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.

2 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; 138: 1224 WHO 2C 1C C 2C

3 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

4 ICU BPS ICU B 2C 2C Numeric Rating Scale NRS 10 Visual Analog Scale VAS 10 NRS VAS ICU CCM 2002 30 s97 ICU 1st.

5 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.

6 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

7 160 906 ICU 48 Crit care 2005 9 R375 44-80 JAMA 2001 286 2703 CCM 2005 33 1260 ICM 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.

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

9 ICU .. 1B