The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation and delirium in critically ill patients.

The main recommendations include:

  • Integrating a multiprofessional approach to managing pain, agitation, sedation, and delirium to achieve significant, synergistic benefits to improve patient outcomes.
  • Utilizing valid and reliable bedside assessment tools for pain, sedation, and delirium, so as to target appropriate treatment strategies.
  • Decreasing levels of sedation, while assuring adequate pain control and delirium management, to allow patients active participation in ventilator weaning trials along with early mobility activities.
  • Instituting prevention strategies in the ICU to avoid complications and improve clinical outcomes.
The ABCDEF Bundles​ are available to teams so that choices can be made based on hospital resources and team orientation.
The guidelines are expected to be updated every three to four years. The 2013 publication was an update and expansion of the 2002 clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.

 Protocols and Implementation


Colleagues share the tools they have developed in their own institutions as they implement the Pain, Agitation, and Delirium Guidelines. Here you will find locally-created protocols, checklists, policies, and similar documents so you do not have to start from scratch. Note these documents relate to the 2013 guidelines.

Spectrun Health
Sedation and Analgesia for Ventilated Patients

Saint Joseph Mercy Health System
Pain, Agitation & Delirium (PAD) Guideline in Mechanically Ventilated Adult ICU Patients

Sutter Health: Sacramento-Sierra
Regional ICU Delirium Protocol


 Guideline Translations


ICU Liberation is committed to improving care for patients worldwide. 

Japanese Guidelines Translation