Evidence-based clinical practice guidelines for the management of sedoanalgesia and delirium in critically ill adult patients

Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented.

[Military tropical medicine and maps: analysis of 100 years of publication (1864-1963)]

As early as 1864, maps began appearing in articles published in Tropical Medicine. Initially used for illustration only, maps gradually became an essential tool for research and communication of scientific findings. Analysis of maps published in the Tropical Medicine Revue from 1864 to 1964 reflects the progression in the use of this informational tool by authors. Study of these documents also provides insight into the scientific and sociopolitical context and provides new knowledge that improves understanding of how history and science were viewed by mapmakers and readers.