Protocol Use in Surgical Intensive Care Units

Background: Protocols are common in intensive care, however the association between protocol prevalence and outcomes in surgical ICU patients is unclear. We hypothesized that ICUs in a multicenter database using more protocols had better outcomes. Material and Methods: This is a retrospective analysis of prospectively collected data from a 2-d prevalence study with 30-d follow up, on surgical and trauma patients in ICUs at 42 trauma centers. Use of forty clinical protocols was queried. Protocol prevalence was categorized by quartile into Low (first), Moderate (second and third), or High (fourth) use ICUs. The primary outcome was in-hospital mortality; secondary outcomes were ventilator, ICU, and hospital days, mechanical ventilation, tracheostomy, renal replacement, transfusion, and hospital-acquired infections. Results: Data from 1044 surgical and trauma patients were analyzed. Protocol use was not different for closed (n=20), open (n=9), or semi-open (n=13) ICUs (P=0.20). Thirty-day in-hospital mortality was 8.4%, and not associated with number of protocols (OR 1.01 [95% CI 0.98-1.03], P=0.65). There was no statistically significant difference between High and Low use ICUs for ventilator days (OR 0.86; 0.52-1.43), tracheostomy (OR 0.8; 0.47-1.38), renal replacement therapy (OR 0.66; 0.04-9.82), transfusion (OR 0.95; 0.58-1.57), or hospital-acquired infections (OR 1.07; 0.67-1.7). Higher mortality was seen in open (versusclosed; OR 1.74 [1.05-2.89], P=0.033), and surgical/trauma (versustrauma; OR 1.86 [1.33-2.61]; P < 0.001). Conclusions: In this multicenter observational study of surgical ICU patients, no association was found between the number of protocols used and patient outcomes. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

In this multicenter observational study of surgical ICU patients, no significant association was found between the number of protocols used and patient outcomes. Higher mortality rates were seen in open ICUs and surgical/trauma patients.