Quality Management in the ICU: Understanding the Process and Improving the Art

  • P. Murabito
  • F. Rubulotta
  • A. Gullo


Recently clinicians, researchers, nursing-staff, economists and experts in the field of health system governance have stressed the importance of quality improvement for clinical management optimization. The advances made toward quality improvement have been marked by the ability of the team leader to ration resources and improve work through the development of guidelines and audit control. Evidence-based medicine is a modern approach for integrating current medical knowledge into clinical practice. It states that management of patients should be based on the rigorous assessment of the results of randomized controlled trials (RCTs) combined with evidence from other forms of research. This approach has merit. Variations in the management of patients can result in care of varying quality and varying mortality [1]. Critical care physicians and nurses are involved in the quality improvementprocess in accordance with the assumptions of Davidoff and Batalden: in contrast with the primary goals of science, which are to discover and disseminate new knowledge, the primary goal of improvement is to change performance [2]. The formal version of that cycle — the Plan-Do-Study-Act model — is now a key component of medical quality improvement [3] and also includes a “Publish” step. Indeed, the biologist Edward O. Wilson has gone so far as to state that: “One of the strictures of the scientific ethos is that a discovery does not exist until it is safely reviewed and in print” [4]. Unfortunately, publication in medical quality improvement has played a limited role to date. This lack of published reports has arguably deprived the health care system of rigorous scholarly evidence on work improvement and hence has slowed the development of the improvement process [5].


Intensive Insulin Therapy Spontaneous Breathing Trial Noninvasive Positive Pressure Ventilation Medical Emergency Team Clinical Governance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Brochard L, Mancebo J, Tobin M (2002) Searching for evidence, don’t forget the foundations. Intensive Care Med 29:2109–2111Google Scholar
  2. 2.
    Davidoff F, Batalden P (2005) Toward stronger evidence on quality improvement. Draft publication guidelines: the beginning of a consensus project. Qual Saf Health Care 14:319–325PubMedCrossRefGoogle Scholar
  3. 3.
    Johansen KL (2007) Value of quality improvement reporting. Clin J Am Soc Nephrol [Epub ahead of print]Google Scholar
  4. 4.
    Wilson EO (2001) Unity of Knowledge: the convergence of natural and human science Ann NY Acad Sci 935:12–17Google Scholar
  5. 5.
    Vemula R, Robyn Assaf R, Al-Assaf AF (2007) Making the Patient Safety and Quality Improvement Act of 2005 work. J Health Qual 29:6–10Google Scholar
  6. 6.
    Ledingham IM (2001) Evidence based medicine: physicians’ perceptions. Intensive Care Med 27:464–466PubMedCrossRefGoogle Scholar
  7. 7.
    Committee on Quality of Health Care in America: Crossing the quality chasm: a new health system for the 21st century (2001) Washington, DC, National Academy PressGoogle Scholar
  8. 8.
    Pronovost PJ, Berenholtz SM, Ngo K, et al (2003) Developing and pilot testing quality indicators in the intensive care unit. J Crit Care 18:145–155PubMedCrossRefGoogle Scholar
  9. 9.
    Rollins G (2007) Quality. New Joint Commission measures in the works. Hosp Health Net 81:32Google Scholar
  10. 10.
    Curtis JR, Cook DJ, Wall RJ, et al (2006) Intensive care unit quality improvement: a “how-to” guide for the interdisciplinary team. Crit Care Med 34:211–218PubMedCrossRefGoogle Scholar
  11. 11.
    Donabedian A (1993) Continuity and change in the quest for quality. Clin Perform Qual HealthCare 1:9–16Google Scholar
  12. 12.
    Pronovost PJ, Angus DC, Dorman T, et al (2002) Physician staffing patterns and clinical outcomes in critically ill patients: A systematic review. JAMA 288:2151–2162PubMedCrossRefGoogle Scholar
  13. 13.
    Kane RL, Shamliyan T, Mueller C et al. (2007) Nurse staffing and quality of patient care. Evid Rep Technol Assess 151:1–115Google Scholar
  14. 14.
    Stone PW, Mooney-Kane C, Larson EL et al (2007) Nurse working conditions and patient safety outcomes. Med Care 45:571–578PubMedCrossRefGoogle Scholar
  15. 15.
