2018 Guidelines for the Prevention and Mx of Pain, Agitation
Updating the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU, the Society of Critical Care Medicine (SCCM) has released recommendations for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption (PADIS) in adult patients in the ICU.

The highlights of the updated guidance are two inextricably related clinical care topics (immobility and sleep) and patients as collaborators and co-authors have been included. Only two of the 37 recommendations are strong; most are conditional. Compared with a strong recommendation (most desirable to clinicians), conditional recommendations apply to most, but not all critically ill adults.

Some of the key recommendations are:-
• Management of pain for adult ICU patients should be guided by routine pain assessment and pain should be treated before a sedative agent is considered

• Assessment-driven, protocol based, stepwise approach is suggested for pain and sedation management in critically ill adults

• Offer cold therapy for procedural pain management in critically ill adults

• Critically ill adults should be regularly assessed for delirium using a valid tool

• The authors suggest not using haloperidol, an atypical antipsychotic, dexmedetomidine, a HMG-CoA reductase inhibitor (i.e., statin), or ketamine to prevent delirium in all critically ill adults

• Using dexmedetomidine is suggested for delirium in mechanically ventilated adults where agitation is precluding weaning/extubation

• The authors suggest not routinely using physiologic sleep monitoring clinically in critically ill adults

• Not using propofol is suggested to improve sleep in critically ill adults

• A sleep-promoting, multicomponent protocol is suggested in critically ill adults

• No recommendation regarding the use of melatonin to improve sleep in critically ill adults


About SCCM
The Society of Critical Care Medicine, established in 1970, is an independently incorporated, international, educational and scientific society. Its members are health professionals providing care to critically ill and injured patients.

Note: This list is a brief compilation of some of the key recommendations included in the Guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://journals.lww.com/ccmjournal/Fulltext/2018/09000/Clinical_Practice_Guidelines_for_the_Prevention.29.aspx
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