Few aspects of critical care practice have changed as dramatically in the last 10 years as our approach to sedation, analgesia, and delirium. The American College of Critical Care Medicine guidelines for management of pain, agitation, and delirium (PAD) have recently been published, updating the 2002 version and calling attention to areas needing future study and learning.1,2 

In 2006, twenty critical care clinicians with expertise in intensive care unit (ICU) pain, agitation, and delirium were recruited to create evidence-based, transparently derived clinical practice guidelines to improve the comfort and outcomes of adult critically ill patients using a patient-centered approach. Four subgroups evaluated the literature and developed PICO (population, intervention, control, outcomes) formatted questions felt to represent the most pressing or controversial issues facing ICU practitioners. The GRADE method was used to rank recommendations based on the quality of evidence...

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