    Stucke S, Menzel NN (2007) Ergonomic assessment of a critical care unit. Crit Care Nurs Clin North Am 19:155–165PubMedCrossRefGoogle Scholar
  16. 16.
    Carlet J (1996) Quality assessment of intensive care units. Curr Opin Crit Care 2:319–325CrossRefGoogle Scholar
  17. 17.
    Kalassian KG, Dremsizov T, Angus DC (2002) Translating research evidence into clinical practice: new challenges for critical care. Crit Care 6:11–14PubMedCrossRefGoogle Scholar
  18. 18.
    Garland A. (2005) Improving the ICU: Part 1. Chest 127:2151–2164PubMedCrossRefGoogle Scholar
  19. 19.
    Ledoux D, Finfer S, McKinley S (2005) Impact of operator expertise on collection of the APACHE II score and on the derived risk of death and standardized mortality ratio. Anaesth Intensive Care 33:585–590PubMedGoogle Scholar
  20. 20.
    SAPS-3. Available at: Accessed February 5, (2006) Chest 128:348sGoogle Scholar
  21. 21.
    Arabi Y, Al Shirawi N, Memish Z, et al. (2003) Assessment of six mortality prediction models in patients admitted with severe sepsis and septic shock to the intensive care unit: a prospective cohort study. Crit Care 7:R116–R122PubMedCrossRefGoogle Scholar
  22. 22.
    Herridge MS (2003) Prognostication and intensive care unit outcome: the evolving role of scoring systems. Clin Chest Med 24:751–762PubMedCrossRefGoogle Scholar
  23. 23.
    Hyzy RC (1995) ICU scoring systems and clinical decision making. Chest 107:1482–1483PubMedCrossRefGoogle Scholar
  24. 24.
    Goldfrad C, Rowan K (2000) Consequences of discharges from intensive care at night. Lancet 355:1138–1142PubMedCrossRefGoogle Scholar
  25. 25.
    Beck DH, Mc Quillan P, Smith GB (2002) Waiting for the break of dawn? The effects of discharge time, discharge TISS scores and discharge facility on hospital mortality after intensive care. Intensive Care Med 28:1287–1293PubMedCrossRefGoogle Scholar
  26. 26.
    Marik PE, Hedman L (2000) What’s in a day? Determining intensive care unit length of stay. Crit Care Med 28:2090–2093PubMedCrossRefGoogle Scholar
  27. 27.
    Daly K, Beale R, Chang RW (2001) Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model. BMJ 322:1274–1276PubMedCrossRefGoogle Scholar
  28. 28.
    Kalb PE, Miller DH. (1989) Utilization strategies for intensive care units. JAMA 261:2389–2395PubMedCrossRefGoogle Scholar
  29. 29.
    Abbott KH, Sago JG, Breen CM et al (2001) Families looking back: one year after discussion of withdrawal or withholding of life-sustaining support. Crit Care Med 29:197–201PubMedCrossRefGoogle Scholar
  30. 30.
    Williams B. (1994) Patient satisfaction: a valid concept? Soc Sci Med 38:509–516PubMedCrossRefGoogle Scholar
  31. 31.
    Avis M, Bond M, Arthur A (1995) Satisfying solutions? A review of some unresolved issues in the measurement of patient satisfaction. J Adv Nurs 22:316–322PubMedCrossRefGoogle Scholar
  32. 32.
    Azoulay E, Pochard F, Chevret S, et al (2001) Meeting the needs of intensive care unit patient families: a multicenter study. Am J Respir Crit Care Med 163:135–139PubMedGoogle Scholar
  33. 33.
    Malacrida, R, Molo Bettelini, C, Degrate, A, et al. (1998) Reasons for dissatisfaction: a survey of relatives of intensive care patients who died. Crit Care Med 26, 1187–1193PubMedCrossRefGoogle Scholar
  34. 34.
    Johnson D, Wilson M, Cabanaugh B et al (1998) Measuring the ability to meet family needs in an intensive care unit. Crit Care Med 26:266–271PubMedCrossRefGoogle Scholar
  35. 35.
    Guyatt GH, Mitchell A, Molloy DW et al (1995) Measuring patient and relative satisfaction with level or aggressiveness of care and involvement in care decisions in the context of life threatening illness. J Clin Epidemiol 48:1215–1224PubMedCrossRefGoogle Scholar
  36. 36.
