. Juliana Barr Stanford Univ. 21 key word iPad ICU-Pain, Agitation and Delirium ABCDE A Awaken the patient daily Sedation Cessation B Breathing daily interruption of mechanical ventilation C Coordination A + B Choice of sedation or analgesic exposure D Delirium monitoring and management E Early mobility and Exercise Chest 2010.

2 138: 1224 WHO 2C 1C C 2C 1A .. 1C 2B ICU Jm J Crit Care 2002 11 415 CCM 2002 30 s97 ICU B B ICU B 1B A B 2B ICU ICU 1B ICU BPS ICU B 2C

3 2C Numeric Rating Scale NRS 10 Visual Analog Scale VAS 10 NRS VAS ICU CCM 2002 30 s97 ICU 1st .. 2B RASS SAS B BIS 1B 2B ICU NEJM 2000; 342: 1471-7 Lancet 2008; 371: 126-34 light sedation B deep sedation light sedation 1B 1 ICU Crit Care Med 2009.

4 37: 2527-34 dairy interruption light sedation 1B 1C Sedation vacation light sedation OK Hyper active derilium Hypo active derilium quiet derilium Mixed derilium ICU Arch Intern Med 2000 160 906 ICU 48 Crit Care 2005 9 R375 44-80 JAMA 2001 286 2703 CCM 2005 33 1260 ICM

5 2007 33 1726 JAMA 2004 291 1753 CCM 2004 32 2254 0-1 88-90 12 ICM 2007 33 1726 ICU A ICU A ICU B CAM-ICU Confusion Assessment Method for the ICU ICDSC Intensive Care Delirium Screening Checklist CAM-ICU ICU 1B CAM-ICU ICDSC A B B B B B C ICU B.

6 2- 4 8 20-30 1/4 8 C 2C QT TdP 2C 2C 1B ICU C C C ICU .. 1B