Protocols and hospital mortality in critically ill patients

The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

Jonathan E. Sevransky, William Checkley, Phabiola Herrera, Brian W. Pickering, Juliana Barr, Samuel M. Brown, Steven Y. Chang, David Chong, David Kaufman, Richard D. Fremont, Timothy D. Girard, Jeffrey Hoag, Steven B. Johnson, Mehta P. Kerlin, Janice Liebler, James O'Brien, Terence OKeeffe, Pauline K. Park, Stephen M. Pastores, Namrata Patil & 8 others Anthony P. Pietropaoli, Maryann Putman, Todd W. Rice, Leo Rotello, Jonathan Siner, Sahul Sajid, David J. Murphy, Greg S. Martin

Research output: Contribution to journalArticle

Abstract

Objective: Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized ICUs have superior patient outcomes compared with less highly protocolized ICUs. Design: Observational study in which participating ICUs completed a general assessment and enrolled new patients 1 day each week. Patients: A total of 6,179 critically ill patients. Setting: Fifty-nine ICUs in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. Interventions: None. Measurements and Main Results: The primary exposure was the number of ICU protocols; the primary outcome was hospital mortality. A total of 5,809 participants were followed prospectively, and 5,454 patients in 57 ICUs had complete outcome data. The median number of protocols per ICU was 19 (interquartile range, 15-21.5). In single-variable analyses, there were no differences in ICU and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in ICUs with a high versus low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p = 0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between ICUs with high versus low numbers of protocols for lung protective ventilation in acute respiratory distress syndrome (47% vs 52%; p = 0.28) and for spontaneous breathing trials (55% vs 51%; p = 0.27). Conclusions: Clinical protocols are highly prevalent in U.S. ICUs. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality

Original languageEnglish (US)
Pages (from-to)2076-2084
Number of pages9
JournalCritical care medicine
Volume43
Issue number10
DOIs
StatePublished - Oct 1 2015

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Hospital Mortality
Critical Illness
Outcome Assessment (Health Care)
Wounds and Injuries
Guideline Adherence
Clinical Protocols
Adult Respiratory Distress Syndrome
Mechanical Ventilators
Artificial Respiration
Observational Studies
Ventilation
Length of Stay
Respiration
Lung
Mortality

Keywords

  • Intensive care unit
  • Mortality
  • Protocol

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Protocols and hospital mortality in critically ill patients : The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. / Sevransky, Jonathan E.; Checkley, William; Herrera, Phabiola; Pickering, Brian W.; Barr, Juliana; Brown, Samuel M.; Chang, Steven Y.; Chong, David; Kaufman, David; Fremont, Richard D.; Girard, Timothy D.; Hoag, Jeffrey; Johnson, Steven B.; Kerlin, Mehta P.; Liebler, Janice; O'Brien, James; OKeeffe, Terence; Park, Pauline K.; Pastores, Stephen M.; Patil, Namrata; Pietropaoli, Anthony P.; Putman, Maryann; Rice, Todd W.; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J.; Martin, Greg S.

In: Critical care medicine, Vol. 43, No. 10, 01.10.2015, p. 2076-2084.

Research output: Contribution to journalArticle

Sevransky, JE, Checkley, W, Herrera, P, Pickering, BW, Barr, J, Brown, SM, Chang, SY, Chong, D, Kaufman, D, Fremont, RD, Girard, TD, Hoag, J, Johnson, SB, Kerlin, MP, Liebler, J, O'Brien, J, OKeeffe, T, Park, PK, Pastores, SM, Patil, N, Pietropaoli, AP, Putman, M, Rice, TW, Rotello, L, Siner, J, Sajid, S, Murphy, DJ & Martin, GS 2015, 'Protocols and hospital mortality in critically ill patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study', Critical care medicine, vol. 43, no. 10, pp. 2076-2084. https://doi.org/10.1097/CCM.0000000000001157
Sevransky, Jonathan E. ; Checkley, William ; Herrera, Phabiola ; Pickering, Brian W. ; Barr, Juliana ; Brown, Samuel M. ; Chang, Steven Y. ; Chong, David ; Kaufman, David ; Fremont, Richard D. ; Girard, Timothy D. ; Hoag, Jeffrey ; Johnson, Steven B. ; Kerlin, Mehta P. ; Liebler, Janice ; O'Brien, James ; OKeeffe, Terence ; Park, Pauline K. ; Pastores, Stephen M. ; Patil, Namrata ; Pietropaoli, Anthony P. ; Putman, Maryann ; Rice, Todd W. ; Rotello, Leo ; Siner, Jonathan ; Sajid, Sahul ; Murphy, David J. ; Martin, Greg S. / Protocols and hospital mortality in critically ill patients : The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. In: Critical care medicine. 2015 ; Vol. 43, No. 10. pp. 2076-2084.
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AU - Sevransky, Jonathan E.

AU - Checkley, William

AU - Herrera, Phabiola

AU - Pickering, Brian W.

AU - Barr, Juliana

AU - Brown, Samuel M.

AU - Chang, Steven Y.

AU - Chong, David

AU - Kaufman, David

AU - Fremont, Richard D.

AU - Girard, Timothy D.

AU - Hoag, Jeffrey

AU - Johnson, Steven B.

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AU - O'Brien, James

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AU - Park, Pauline K.

AU - Pastores, Stephen M.

AU - Patil, Namrata

AU - Pietropaoli, Anthony P.

AU - Putman, Maryann

AU - Rice, Todd W.

AU - Rotello, Leo

AU - Siner, Jonathan

AU - Sajid, Sahul

AU - Murphy, David J.

AU - Martin, Greg S.

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N2 - Objective: Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized ICUs have superior patient outcomes compared with less highly protocolized ICUs. Design: Observational study in which participating ICUs completed a general assessment and enrolled new patients 1 day each week. Patients: A total of 6,179 critically ill patients. Setting: Fifty-nine ICUs in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. Interventions: None. Measurements and Main Results: The primary exposure was the number of ICU protocols; the primary outcome was hospital mortality. A total of 5,809 participants were followed prospectively, and 5,454 patients in 57 ICUs had complete outcome data. The median number of protocols per ICU was 19 (interquartile range, 15-21.5). In single-variable analyses, there were no differences in ICU and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in ICUs with a high versus low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p = 0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between ICUs with high versus low numbers of protocols for lung protective ventilation in acute respiratory distress syndrome (47% vs 52%; p = 0.28) and for spontaneous breathing trials (55% vs 51%; p = 0.27). Conclusions: Clinical protocols are highly prevalent in U.S. ICUs. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality

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