    Heyland DK, Rocker FM, Dodek PM et al (2002) Family satisfaction with care in the intensive care unit: results of a multiple center study. Crit Care Med 30:1413–1418PubMedCrossRefGoogle Scholar
  37. 37.
    Larson CO, Nelson EC, Gustafson D, et al (1996) The relationship between meeting patients’ information needs and their satisfaction with hospital care and general health status outcome. Int J Qual Health Care 8:447–456PubMedGoogle Scholar
  38. 38.
    Decker PJ, Strader MK (1997) Beyond JCAHA: Using competency models to improve health care organizations. Hospital Topics 75:10–17PubMedCrossRefGoogle Scholar
  39. 39.
    Moullin M (2004). Eight essentials of performance measurement. Int J Health Care Qual Assur Inc Leadersh Health Serv 17:110–112PubMedGoogle Scholar
  40. 40.
    Garland A (2005) Improving the ICU: Part 2. Chest 127:2165–2179PubMedCrossRefGoogle Scholar
  41. 41.
    Motwani J, Sower VE, Brashier LW (1996) Implementing TQM in the health care sector. Health Care Manage Rev 21:73–82PubMedGoogle Scholar
  42. 42.
    ICU Quality Improvement: Professional Resources for Quality Improvement and Quality Corner. Society of Critical Care Medicine (2005) Available at: http://www.sccm.orgGoogle Scholar
  43. 43.
    Docimo AB, Pronovost PJ, Davis RO et al (2000) Using the online and offline change model to improve efficiency for fast-track patients in an emergency department. Jt Comm J Qual Improv 26:503–514PubMedGoogle Scholar
  44. 44.
    Cook DJ, Montori VM, McMullin JP, et al (2004) Improving patients’ safety locally: changing clinician behaviour. Lancet 363:1224–1230PubMedCrossRefGoogle Scholar
  45. 46.
    Pronovost PJ, Weast B, Holzmueller CG et al (2007) Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center. Qual Saf Health Care 12:405–410CrossRefGoogle Scholar
  46. 47.
    Dodek PM, Heyland DK, Rocker GM et al (2004) Translating family satisfaction data into quality improvement. Crit Care Med 32:1922–1927PubMedCrossRefGoogle Scholar
  47. 48.
    Grimshaw JM, Shirran L, Thomas R et al (2001) Changing provider behavior: an overview of systematic reviews of interventions. Med Care 39:112–1145CrossRefGoogle Scholar
  48. 49.
    Cabana MD, Rand CS, Power NR et al (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282:1458–1465PubMedCrossRefGoogle Scholar
  49. 50.
    Thomson O’Brien MA, Oxman AD, Davis DA et al (2000) Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev CD000259Google Scholar
  50. 51.
    Grol R (2001) Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. JAMA 286:2578–2585PubMedCrossRefGoogle Scholar
  51. 52.
    NSW Health Department (2001) The clinician’s toolkit for improving patient care NSW Health Department, SydneyGoogle Scholar
  52. 53.
    Ronald M, Campbell S, Wilkin D (2001) Clinical governance: a convincing strategy for quality improvement? J Manag Med 15(3)188–201CrossRefGoogle Scholar
  53. 54.
    Scally G, Donaldson L (1998) Clinical governance and the drive for quality improvement in the NHS. BMJ 317:61–65PubMedGoogle Scholar
  54. 55.
    Warburton RN (2005) Patients Safety how much is enough? Health policy 71:223–232PubMedCrossRefGoogle Scholar
  55. 56.
    Holcolm BW, Wheeler AP, Ely EW (2001) New ways to improve unnecessary variation and improve outcomes in the intensive care unit. Curr Opin Crit Care 7:304–311CrossRefGoogle Scholar
  56. 57.
    Nelson EC, Batalden PB, Ryer, JC (1998) Clinical Improvement Action Guide. Oakbrook Terrace, Illinois, Joint Commission Google Scholar
  57. 58.
    Berwick DM (1998) Developing and testing changes in delivery of care. Ann Intern Med 128:651–656PubMedGoogle Scholar
  58. 59.
