Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS)

The 2018 PADIS guideline (Pain, Agitation/Sedation, Delirium, Immobility, Sleep) updated the 2013 PAD guideline with new evidence on ICU delirium, early mobility, and sleep.

Evidence-based guideline using GRADE methodology by SCCM.

Key recommendations: (1) Light sedation targets (RASS −1 to 0) preferred over deep sedation; (2) Propofol or dexmedetomidine preferred over benzodiazepines; (3) CAM-ICU or ICDSC for delirium screening; (4) Avoid antipsychotics for delirium prevention; (5) Early progressive mobility; (6) ABCDEF bundle implementation reduces delirium and improves outcomes.

Know the ABCDEF bundle: Assess/treat pain, Both SAT and SBT, Choice of sedation, Delirium assess/manage, Early mobility, Family engagement. Light sedation (RASS −1 to 0) is standard. Benzodiazepines increase delirium — use propofol or dexmedetomidine. CAM-ICU is the validated delirium tool.

Guideline — some recommendations based on low-quality evidence. ABCDEF bundle implementation requires multidisciplinary coordination.