PRACTICE PARAMETERS FOR INTRAVENOUS ANALGESIA AND SEDATION FOR ADULT PATIENTS IN THE INTENSIVE-CARE UNIT - AN EXECUTIVE SUMMARY

Objective: The development of practice parameters for intravenous anal gesia and sedation for adult patients in the intensive care unit (ICU) setting for the purpose of guiding clinical practice. Participants: A task force of more than 40 experts in disciplines related to the use of analgesic and sedative agents in the ICU was convened from the memb ership of the American College of Critical Care Medicine (ACCM) and th e Society of Critical Care Medicine (SCCM). Evidence: The task force m embers provided the personal experience and determined the published l iterature (MEDLINE articles, textbooks, pharmacopeias, etc.) from whic h consensus would be sought. Published literature was reviewed and cla ssified into one of four predetermined categories, according to study design and scientific value. Consensus Process: The task force met sev eral times as a whole, and numerous times in smaller groups by telecon ference, over a 1-yr period to identify the pertinent literature and a rrive at consensus recommendations for the whole task force to discuss . Consideration was given to the relationship between the weight of sc ientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and d ebated by the task force members until consensus was reached by nomina l group process, The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM, After steering committee approval, the draft document was reviewed and approved by the SCCM Cou ncil. Data Synthesis: To facilitate rapid communication of the six rec ommendations contained within the complete and unabridged practice par ameter document, an executive summary was prepared for publication by the ACCM Board of Regents, and this executive summary was approved by the task force steering committee and the SCCM Executive Council. Conc lusions: A consensus of experts provided six recommendations with supp orting data for intravenous analgesia and sedation in the ICU setting: a) morphine sulfate is the preferred analgesic agent for critically i ll patients; b) fentanyl is the preferred analgesic agent for critical ly ill patients with hemodynamic instability, for patients manifesting symptoms of histamine release with morphine, or morphine allergy; c) hydromorphone can serve as an acceptable alternative to morphine; d) m idazolam or propofol are the preferred agents only for the short-term (<24 hrs) treatment of anxiety in the critically ill adult; e) lorazep am is the preferred agent for the prolonged treatment of anxiety in th e critically ill adult; f) haloperidol is the preferred agent for the treatment of delirium in the critically ill adult. This executive summ ary selectively presents supporting information and is not intended as a substitute for the complete document.