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Development and simultaneous application of multiple care protocols in critical care: a multicenter feasibility study

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Abstract

Objective

To test the feasibility of and interactions among three software-driven critical care protocols.

Design

Prospective cohort study.

Setting

Intensive care units in six European and American university hospitals.

Patients

174 cardiac surgery and 41 septic patients.

Interventions

Application of software-driven protocols for cardiovascular management, sedation, and weaning during the first 7 days of intensive care.

Measurements and results

All protocols were used simultaneously in 85% of the cardiac surgery and 44% of the septic patients, and any one of the protocols was used for 73 and 44% of study duration, respectively. Protocol use was discontinued in 12% of patients by the treating clinician and in 6% for technical/administrative reasons. The number of protocol steps per unit of time was similar in the two diagnostic groups (n.s. for all protocols). Initial hemodynamic stability (a protocol target) was achieved in 26 ± 18 min (mean ± SD) in cardiac surgery and in 24 ± 18 min in septic patients. Sedation targets were reached in 2.4 ± 0.2 h in cardiac surgery and in 3.6 ± 0.2 h in septic patients. Weaning protocol was started in 164 (94%; 154 extubated) cardiac surgery and in 25 (60%; 9 extubated) septic patients. The median (interquartile range) time from starting weaning to extubation (a protocol target) was 89 min (range 44–154 min) for the cardiac surgery patients and 96 min (range 56–205 min) for the septic patients.

Conclusions

Multiple software-driven treatment protocols can be simultaneously applied with high acceptance and rapid achievement of primary treatment goals. Time to reach these primary goals may provide a performance indicator.

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Author information

Authors and Affiliations

  1. Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Jukka Takala, Stephan M. Jakob & Raymond Friolet

  2. Critical Care Division, Dorrance 393, Cooper University Hospital, One Cooper Plaza, 08103, Camden, NJ, USA

    R. Philip Dellinger

  3. Intensium Ltd., Microkatu 1, 70211, Kuopio, Finland

    Kati Koskinen

  4. Surgical Critical Care, Rm 4B 42, Washington Hospital Center, 110 Irving Street NW, 20010, Washington, DC, USA

    Arthur St. Andre

  5. Critical Care Services, Cardiff and Vale NHS Trust, University Hospital of Wales, Heath Park, CF14 4XW, Cardiff, UK

    Martyn Read

  6. Medical Intensive Care Unit, Rhode Island Hospital, 593 Eddy Street, 02906, Providence, RI, USA

    Mitchell Levy

  7. Intensive Care Unit, Hospital de Terapia Intensiva, Universidade Estadual Piaui, 2131 Anfrisio Lobao Teresina, 64041-280, Piaui, Brazil

    Patricia Veiga C. Mello

  8. Department of Intensive Care, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland

    Esko Ruokonen

Authors
  1. Jukka Takala
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  2. R. Philip Dellinger
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  3. Kati Koskinen
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  4. Arthur St. Andre
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  5. Martyn Read
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  6. Mitchell Levy
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  7. Stephan M. Jakob
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  8. Patricia Veiga C. Mello
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  9. Raymond Friolet
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  10. Esko Ruokonen
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Corresponding author

Correspondence to Jukka Takala.

Additional information

These authors performed this study on behalf of the CPIC Study Group.

Conflicts of interest: This trial was investigator initiated and received funding from TEKES (Finnish funding agency for technology and innovation), and from Deio (Helsinki, Finland) to cover part of the research personnel costs and the costs of data collection and statistical analysis. The software prototype was written by Deio based on specifications from the investigators. Author K.K. is an employee of Intensium (Kuopio, Finland), a company that managed the data collection and statistical analysis. No other conflicts of interest are declared.

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Takala, J., Dellinger, R.P., Koskinen, K. et al. Development and simultaneous application of multiple care protocols in critical care: a multicenter feasibility study. Intensive Care Med 34, 1401–1410 (2008). https://doi.org/10.1007/s00134-008-1084-x

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  • DOI: https://doi.org/10.1007/s00134-008-1084-x

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