Author Affiliations: Departments of Medicine and Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario (Dr Meade); Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Health Services Research of Vanderbilt University, Geriatric Research Education and Clinical Center (GRECC), Nashville, Tenn (Dr Ely).
In addition to the celebrated technological and pharmaceutical advances
in intensive care, an unassuming type of research testing the use of protocols
in care has yielded some of the most important improvements in patient mortality
and morbidity, and in the costs of critical illness. The basic concept is
that routine clinical care is enhanced when interdisciplinary teams of health
professionals use evidence-based protocols to complement their clinical judgment.1 Perhaps the greatest value obtained from the use of
protocols is that of reducing unnecessary variations in intensive care practice.
Positive randomized trials now support the role of protocols for critical
care interventions such as lung-protective ventilation,2 weaning
from mechanical ventilation,3- 8 transfusion
of blood products,9 sepsis resuscitation,10 glycemic control,11 and
sedation and analgesia.12,13
Meade MO, Ely EW. Protocols to Improve the Care of Critically Ill Pediatric and Adult Patients. JAMA. 2002;288(20):2601-2603. doi:10.1001/jama.288.20.2601