The 2018 PADIS Guideline Panel Collaborative recently updated and expanded the 2013 SCCM Pain, Agitation, and Delirium (PAD) Practice Guideline and added two new topics—immobility and sleep disruption—while focusing on evaluating longer-term, post-ICU outcomes.
The collaborative recommendations are available in the article titled “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
,” which was published in the September 2018 issue of Critical Care Medicine.
It provides updated evidence-based recommendations for managing five issues affecting nearly every patient in the intensive care unit:
- Pain. The guidelines call for a protocol-based approach to pain assessment and management. They include specific recommendations regarding the use non-opioid analgesics; a multimodal pain treatment approach is an important strategy to reduce opioid use in hospitalized patients. Other recommendations address nondrug approaches to pain management, including massage, music therapy, cold therapy, and relaxation techniques.
- Agitation/Sedation. Light sedation is recommended over deep sedation for most ICU patients. Propofol or dexmedetomidine is recommended over benzodiazepines in patients requiring continuous sedation. Although physical restraints are commonly used in the United States, the evidence to support their use is very limited.
- Delirium. The panel recommends using multicomponent, nonpharmacologic interventions to reduce modifiable factors for delirium in the ICU. Medications, including antipsychotics, are not recommended as a routine strategy to either prevent or treat delirium. Dexmedetomidine is conditionally recommended for delirium in mechanically ventilated adults when agitation precludes weaning or extubation.
- Immobility. Rehabilitation/mobilization interventions are recommended to reduce ICU-acquired muscle weakness due to immobility. Starting and stopping criteria for rehabilitation/mobility are provided.
- Sleep Disruption. Multicomponent protocols are recommended to promote sleep in critically ill adults, including volume control ventilator modes and nocturnal strategies to reduce ICU noise and light. Recommendations regarding the use of medications to improve sleep were not able to be made.
The updated guidelines include 37 actionable recommendations, 2 best practice statements, and 32 ungraded statements. In addition to the full guidelines
, the September issue of Critical Care Medicine
contains an executive summary
of the updated PADIS recommendations. The guidelines are also accompanied by an article offering guidance on interpretation and implementation
of the recommendations.
SCCM’s ICU Liberation Initiative provides several resources focused on boosting the implementation of the PADIS guideline recommendations by promoting the use of the ABCDEF bundle
in daily ICU practice.
to access PADIS Guidelines and other ICU Liberation resources. Join the conversation on Twitter with #ICULiberation