Abstract
Objective
To assess adherence to clinical practice guidelines for three interventions routinely used in critical care medicine.
Design and setting
Multicenter, 1-day cross-sectional observational study in 44 intensive care units in four countries.
Patients
A total of 419 patients hospitalized in participating ICUs on the day of the survey.
Measurements and results
Red blood cell transfusion (n = 29) was performed appropriately in 22 patients (76%), while among the 390 patients who received no transfusion 4 (1%) had a valid indication. Setting of tidal volume in acute respiratory distress syndrome, assessed in 45 patients, was deemed appropriate in 37 cases (82%). Prescription of stress ulcer prophylaxis (n = 128) was appropriate in only 24 patients (19%), while among the 268 patients who were not treated 28 (10%) had an indication.
Conclusions
The implementation of recommendations varies across different domains of care. While the adherence to current recommendations in routine practice is acceptable as regards tidal volume settings in acute respiratory distress syndrome, it is suboptimal for blood transfusion and prevention of upper gastrointestinal bleeding. Practice surveys are useful to inform strategies currently developed to assess practices of health-care professionals and develop strategies for more effective dissemination of medical knowledge.
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References
Simes RJ (2002) Clinical trials and “real-world” medicine. Med J Aust 177:407–408
Kalassian KG, Dremsizov T, Angus DC (2002) Translating research evidence into clinical practice: new challenges for critical care. Crit Care 6:11–14
Davis D, O'Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A (1999) Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing activities change physician behaviour or health care outcomes? JAMA 282:867–874
Mann H (2002) Research ethics committees and public dissemination of clinical trial results. Lancet 360:406–408
Pitch J, Carne X, Arnaiz JA, Gmoez B, Trilla A, Rodes J (2003) Role of research ethics committee in follow-up and publication of results. Lancet 361:1015–1016
Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, Sicignano A, Palazzo M, Moreno R, Boulmé R, Lapage E, Le Gall JR (2002) Epidemiology of sepsis and infection in ICU patients from an international multicenter cohort study. Intensive Care Med 28:108–121
EPISEPSIS Study Group (2004) EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care Units. Intensive Care Med 30:580–588
Sakr Y, Reinhart K, Vincent JL, Sprung CL, Moreno R, Ranieri M, De Baker D, Payen D (2006) Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) study. Crit Care Med 34:589–597
Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340:409–417
Sloane PJ, Gee MH, Gottlieb JE, Albertine KH, Peters SP, Burns JR, Machiedo G, Fish JE (1992) A multicenter registry of patients with acute respiratory distress syndrome: physiology and outcome. Am Rev Respir Dis 146:149–126
Zilberberg MD, Epstein SK (1998) Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med 157:1159–1164
Tsuno K, Miura K, Takeya M, Kolobow T, Morioka T (1991) Histopathologic pulmonary changes from mechanical ventilation at high peak airway pressures. Am Rev Respir Dis 143:1115–1120
Dreyfuss D, Basset G, Soler P, Saumon G (1985) Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis 132:880–884
Acute Respiratory Distress Syndrome NetWork (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308
Raynard B, Bernard B, Bleichner G, Fagon JY (2000) Prévention des hémorragies digestives hautes de stress en réanimation. Révision de la conférence de consensus de 1988. Reanimination Soins Intensifs Med Urgence 9:555–560
Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European /North American multicenter study. JAMA 270:2957–2963
Kantorova I, Svoboda P, Scheer P, Doubek J, Rehorkova D, Bosakova H, Ochmann J (2004) Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology 51:757–761
Daley RJ, Rebuck JA, Welage LS, Rogers FB (2004) Prevention of stress ulceration: current trends in critical care. Crit Care Med 32:2008–2013
Faisy C, Guerot E, Diehl JL, Iftimovici E, Fagon JY (2003) Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis. Intensive Care Med 29:1306–1313
Cook D, Guyatt G, Marshall J, Leasa D, Fuller H, Hall R, Peters S, Rutledge F, Griffith L, McLellan A, Wood G, Kirby A (1998) A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care trials Group. N Engl J Med 338:791–797
Cook DJ, Reeve BK, Guyatt GH, Heyland DK, Griffith LE, Buckingam L, Tryba M (1996) Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA 275:308–314
Hebert PC, Fergusson DA, Stather D, McInthyre L, Martin C, Doucette S, Blajchman M, Graham ID for the Canadian Critical Care Trials Group (2005) Revisiting transfusion practices in critically ill patients. Crit Care Med 33:7–12
Weinert CR, Gross CR, Marinelli WA (2003) Impact of randomized trial results on acute lung injury ventilator therapy in teaching hospital. Am J Respir Crit Care Med 167:1304–1309
