ICU机械通气患者的镇静与镇痛:指南vs现实

Analgesia and sedation for mechanically ventilated patients in ICU: guidelines vs. reality

2002年ICU成人重症患者镇痛、镇静剂临床应用指南改变了ICU医护人员对机械通气患者实施镇痛、镇静治疗重要性的认识,2013年更新的PAD指南以及2016年e CASH理念进一步提出以充分镇痛为基础的浅镇静为导向的镇痛、镇静策略有益于改善临床预后。由此可见,指南对规范并改进临床实践具有普遍意义。然而,现实情况是更新的指南当今临床依从性并不乐观。在众多原因中,广大临床医师镇痛、镇静认识提高后,新理念在临床实施中尚存在诸多障碍可能是重要因素,如疼痛的客观评价、浅镇静的安全风险以及e CASH的适应群体等。因此,进一步研究解决上述问题是新理念有效推广的关键。

2002 published guidelines greatly promoted knowledge of intensive caring providers on analgesia and sedation for mechanically ventilated patients. Updated PAD guidelines in 2013 and eCASH concept in 2016 further suggested that adequate analgesia based light sedation-directed strategy be benefcial to outcomes. Accordingly, guidelines were valuable for standardizing as well as improving clinical practices extensively. However, it is the fact that compliance was signifcantly low to updated guidelines nowadays. Barriers happened in implementation of new approaches, such objective assessment of pain intensity, risk of light sedation on safety and right populations for eCASH as well, might be important one of the multiple impacting factors since knowledge of analgesia and sedation was widely promoted. Therefore, it is crucial for well implement of these new approaches to solve these problems.