Intensive Care Medicine

, Volume 34, Issue 8, pp 1393–1400

Bedside adherence to clinical practice guidelines in the intensive care unit: the TECLA study

  • Jean-Pierre Quenot
  • Hervé Mentec
  • François Feihl
  • Djillali Annane
  • Christian Melot
  • Philippe Vignon
  • Christian Brun-Buisson
  • TECLA Study Group
Original

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.

Keywords

Transfusion Practice guidelines Respiratory distress syndrome Stress ulcer prophylaxis Intensive care 

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Jean-Pierre Quenot
    • 1
    • 2
  • Hervé Mentec
    • 2
  • François Feihl
    • 2
  • Djillali Annane
    • 2
  • Christian Melot
    • 2
  • Philippe Vignon
    • 2
  • Christian Brun-Buisson
    • 2
  • TECLA Study Group
  1. 1.Service de Réanimation MédicaleHôpital BocageDijonFrance
  2. 2.Commission d’Epidémiologie et de Recherche CliniqueSociété de Réanimation de Langue FrançaiseParisFrance

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