The Dutch Clinical Practice Guideline: Pain, analgesia/sedation, delirium, immobility and sleep disturbances; PADIS

Abstract

Objective: To update the Dutch Pain Sedation and Analgesia (PSA) guideline and to combine this with Delirium, Immobility and Sleep disturbances (DIS) to form the Dutch multidisciplinary PADIS guideline. Methods: A multidisciplinary team of 23 professionals with expertise from different fields of intensive care, geriatrics, psychiatry, nursing, pharmacists and allied health professions, and patient representatives worked together with guideline and review experts of the Dutch Association of Medical Specialists on this guideline. Research questions were described in Patient-Intervention-Comparison- Outcome-(Time) (PICO[T]) form and for each question 5–7 outcomes measures (crucial and important) were determined followed by a systematic review per question. Eighteen comprehensive searches were performed by an information specialist in the databases Medline, Embase and Cinahl. Articles were selected independently by two panel members. To determine the level of evidence the GRADE criteria were used. Results: This guideline consists of 5 parts: Pain, analgesia/sedation, delirium, immobility, sleep disturbances. A subsection was added on how to organize ICU care for patients treated with analgesics and sedation. In total 21 research questions were formulated and answered resulting in 22 recommendations. Conclusion: The Dutch multidisciplinary PADIS guideline consists of a comprehensive overview of the literature specified for the national situation. A set of clinically relevant recommendations on the five domains were presented which are relevant to ICU professionals and were approved by all relevant Dutch medical and nursing societies as well as the Dutch representative organizations of ICU patients and families. Implications for Clinical Practice: This multidisciplinary guideline provides healthcare professionals working in the ICU tools for working evidence-based regarding managing pain, delirium, sedation, sleep, and immobility in ICU patients, based on 22 recommendations.