Clinical practice guidelines are published, often by professional societies, because they provide a current and transparently analyzed review of relevant research with the aim to guide clinical practice. The 2018 Pain, Agitation/ sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep (disruption) (PADIS) guideline builds on this mission by updating the 2013 Pain, Agitation, and Delirium (PAD) guidelines (1); by adding two inextricably related clinical care topics—rehabilitation/mobilization and sleep; by including patients as collaborators and coauthors; and by inviting an international panel of experts from high-income countries as an early step toward incorporating more diverse practices and expertise from the global critical care community. Readers will find rationales for 37 recommendations (derived from actionable Patient, Intervention, Comparison, and Outcome [PICO] questions); two ungraded good practice statements (derived from actionable PICO questions where it is unequivocal, the benefits of the intervention outweigh the risks but direct evidence to support the intervention does not exist); and 32 ungraded statements (derived from nonactionable, descriptive questions) across the five guideline sections. The supplemental digital content figures and tables linked to this guideline provide background on how the questions were established, profiles of the evidence, the evidence-to-decision tables used to develop recommendations, and voting results. Evidence gaps and future research directions are highlighted in each section. The five sections of this guideline are interrelated, and thus, the guideline should be considered in its entirety rather than as discrete recommendations. Knowledge translation and implementation effectiveness are an important segue to our guideline document and work to foster advances in clinical practice related to PADIS assessment, prevention, and treatment. A PADIS guideline implementation and integration article separately created to facilitate this is available (2). Many challenges characterize developing effective PADIS-related educational and quality improvement programs. Although some have not achieved expected outcomes (3, 4), many quality improvement efforts in this field have been successful (5–10).
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