Differences in prevalence of ICU protocols between neurologic and non-neurologic patient populations

Michael E Billington; Raghu R Seethala; Peter C Hou; Sukhjit S Takhar; Reza Askari; Imo P Aisiku; USIITG-CIOS investigators

doi:10.1016/j.jcrc.2019.03.002

Differences in prevalence of ICU protocols between neurologic and non-neurologic patient populations

J Crit Care. 2019 Aug:52:63-67. doi: 10.1016/j.jcrc.2019.03.002. Epub 2019 Mar 27.

Authors

Michael E Billington¹, Raghu R Seethala², Peter C Hou³, Sukhjit S Takhar⁴, Reza Askari⁵, Imo P Aisiku⁶; USIITG-CIOS investigators⁷

Affiliations

¹ Harvard University School of Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. Electronic address: mbillington@bwh.harvard.edu.
² Harvard University School of Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. Electronic address: rseethala@bwh.harvard.edu.
³ Harvard University School of Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. Electronic address: phou@bwh.harvard.edu.
⁴ Harvard University School of Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. Electronic address: stakhar@bwh.harvard.edu.
⁵ Harvard University School of Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. Electronic address: raskari@bwh.harvard.edu.
⁶ Harvard University School of Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. Electronic address: iaisiku@bwh.harvard.edu.
⁷ Harvard University School of Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.

PMID: 30981927
DOI: 10.1016/j.jcrc.2019.03.002

Abstract

Purpose: To compare the differences in the presence of protocols aimed at addressing complications for neurologically injured patients vs. non-neurologic injured patients in a large sample of ICUs across the United States.

Materials and methods: Prospective observational multi-center cohort study. This was a subgroup analysis of the multi-centered prospective observational cohort study of medical, surgical, and mixed intensive care units from across the country. USCIITG-CIOS study group.

Results: Sixty-nine ICUs participated in the study of which 25 (36%) were medical, 24 were surgical (35%) and 20 (29%) were of mixed type, and 64 (93%) were in teaching hospitals. There were 6179 patients across all sites with 1266 (20.4%) with central nervous system diagnoses. Protocol utilization in central nervous system vs. non- central nervous system patients was as follows: Sedation interruption 973/1266 (76.9%) vs. 3840/4913 (78.2%) (p = .32); acute lung injury ventilation 847/1266 (66.9%) vs. 4069/4913 (82.8%) (p < .0001); ventilator associated pneumonia 1193/1266 (94.2%) vs. 4760/4913 (96.9%) (p < .0001); ventilator weaning 1193/1266 (94.2%) vs. 4490/4913 (91.4%) (p = .0009); and early mobility 378/1266 (29.9%) vs. 1736/4913 (35.3%) (p = .0002).

Conclusion: In this cohort, we found differences in the prevalence of respiratory illness prevention protocols between critically ill patients with neurologic illness and the general critically ill population.

Keywords: CNS; ICU; Lung injury; Neurologic; Protocols; Ventilator.

Publication types

Comparative Study
Multicenter Study
Observational Study

MeSH terms

APACHE
Acute Lung Injury / prevention & control
Adult
Aged
Central Nervous System / injuries*
Critical Care / standards*
Critical Illness
Female
Guidelines as Topic
Humans
Intensive Care Units*
Male
Middle Aged
Prevalence
Prospective Studies
Respiration, Artificial
United States
Venous Thrombosis / prevention & control
Ventilators, Mechanical
Wounds and Injuries / complications*