    Angus DC, Black N (2004) Improving care of the critically ill: institutional and healthcare system approaches. The Lancet 303:1314–1320CrossRefGoogle Scholar
  59. 60.
    Reinertsen JL (1998) Physicians as leaders in the improvement of health care systems. Ann Intern Med. 128:833–888PubMedGoogle Scholar
  60. 61.
    Joint Commission (1999). Pocket Guide to Using Performance Improvement Tools Oakbrook Terrace, Illinois, Joint Commission Google Scholar
  61. 62.
    Langley GJ, Nolan KM, Nolan TW et al (1996) The Improvement Guide: a Practical Approach to Enhancing Organizational Performance. San Francisco, Jossey-BassGoogle Scholar
  62. 63.
    Kohn LT, Corrigan JM, Donaldson MS (2000) To err is human: building a safer health system. Washington, DC, National Academy PressGoogle Scholar
  63. 64.
    Starfield B (2000) Is US health really the best in the world? JAMA 284:483–484PubMedCrossRefGoogle Scholar
  64. 65.
    Zhan C, Miller MR (2003) Excess length of stay, charges and mortality attributable to medical injuries during hospitalization. JAMA 290:1868–1874PubMedCrossRefGoogle Scholar
  65. 66.
    Haywood RA, Hofer TP. (2001) Estimating hospital deaths due to medical errors. JAMA 286:415–420CrossRefGoogle Scholar
  66. 67.
    Safe Practices for Better Healthcare: A Consensus Report (2003) Available at: Scholar
  67. 68.
    Sexton JB, Thomas EJ, Helmreich RL (2000) Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 320:745–749PubMedCrossRefGoogle Scholar
  68. 69.
    Miller PA (2001) Nurse-physician collaboration in an intensive care unit. Am J Crit Care 10:341–350PubMedGoogle Scholar
  69. 70.
    Baggs JG, Schmitt MH, Mushlin AI et al (1997) Nurse-physician collaboration and satisfaction with the decision-making process in three critical care units. Am J Crit Care 6:393–399PubMedGoogle Scholar
  70. 71.
    Reader TW, Flin R, Mearns K et al. (2007) Interdisciplinary communication in the intensive care unit. Br J Anaesth 98:347–352PubMedCrossRefGoogle Scholar
  71. 72.
    Ashton CM, Kuykendall DH, Johnson ML et al (1995) The association between the quality of inpatient care and early readmission. Ann Intern Med 122:415–421PubMedGoogle Scholar
  72. 73.
    Schuster MA, McGlynn EA, Brook RH (1998) How good is the quality of health care in the United States? Milbank Q 76:517–563PubMedCrossRefGoogle Scholar
  73. 74.
    McNeil BJ. (2001) Shattuck lecture: hidden barriers to improvement in the quality of care. N Engl J Med 345:1612–1620PubMedCrossRefGoogle Scholar
  74. 75.
    Performance Measurement in Health Care. (2005). Joint Commission on Accreditation of Healthcare Organizations Available at: Scholar
  75. 76.
    VHA Health Foundation (2006) Scholar
  76. 77. Available at: Accessed February 10, 2006Google Scholar
  77. 78.
    The National Quality Forum. Available at: Accessed January 12, 2006Google Scholar
  78. 79.
    The Leapfrog Group. Available at: Accessed January 12, 2006Google Scholar
  79. 80.
    Croley WC, Rothenberg DM (2007) Education of trainees in the intensive care unit. Crit Care Med 35(2 Suppl):S117–121PubMedCrossRefGoogle Scholar
  80. 81.
    Tuttle RP, Cohen MH, Augustine AJ et al (2007) Utilizing simulation technology for competency skills assessment and a comparison of traditional methods of training to simulation-based training. Respir Care 52:263–270PubMedGoogle Scholar
  81. 82.
    Dunn EJ, Mills PD, Neily J et al (2007) Medical team training: applying crew resource management in the Veterans Health Administration. Jt Comm J Qual Patient Saf 33:317–325PubMedGoogle Scholar
  82. 83.
    Rashid M (2007) Developing scales to evaluate staff perception of the effects of the physical environment on patient comfort, patient safety, patient privacy, family integration with patient care, and staff working conditions in adult intensive care units: a pilot study. Crit Care Nurs Q 30:271–283PubMedGoogle Scholar
  83. 84.
    The interface between clinical audit and management A report of working group set up by clinical resource and audit group. The Scottish Office 1993: p9Google Scholar
  84. 85.
    Principles for Best Practice in Clinical Audit. London: NICE (2002) Scholar
  85. 86.
    Lack JA, White LA, Thoms GM, Rollin AM (eds) (2000) Raising the standard: a compendium of audit recipes for continuous quality improvement in anaesthesia. London, Royal College of AnaesthetistsGoogle Scholar
  86. 87.
    The NHS Clinical Governance Support Team. Practical Clinical Audit Handbook (2005) it/]Google Scholar
  87. 88.
    Wakabayashi H, Sano T, Yachida S, Okano K, Izuishi K, Suzuki Y. (2007) Validation of risk assessment scoring systems for an audit of elective surgery for gastrointestinal cancer in elderly patients. Int J Surg 5:323–327PubMedCrossRefGoogle Scholar
  88. 89.
    Thomson O’Brien MA, Oxman AD, Davis DA et al (2000) Audit and feedback: effects on professional practice and health care outcomes (Cochrane review). In: The Cochrane Library, Issue 4, Oxford: Update SoftwareGoogle Scholar
  89. 90.
    Thomson O’Brien MA, Oxman AD, Davis DA et al. (2000) Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes (Cochrane review). In: The Cochrane Library, Issue 4. Oxford: Update Software.Google Scholar
  90. 91.
    Ursprung R, Gray JE, Edwards VH et al (2005) Real time patient safety audits: improving safety every day. Qual Saf Health Care 14:284–289PubMedCrossRefGoogle Scholar
  91. 92.
    Sinuff T, Cook D, Giacomini M et al (2007) Facilitating clinician adherence to guidelines in the intensive care unit: a multicenter, qualitative study. Crit Care Med 35:2083–2089PubMedCrossRefGoogle Scholar
  92. 93.
    Simpson P, Harmer M (2005) Audit using both the good and the bad news to improve patient care. BJA 95:121–123PubMedCrossRefGoogle Scholar
  93. 94.
    Gullo A (2006) Postoperative monitoring: principles, organization and quality of care. Definition of risk, evidence-based medicine, audit and quality of care. Minerva Anestesiol 72:171–181PubMedGoogle Scholar
  94. 95.
    Standl T (2007) Abdominal compartment syndrome: a still underestimated problem? Anasthesiol Intensivmed Notfallmed Schmerzther 42:500–503PubMedCrossRefGoogle Scholar
  95. 96.
    Ball AP, Bartlett JG, Graig WA et al (2004) Future trends in antimicrobial chemotherapy: expert opinion on the 43rd ICAAC. J Chemiother 16:419–436Google Scholar
  96. 97.
    Bax RP, Mullan N (1999) Response of the pharmaceutical industry to antimicrobial resistance. Balliere Clin Infect Dis 5:289–304Google Scholar
  97. 98.
    Coates ARM, Hu Y (2007) Novel approaches for developing new antibiotics for bacterial infections. Br J Pharmacol [Epub ahead of print]Google Scholar
  98. 99.
    Taylor MJ, Scuffham PA, McCollam PL, Newby DE (2007) Acute coronary syndromes in Europe: 1-year costs and outcomes. Curr Med Res Opin 23:495–503PubMedCrossRefGoogle Scholar
  99. 100.
    Collet JP, Montalescot G (2007) Management coronary syndrome in the acute phase. Ann Cardiol Angeiol (Paris). 56Suppl 1:S21–28CrossRefGoogle Scholar
  100. 101.
    Ferrières J, Cambou J (2007) Epidemiology of acute coronary syndrome in France. Ann Cardiol Angeiol (Paris). 56Suppl 1:S8–S15CrossRefGoogle Scholar
  101. 102.
    Alexander KP, Newby LK, Armstrong PW et al (2007) Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. American Heart Association Council on Clinical Cardiology; Society of Geriatric Cardiology. Circulation 115:2570–2589PubMedCrossRefGoogle Scholar
  102. 103.
    Van Horn SE Jr, Maniu CV. (2007). Management of non-ST-segment elevation myocardial infarction. Med Clin North Am 91:683–700PubMedCrossRefGoogle Scholar
  103. 104.