Esteban A, Anzuetto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ, Mechanical Ventilation International Study Group (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355
Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, Lewandowski K, Bion J, Romand JA, Villar J, Thorsteinsson A, Damas P, Armaganidis A, Lemaire F (2004) Epidemiology and outcome of ALI in European ICUs. Results from ALIVE study. Intensive Care Med 30:51–61
Fergusson ND, Frutos-Vivar F, Esteban A, Anzueto A, Alia I, Brower RG, Stewart TE, Apezteguia C, Gonzales M, Soto L, Abroug F, Brochard L, for the Mechanical Ventilation International Study Group (2005) Airway pressures, tidal volumes, and mortality with acute respiratory distress syndrome. Crit Care Med 33:21–30
Kahn JM, Doctor JN, Rubenfeld GD (2006) Stress ulcer prophylaxis in mechanically ventilated patients: integrating evidence and judgment using a decision analysis. Intensive Care Med 32:1151–1158
Pitimana-aree S, Forrest D, Brown G, Anis A, Wang XH, Dodek P (1998) Implementation of a clinical practice guideline for stress ulcer prophylaxis increases appropriateness and decreases cost of care. Intensive Care Med 24:217–223
Cook DJ, Walter SD, Cook RJ, Grifith LE, Guyatt GH, Leasa D, Jaeschke RZ, Brun-Buisson C (1998) Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129:433–440
Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patient's care. Lancet 362:1225–1230
Acknowledgements
TECLA Steering Committee members were: F. Feihl, MD, H. Mentec, MD, D. Annane, MD, PhD, C. Brun-Buisson, MD, PhD, C. Melot, MD, PhD, P. Vignon, MD, PhD. Members of the Epidemiology and Clinical Research Commission (Commission d'Epidemiologie et de Recherche Clinique) were: Hervé Mentec (Argenteuil, France), Djillali Annane (Garches, France), Pascal Beuret (Roanne, France), Julien Bohé (Lyon, France), Bernard Bouffandeau (Elbeuf, France), Fabrice Bruneel (Versailles, France), Christian Brun-Buisson (Créteil, France), Yves Cohen (Bobigny, France), Robin Cremer (Lille, France), François Feihl (Lausanne, Switzerland), Bertrand Guidet (Paris, France), Mercé Jourdain (Lille, France), Jean-Michel Liet (Nantes, France), Christian Melot (Brussels, Belgium), Mehran Monchi (Massy, France), Jean-Charles Preiser (Liege, Belgium), Jean-Pierre Quenot (Dijon, France), Jean-Philippe Rigaud (Dieppe, France), Marie-Denise Schaller (Lausanne, Switzerland), Philippe Vignon (Limoges, France), Christophe Vinsonneau (Paris, France). Participants by country (listed alphabetically) were: France: C. Galland, Saint-Omer Hospital; C. Brun-Buisson, Henri Mondor Hospital, Créteil, E. Maury, Saint-Antoine Hospital, Paris; M. Jourdain, R. Salengro Hospital, Lille; P. Beuret Roanne Hospital; S. Moulront, Dunkerque Hospital; N. Milesi-Defrance, General Hospital, Dijon; I. Coquet and J.P. Quenot, Bocage Hospital, Dijon; E. Boulet R. Dubos Hospital, Pontoise; L. Holzapfel Fleyriat Hospital, Bourg en Bresse; D. Annane, Raymond Poincaré Hospital, Garches; S. Jamali, Dourdan Hospital; H. Mentec, Victor Dupouy Hospital, Argenteuil; M. Monchi, J. Cartier Institut, Massy Palaiseau; D. Goldran-Toledano, Sainte Justine Hospital, Gonesse; P. Vignon, Dupuytren Hospital, Limoges; M. Fartoukh, Tenon Hospital, Paris; J.C. Farkas, Saint André Polyclinic; J.P. Rigaud, Dieppe Hospital; J.L. Ricome Poissy Hospital, St Germain en Laye; C. Broux, Michalon Hospital, Grenoble; A. Mercat, Angers Hospital; J. Bohé Lyon Sud Hospital; P.E. Bollaert, Central Hospital, Nancy; D. Villers, Hotel Dieu Hospital, Nantes; A. Combes, Pitié Salpêtrière Hospital, Paris; B. Raynard, G. Roussy Institut, Villejuif; D. Dubois, Arras Hospital; J.F. Loriferne, St. Camille Hospital, Bry sur Marne; Richard C. Bicêtre Hospital; I. Mohammedi, E. Herriot Hospital, Lyon; T. Boulain, Orléans Hospital; P. Tourneux, Amiens Hospital; A. Lepape, Lyon Sud Hospital, Lyon, Switzerland: C. Vannay-Boubiche, Lausanne Hospital; F. Feihl, Lausanne Hospital; MD Schaller Lausanne Hospital Canada: P. Jouvet, Sainte Justine Hospital, Montreal, Quebec. Belgium: V. Fraipont, Citadelle Hospital, Liege; C. Mélot, Erasm Hospital, Brussels. The TECLA Study Group is indebted to the Société de Réanimation de Langue Française, the company SCDMI (www.scdmi.com) and to the Polytechnic School of the Free University of Brussels. We gratefully thank all the participating members of the study. We thank Fiona Ecarnot for editorial assistance.
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The full list of investigators participating in the TECLA study appears under Acknowledgements.
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Quenot, JP., Mentec, H., Feihl, F. et al. Bedside adherence to clinical practice guidelines in the intensive care unit: the TECLA study. Intensive Care Med 34, 1393–1400 (2008). https://doi.org/10.1007/s00134-008-1059-y
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DOI: https://doi.org/10.1007/s00134-008-1059-y