An Overview on Recent Guidelines and Protocols in ICU

Abstract

Protocols appear to be a useful tool for improving processes of medical care in the ICU and patient outcomes. Although the overall quality of evidence supporting the efficacy of protocols may be less than ideal, the reported success following their implementation provides justification for expanded use of these tools for the management of critically ill patients. Protocols appear to consistently improve the delivery of recommended therapies and as a result may improve patient outcomes. Given that well-designed protocols generally expose patients to no additional risks and are associated with relatively little acquisition cost, their implementation should become more standard in the management of complex disease processes like acute respiratory failure and severe sepsis. However, it is important to update such protocols as new information becomes clinically available. The criteria generally used to decide whether to admit to ICU or not are the prioritization model, which defines an order from the patients who will benefit most from the ICU, to those that will not benefit at all from ICU admission. PPIs are generally well tolerated and considered superior in the treatment of acid-related conditions such as peptic ulcer disease. PPIs are more effective at keeping a constant gastric pH > 4.0, which may be sufficient to prevent stress ulceration, compared to H2RAs. All patients admitted to intensive care units (ICUs) are considered high risk for VTE,even after routine prophylactic anticoagulation. Critical illness is typically associated with a catabolic stress state in which patients commonly demonstrate a systemic inflammatory response. This response is coupled with complications of increased infectious morbidity, multi-organ dysfunction, prolonged hospitalization. Nutritional modulation of the stress response to critical illness includes early enteral nutrition (EN), appropriate macronutrient and micronutrient delivery, and meticulous glycemic control. The principal focus of critical care management for severe TBI is to limit secondary brain injury. In general, treatment efforts are aimed at intracranial pressure management and maintenance of cerebral perfusion as well as optimizing oxygenation and blood pressure and managing temperature, glucose, seizures, and other potential secondary brain insults. In stroke patients stabilization of airway, breathing, circulation, and rapid neurologic evaluation are important, as well as early key management issues that often arise in acute stroke include blood pressure control, fluid management, treatment of abnormal blood glucose levels, swallowing assessment and treatment of fever and infection. Care in a dedicated stroke unit is associated with better outcomes.

Analgesic and sedative/hypnotic infusions are routinely used in intensive care on patients requiring mechanical ventilation. these infusions are often required for patient comfort, to facilitate procedures and for patient-ventilator synchrony. Acute coronary syndrome (ACS) describes the range of myocardial ischemic states that includes unstable angina (UA), non-ST elevated myocardial infarction (NSTEMI), or ST-elevated myocardial infarction (STEMI). The diagnosis and classification of ACS is based on a thorough review of clinical features, including electrocardiogram (ECG) findings and biochemical markers of myocardial necrosis. In shocked patients whatever the cause of shock, preliminary assessment in the ED begins with a primary survey to identify the need for critical inter¬ventions such as intubation, mechanical ventilation, or obtaining vascular access. Patients may need to be immediately intubated for refractory hypoxemia, hypoventilation, or the inability to protect their air¬way, then goal directed to treat specific cause of shock and determine the need for vasopressor agents. Infection control is a discipline that applies epidemiologic and scientific principles and statistical analysis to the prevention or reduction in rates of nosocomial infections. Some experts in the field now prefer to use the phrase "infection prevention and hospital epidemiology" over the term infection control. Indeed, infection control is a key component of the broader discipline of hospital epidemiology. Effective infection control programs reduce rates of nosocomial infections and are cost-effective.