Treatment algorithms in critical care: Do they improve outcomes?

Stephen W. Nissen, Keith M. Olsen

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Patients admitted to the intensive care unit (ICU) often have significant underlying morbidities that require complex treatment plans. Because of these complexities, numerous guidelines have been developed to facilitate the management of the critically ill patient. Some of these guidelines include sepsis, community-acquired and ventilator-associated pneumonia, sedation, and glycemic control. Once guidelines are written, a treatment protocol must be developed and implemented within the critical care unit. Our medical center has implemented multiple treatment protocols, often with preprinted order sets with various degrees of success. In 2003, we implemented and later evaluated a sedation order form and protocol. Patients whose sedation was initiated with a standardized order form had more frequent sedation score assessment, less time between sedation vacations, reduced ICU length of ICU stay, and a trend in reduction of ventilator days. However, only 37% of eligible patients were treated using the order form and the protocol, despite the potentially beneficial effects. Some recommendations within guidelines are based on sound clinical evidence supported by randomized controlled trials, although others are based on expert opinion only. The most often-cited reason for protocol noncompliance is disagreement with the published clinical trial data. This paper examines both infectious and noninfectious treatment guidelines and the supportive evidence that they improved patient outcomes. In addition, strategies for successful implementation of a treatment guideline are discussed for clinicians to follow in order to maximize clinical outcomes.

Original languageEnglish (US)
Pages (from-to)61-68
Number of pages8
JournalJournal of Pharmacy Practice
Volume23
Issue number1
DOIs
StatePublished - Mar 19 2010

Fingerprint

Critical Care
Guidelines
Intensive Care Units
Clinical Protocols
Therapeutics
Ventilator-Associated Pneumonia
Expert Testimony
Mechanical Ventilators
Critical Illness
Sepsis
Randomized Controlled Trials
Clinical Trials
Morbidity

Keywords

  • Critical care
  • Outcomes
  • Pneumonia
  • Sedation
  • Sepsis

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Treatment algorithms in critical care : Do they improve outcomes? / Nissen, Stephen W.; Olsen, Keith M.

In: Journal of Pharmacy Practice, Vol. 23, No. 1, 19.03.2010, p. 61-68.

Research output: Contribution to journalReview article

Nissen, Stephen W. ; Olsen, Keith M. / Treatment algorithms in critical care : Do they improve outcomes?. In: Journal of Pharmacy Practice. 2010 ; Vol. 23, No. 1. pp. 61-68.
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