Acute Crit Care.  2022 Feb;37(1):1-25. 10.4266/acc.2022.00094.

2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit

• Seo Y
• Lee HJ
• Ha EJ
• Ha TS

• KMID: 2527903
• DOI: http://doi.org/10.4266/acc.2022.00094

Abstract

We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.

Keyword

agitation; delirium; guideline; pain; rehabilitation; sleep

Figure

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  Figure 1. Various pain assessment scales: Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), and Faces Pain Scale (FPS).

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  Figure 2. Flowchart of pain management for critically ill patients in the intensive care unit. aOpioids: morphine, hydromorphone, fentanyl, and remifentanil; bSide effects: respiratory depression, coma, lower gastrointestinal tract paralysis/ileus, hyperalgesia, and immunosuppression; cKetorolac: recommended for use within 5 days; dNeuropathic agents: gabapentin, pregabalin, and carbamazepine.

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  Figure 3. Pharmacologic treatment flowchart for agitation in mechanically ventilated patients. IV: intravenous.

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  Figure 4. Delirium assessment tool: the Confusion Assessment Method for the intensive care unit (CAM-ICU) flowchart. RASS: Richmond Agitation-Sedation Scale.

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