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Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023.
Honarmand, Kimia; Wax, Randy S; Penoyer, Daleen; Lighthall, Geoffery; Danesh, Valerie; Rochwerg, Bram; Cheatham, Michael L; Davis, Daniel P; DeVita, Michael; Downar, James; Edelson, Dana; Fox-Robichaud, Alison; Fujitani, Shigeki; Fuller, Raeann M; Haskell, Helen; Inada-Kim, Matthew; Jones, Daryl; Kumar, Anand; Olsen, Keith M; Rowley, Daniel D; Welch, John; Baldisseri, Marie R; Kellett, John; Knowles, Heidi; Shipley, Jonathan K; Kolb, Philipp; Wax, Sophie P; Hecht, Jonathan D; Sebat, Frank.
Afiliação
  • Honarmand K; Division of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, ON, Canada.
  • Wax RS; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  • Penoyer D; Department of Critical Care Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
  • Lighthall G; Department of Critical Care, Lakeridge Health, Oshawa, ON, Canada.
  • Danesh V; Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, FL.
  • Rochwerg B; Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, CA.
  • Cheatham ML; Veterans Affairs Medical Center, Palo Alto, CA.
  • Davis DP; Center for Applied Health Research, Baylor Scott and White Health, Dallas, TX.
  • DeVita M; Division of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, ON, Canada.
  • Downar J; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  • Edelson D; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
  • Fox-Robichaud A; Division of Surgical Education, Orlando Regional Medical Center, Orlando, FL.
  • Fujitani S; Emergency Medical Services, Logan Health, Kalispell, MT.
  • Fuller RM; Columbia Vagelos College of Physicians and Surgeons, Department of Medicine Harlem Hospital Medical Center, New York City, NY.
  • Haskell H; Division of Critical Care, Department of Medicine, University Health Network, Toronto, ON, Canada.
  • Inada-Kim M; Division of Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL.
  • Jones D; Division of Critical Care, Department of Internal Medicine, Thrombosis and Atherosclerosis Research Institute, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
  • Kumar A; Division of Critical Care, Department of Emergency Medicine, Saint Marianna University, Kawasaki, Japan.
  • Olsen KM; Division of Trauma and Critical Care, Department of Emergency Medicine, Advocate Condell Medical Center, Libertyville, IL.
  • Rowley DD; Mothers Against Medical Error, Columbia, SC.
  • Welch J; Department of Acute Medicine, Hampshire Hospitals NHS Foundation Trust and University of Southampton, Southampton, United Kingdom.
  • Baldisseri MR; Division of Surgery, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
  • Kellett J; Division of Critical Care, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
  • Knowles H; University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE.
  • Shipley JK; Respiratory Therapy Services, University of Virginia Medical Center, Charlottesville, VA.
  • Kolb P; Critical Care Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
  • Wax SP; Department of Critical Care, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Hecht JD; Department of Emergency Medicine, University of Southern Denmark, Odense, Denmark.
  • Sebat F; Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX.
Crit Care Med ; 52(2): 314-330, 2024 02 01.
Article em En | MEDLINE | ID: mdl-38240510
ABSTRACT
RATIONALE Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care hospitals have implemented systems aimed at detecting and responding to such patients.

OBJECTIVES:

To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients. PANEL

DESIGN:

The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based Clinical Practice Guidelines.

METHODS:

We generated actionable questions using the Population, Intervention, Control, and Outcomes (PICO) format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation Approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).

RESULTS:

The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among unselected patients. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system.

CONCLUSIONS:

The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Críticos / Deterioração Clínica Tipo de estudo: Guideline / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Crit Care Med Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Críticos / Deterioração Clínica Tipo de estudo: Guideline / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Crit Care Med Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá