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Safe Medication Use in the ICU

Crit Care Med 2017; 45(9):e877-e915


Diagnosis and Management of CIRCI in Critically Ill Patients (Part II)

The Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017 publish a joint guideline. This part II of the guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients is related to acute illnesses that may be complicated by CIRCI. Crit Care Med 2018; 46(1):146-148Published: 4/9/2018


Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient

uidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric (> 1 mo and < 18 yr) critically ill patient expected to require a length of stay greater than 2 or 3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2,032 citations were scanned for relevance. The PubMed/Medline search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1,661 citations. In total, the search for clinical trials yielded 1,107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer one of the eight preidentified question groups for this guideline. We used the Grading of Recommendations, Assessment, Development and Evaluation criteria to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutritional assessment, particularly the detection of malnourished patients who are most vulnerable and therefore potentially may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery is an area of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutritionduring critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.


Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock

The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Crit Care Med. 2017;45(6):1061–1093 
 


Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome

An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline, this document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). Am J Respir Crit Care Med. 2017 May 1;195(9):1253-1263
 


Surviving Sepsis Campaign Guidelines and Translations

The fourth edition of "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016​" are intended to provide guidance for the clinician caring for adult patients with sepsis or septic shock. 


Defining Futile and Potentially Inappropriate Interventions

The Society of Critical Care Medicine and four other major critical care organizations have endorsed a seven-step process to resolve disagreements about potentially inappropriate treatments. The multiorganization statement (entitled: An official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units) provides examples of potentially inappropriate treatments; however, no clear definition is provided. 


ICU Admission, Discharge, and Triage Guidelines

ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research aims to update the SCCM Guidelines for ICU ADT and to provide a framework for the development of institutional policies, further research, and discussion for future refinement of these recommendations


Changes in Commercially Available Parenteral Multivitamin and Multi-Trace Element Products

The parenteral multivitamin preparations that are commercially available in the United States (U.S.) meet the requirements for most patients who receive parenteral nutrition (PN). However, a separate parenteral vitamin D preparation (cholecalciferol or ergocalciferol) should be made available for treatment of patients with vitamin D deficiency unresponsive to oral vitamin D supplementation. 


Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients: Part II

Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part II: Cardiac Ultrasonography aims to establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites.


Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient, from A.S.P.E.N. and the Society of Critical Care Medicine, are based on general conclusions of health professionals who, in developing such guidelines, have balanced potential benefits to be derived from a particular mode of medical therapy against certain risks inherent with such therapy. 


Prophylaxis of Venous Thrombosis in Neurocritical Care Patients

The risk of death from venous thromboembolism (VTE) is high in intensive care unit patients with neurological diagnoses. In response to this need for guidance, the Neurocritical Care Society set out to develop and evidence-based guideline using GRADE to safely reduce VTE and its associated complications.


Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part I

Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part I: General Ultrasonography aims to establish evidence-based guidelines for the use of bedside ultrasound by intensivists and specialists in the ICU and equivalent care sites for diagnostic and therapeutic purposes for organs of the chest, abdomen, pelvis, neck, and extremities.


Critical Care Delivery: The Importance of Process and ICU Structure to Improved Outcomes

Summary of the findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided.


Management of the Potential Organ Donor in the ICU

This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations.
 The goal of this consensus statement is to provide critical care practitioners with essential information and practical recommendations related to management of the potential organ donor, based on the available literature and expert consensus. 


Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units

This multisociety statement provides recommendations to prevent and manage intractable disagreements about the use of such treatments in intensive care units.