A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.

Summary

This focused update recommends dexmedetomidine over propofol for ICU sedation, enhanced mobilization/rehabilitation, and melatonin to support sleep, while withholding recommendations for benzodiazepines in anxiety and antipsychotics for delirium. It broadens PADIS to include anxiety and emphasizes nonpharmacologic care alongside targeted pharmacologic choices.

Key Findings

• Conditional recommendation for dexmedetomidine over propofol for sedation in adult ICU patients.
• Enhanced mobilization/rehabilitation and melatonin administration are suggested.
• No recommendation for benzodiazepines to treat anxiety or antipsychotics to treat delirium.

Clinical Implications

Prefer dexmedetomidine when feasible for ICU sedation; implement enhanced mobilization protocols; consider melatonin for sleep. Avoid routine benzodiazepines for anxiety and antipsychotics for delirium absent strong indications.

Limitations

• Predominantly conditional recommendations due to moderate/low certainty evidence in some areas
• Heterogeneous interventions and outcomes across included studies

Future Directions

Head-to-head RCTs comparing sedation strategies on delirium, ventilator-free days, and long-term outcomes; pragmatic trials for mobilization bundles; robust sleep interventions beyond melatonin.