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November 27, 2002

Protocols to Improve the Care of Critically Ill Pediatric and Adult Patients

Author Affiliations

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).

JAMA. 2002;288(20):2601-2603. doi:10.1001/jama.288.20.2601

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