Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption, and Neuromuscular Blockade

with recently published research, help guide ICU clinicians in the challenging task of optimizing

patient comfort and outcomes while avoiding the complications of under- or oversedation. The PADIS

guidelines were written by 32 international experts, four methodologists, and four critical illness

survivors who met virtually monthly and annually at annual SCCM congresses. Rigorous research has

developed our understanding of the assessment tools and medications used for PADIS, the prevention

and treatment methods used for PADIS, and the long-term effects of the ICU environment on patients

and caregivers. Recommendations for specific ICU populations such as burn, neurologic, neurosurgical

(including traumatic brain injury), and cardiac populations may need specialized consideration.

Adding two critical care topics: rehabilitation/mobilization and sleep disruption

Including patients as collaborators and coauthors

Inviting an international panel of experts from high-income countries to incorporate more diverse

practices and expertise from the global critical care community

Each section of the 2018 PADIS guidelines was represented by content experts, methodologists, and

ICU survivors. Population, Intervention, Comparison, and Outcome and nonactionable descriptive

questions were developed by each section. Members of the guideline group voted on their ranking,

and patients voted on their perceived importance. According to the Grading of Recommendations

Assessment, Development, and Evaluation principles, every Population, Intervention, Comparison, and

Outcomes question was evaluated by members of each section to determine the best level of evidence,

assess quality, and determine recommendations as “strong,” “conditional,” or “good” practice. Evidence

gaps and clinical caveats were explicitly identified.

in the ICU. Much of the management for PADIS involves medications with complex pharmacologic profiles,

allowing many opportunities for pharmacy expertise on the critical care team. As the management of

PADIS in the ICU continues to evolve, pharmacists should seek avenues for contributing to the critical care

community through development of hospital protocols and assessing for quality improvement; providing

education for medical, pharmacy, and nursing colleagues; and/or doing research on pertinent questions

More than half of ICU survivors report severe pain as the most traumatic memory of their ICU stay.

pain in the ICU is challenging, particularly in patients who cannot effectively communicate. If patients

cannot adequately communicate their degree of pain but retain motor activity, medications should be

titrated according to validated behavioral pain scales.