Contemporary strategies for the management of sedation, pain, and delirium in critically ill adult patients: an evidence-based scoping review
DOI:
https://doi.org/10.71112/zhtfnz44Keywords:
Sedation, Pain, Delirium, Intensive care, ABCDEF bundle, PADISAbstract
The management of sedation, pain, and delirium in critically ill patients represents a fundamental component of care in intensive care units (ICUs), given its direct impact on clinical outcomes and both short- and long-term prognosis. Traditionally, these domains have been addressed independently; however, emerging evidence supports an integrated approach based on multimodal and protocolized strategies. The implementation of care bundles such as ABCDEF and the recommendations from the PADIS guidelines have demonstrated improvements in quality of care, optimization of patient recovery, and reduction of associated complications, particularly delirium. Despite these advances, significant variability persists in clinical practice and in the adoption of these strategies.
Objective:
To explore and map the available evidence on contemporary strategies for the management of sedation, pain, and delirium in critically ill adult patients, as well as their impact on clinical outcomes in intensive care units.
Methods:
A scoping review was conducted following the PRISMA-ScR extension guidelines. A systematic search was performed in electronic databases, including PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar. The search strategy included terms related to sedation, analgesia, delirium, intensive care, and multimodal strategies. After screening titles, abstracts, and full texts, twenty studies meeting the eligibility criteria were included. Data were extracted regarding study characteristics, pharmacological and non-pharmacological interventions, assessment tools, and clinical outcomes.
Results:
The included studies demonstrated that non-pharmacological strategies, particularly the implementation of the ABCDEF bundle, are consistently associated with a reduction in delirium incidence, duration of mechanical ventilation, and ICU length of stay. In the pharmacological domain, dexmedetomidine showed advantages in reducing delirium compared to benzodiazepines, although no clear impact on mortality was observed. The use of antipsychotics did not demonstrate consistent benefits in the treatment of delirium. Regarding pain management, the use of validated tools such as CPOT and BPS improved pain detection and treatment. Reported clinical outcomes were heterogeneous; however, integrated and multimodal approaches consistently yielded more favorable results.
Conclusions:
The available evidence supports an integrated, protocolized, and predominantly non-pharmacological approach to the management of sedation, pain, and delirium in critically ill patients. The implementation of multimodal strategies, such as the ABCDEF bundle, represents the cornerstone of contemporary ICU management. Nevertheless, gaps remain in clinical implementation and in the evidence surrounding pharmacological interventions, highlighting the need for future studies to better evaluate their impact on long-term clinical and neurological outcomes.
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Copyright (c) 2026 Patricia Fernanda Galárraga Carrillo, Marilyn Denise Guevara Acurio, Kevin Hair Taipe Mayorga, Tania Dayanara Chanaluisa Cerda, Silvia Katherine Machado Barrera (Autor/a)
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