Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 30 5 2025 10 01 Management of Pain, Agitation, and Delirium in Critical Care Patients: A Systematic Review 1601 1608 230004 10.30491/tm.2025.541825.1872 EN Abasali Delavari Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Marzieh Lak Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Journal Article 2025 08 17 Introduction: Pain, agitation, and delirium (PAD) are frequent complications in ICU patients. This review assesses guideline recommendations for managing PAD in critically ill adults. Method: This systematic review synthesized recommendations from ICU guidelines with recent literature on PAD. We searched the PubMed, Scopus, and Web of Science databases using relevant keywords and MeSH terms. Result: Seven guidelines from North America (SCCM 2013, 2018, 2022, 2025), Europe (ESICM 2025, NICE 2019), Asia (KSCCM 2021), and LMICs (Indian ABCDEF 2023) were included. Recent guidelines emphasize the importance of integrating digital innovations, such as electronic health record systems and AI monitoring. The guidelines from 2022 to 2025 also emphasize intervals in care for special populations by introducing reliable protocols for pediatric patients and by adjusting care to specific needs. Light, titratable sedation agents, such as dexmedetomidine, are recommended to decrease oversedation and the duration of ventilator. Pharmacologic interventions are reserved for refractory cases, utilizing opioids, adjuncts, and emerging agents tailored to individual needs. The guidelines have shifted from a focus on sedation to a patient-centered approach, integrating PAD protocols that emphasize multimodal management and early intervention. Conclusion: The finding showed that managing PAD in the ICU needs a multimodal, guideline-directed procedure that includes both pharmacologic and non-pharmacologic strategies with comprehensive assessment. Future research should evaluate new therapies and develop evidence-based protocols that balance efficacy, safety, and patient-centered outcomes.

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