Home › Research › Prevention and risk
A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
Kimberley A. Lewis, Michele C. Balas, Joanna L. Stollings, Molly McNett, Timothy D. Girard, Gérald Chanques, Michelle E. Kho, Pratik P. Pandharipande et al.. Critical Care Medicine, 2025-02-21
Topic: Risk, prevention and care in population studies
The task force issued five statements related to the management of anxiety, agitation/sedation, delirium, immobility, and sleep disruption in adults admitted to the ICU. In adult patients admitted to the ICU, the task force issued conditional recommendations to use dexmedetomidine over propofol for sedation, provide enhanced mobilization/rehabilitation over usual mobilization/rehabilitation, and administer melatonin. The task force was unable to issue recommendations on the administration of benzodiazepines to treat anxiety, and the use of antipsychotics to treat delirium. The guidelines task force provided recommendations for pharmacologic management of agitation/sedation and sleep, and nonpharmacologic management of immobility in critically ill adults. These recommendations are intended for consideration along with the patient's clinical status.
Key findings
- The task force issued five statements related to the management of anxiety, agitation/sedation, delirium, immobility, and sleep disruption in adults admitted to the ICU.
- In adult patients admitted to the ICU, the task force issued conditional recommendations to use dexmedetomidine over propofol for sedation, provide enhanced mobilization/rehabilitation over usual mobilization/rehabilitation, and administer melatonin.
- The task force was unable to issue recommendations on the administration of benzodiazepines to treat anxiety, and the use of antipsychotics to treat delirium.
- The guidelines task force provided recommendations for pharmacologic management of agitation/sedation and sleep, and nonpharmacologic management of immobility in critically ill adults.
- These recommendations are intended for consideration along with the patient's clinical status.
Why it matters
This guideline update covers sedation, delirium, immobility and sleep in intensive care patients, not Alzheimer's disease itself. It makes conditional recommendations on dexmedetomidine, enhanced mobilization and melatonin, but could not recommend benzodiazepines for anxiety or antipsychotics for delirium.
New to this subject? Start with our plain-English guide: Prevention →
Study details
- Study designsystematic review
- Participants24
- Evidence strengthHigh
How this study scored 79/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for effect reported because the record does not state it. We have no data on senior author's track record, so that was left out: it earned 76 of the 96 points we could judge it on, which is 79 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Critical Care Medicine) |
| Journal's citation record | 3 / 4 | Critical Care Medicine: journal h-index 385 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 1 / 4 | 24 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 5 / 7 | Cited 247 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 82.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 6 / 6 | Cited 188.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 4 / 4 | Cited 247 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 3 / 3 | Centre National de la Recherche Scientifique: institution h-index 2,511 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 24 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39982143) |
| Free to read | 2 / 2 | Free to read |
| Points | 76 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 76 of the 96 points we could judge it on is 79 out of 100. |
| Total | 79 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1097/ccm.0000000000006574
- PubMed: 39982143
- Original source →
- Free full text: HAL (Le Centre pour la Communication Scientifique Directe) →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Lewis, K. A., Balas, M. C., Stollings, J. L., McNett, M., Girard, T. D., Chanques, G., et al. (2025). A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine. https://doi.org/10.1097/ccm.0000000000006574
Vancouver
Lewis KA, Balas MC, Stollings JL, McNett M, Girard TD, Chanques G, et al. A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine. 2025. doi:10.1097/ccm.0000000000006574. PMID: 39982143.
BibTeX
@article{lewis2025-39982143,
author = {Lewis, Kimberley A. and Balas, Michele C. and Stollings, Joanna L. and McNett, Molly and Girard, Timothy D. and Chanques, Gérald and Kho, Michelle E. and Pandharipande, Pratik P. and others},
title = {{A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU}},
journal = {Critical Care Medicine},
year = {2025},
doi = {10.1097/ccm.0000000000006574},
pmid = {39982143},
url = {https://doi.org/10.1097/ccm.0000000000006574}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.
Later studies that cite this one
1 study in the alzhub library lists this one in its references.
Related studies in Prevention and risk
Also tagged “delirium”
858 studies in the library carry the topic tag “delirium”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 858 tagged studies.