In January 2013, The Society of Critical Care Medicine (SCCM) published the Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. These guidelines are in the revision process which occurs approximately every 3-4 years.
The 2013 guidelines, an update and expansion of the 2002 clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult, provides 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 from the 2013 Pain, Agitation, and Delirium (PAD) Guidelines include:

  • Integrating a multi-professional 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.
Note the guidelines offer a care bundle for clincian's consideration. Additional implementation tools via the ABCDEF bundle​ are available to teams so that choices can be made based on hospital resources and team orientation.


PAD Pocket Card
ICU PAD Care Bundle​​​


 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.

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


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Japanese Guidelines Translation