Acute and Critical Care

Guidelines

Pharmacology
2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit: Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha; Acute Crit Care. 2022;37(1):1-25. Published online February 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00094; Correction in: Acute Crit Care 2023;38(1):149

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We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.

Citations

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End‐of‐life care in the intensive care unit
M. Tanaka Gutiez, N. Efstathiou, R. Innes, V. Metaxa
Anaesthesia.2023;[Epub] CrossRef
ICU-Induced Disability Persists With or Without COVID-19—This Is a Call for F to A Bundle Action*
Heidi Engel
Critical Care Medicine.2022; 50(11): 1665. CrossRef
Actigraphy-Based Assessment of Sleep Parameters in Intensive Care Unit Patients Receiving Respiratory Support Therapy
Jiyeon Kang, Yongbin Kwon
Journal of Korean Critical Care Nursing.2022; 15(3): 115. CrossRef

Pulmonary
Clinical Practice Guideline of Acute Respiratory Distress Syndrome: Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi, The Korean Society of Critical Care Medicine and the Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group; Korean J Crit Care Med. 2016;31(2):76-100. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.76

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There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Citations

Citations to this article as recorded by

Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19
Won Ho Han, Jae Hoon Lee, June Young Chun, Young Ju Choi, Youseok Kim, Mira Han, Jee Hee Kim
Acute and Critical Care.2023; 38(1): 41. CrossRef
Treatment of acute respiratory failure: invasive mechanical ventilation
Young Sam Kim
Journal of the Korean Medical Association.2022; 65(3): 151. CrossRef
Treatment of acute respiratory failure: extracorporeal membrane oxygenation
Jin-Young Kim, Sang-Bum Hong
Journal of the Korean Medical Association.2022; 65(3): 157. CrossRef
Prolonged glucocorticoid treatment in acute respiratory distress syndrome – Authors' reply
Rob Mac Sweeney, Daniel F McAuley
The Lancet.2017; 389(10078): 1516. CrossRef
Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness
Gianfranco Umberto Meduri, Andreas Schwingshackl, Greet Hermans
Frontiers in Pediatrics.2016;[Epub] CrossRef

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