    Spinler SA (2007) Managing acute coronary syndrome: evidence-based approaches. Am J Health Syst Pharm 1:64 (Suppl 7):S14–24CrossRefGoogle Scholar
  104. 105.
    Kapoor JR (2007) Nesiritide in acute decompensated heart failure: to use or not to use, that is the question? Am J Cardiol 15:100:745–746CrossRefGoogle Scholar
  105. 106.
    Dunn A, Sachak S (2007) Nesiritide and renal function after cardiac surgery. Am J Health Syst Pharm 1:64:1582–1584CrossRefGoogle Scholar
  106. 107.
    Zemljic G, Bunc M, Yazdanbakhsh AP, Vrtovec B (2007) Levosimendan improves renal function in patients with advanced chronic heart failure awaiting cardiac transplantation. J Card Fail 13:417–421PubMedCrossRefGoogle Scholar
  107. 108.
    Iakobishvili Z, Hasdai D (2007) Cardiogenic shock treatment. Med Clin North Am (2007) 91:713–727PubMedCrossRefGoogle Scholar
  108. 109.
    Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. (2007) Guideline for mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease. Society of Critical Care Medicine, Chinese Medical Association 19:513–518Google Scholar
  109. 110.
    Harrison AM, Cox AC, Davis S et al. (2002) Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors. Pediatr Crit Care Med. 3(2):148–152PubMedCrossRefGoogle Scholar
  110. 111.
    Caroleo S, Agnello F, Abdallah K et al (2007) Weaning from mechanical ventilation: an open issue. Minerva Anestesiol 73:417–427PubMedGoogle Scholar
  111. 112.
    Matić I, Danić D, Majerić-Kogler V et al (2007) Chronic obstructive pulmonary disease and weaning of difficult-to-wean patients from mechanical ventilation: randomized prospective study. Croat Med J 2007 48:51–58PubMedGoogle Scholar
  112. 113.
    Wolthuis EK, Veelo DP, Choi G et al (2007) Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives. Crit Care 11:R77PubMedCrossRefGoogle Scholar
  113. 114.
    Petrucci N, Iacovelli W (2007) Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev (3):CD003844Google Scholar
  114. 115.
    Tobin MJ (2001) Advances in mechanical ventilation. N Engl J Med 344:1986–1996PubMedCrossRefGoogle Scholar
  115. 116.
    The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volume compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308Google Scholar
  116. 117.
    Malhotra A (2007) Low tidal volume ventilation in the acute respiratory distress Syndrome. N Engl J Med 357:1113–1120PubMedCrossRefGoogle Scholar
  117. 118.
    Olasveengen TM, Wik L, Kramer-Johansen J et al (2007) Is CPR quality improving? A retrospective study of out-of-hospital cardiac arrest. Resuscitation [Epub ahead of print]Google Scholar
  118. 119.
    Kramer-Johansen J, Myklebust H, Wik L, (2006) Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. Resuscitation. 71:283–292PubMedCrossRefGoogle Scholar
  119. 120.
    Sahuquillo J, Vilalta A (2007) Cooling the injured brain: how does moderate hypothermia influence the pathophysiology of traumatic brain injury. Curr Pharm Des 13:2310–2322PubMedCrossRefGoogle Scholar
  120. 121.
    Kaneko T, Maekawa T (2007) Clinical application of brain hypothermia therapy for acute brain insults. Masui 56:280–284PubMedGoogle Scholar
  121. 122.
    Fukuda S, Warner DS (2007) Cerebral protection. Br J Anaesth 99:10–17PubMedCrossRefGoogle Scholar
  122. 123.
    Borgel D, Bornstain C, Reitsma PH et al (2007) Comparative study of the protein C pathway in septic and non-septic patients with organ failure. Am J Respir Crit Care Med [Epub ahead of print]Google Scholar
  123. 124.
    Kuang D, Verbine A, Ronco C (2007) Pharmacokinetics and antimicrobial dosing adjustment in critically ill patients during continuous renal replacement therapy. Clin Nephrol 67:267–284PubMedGoogle Scholar
  124. 125.
    Van den Berghe G, Wilmer A, Hermans G et al (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354:5:449–461PubMedCrossRefGoogle Scholar
  125. 126.
    McCowen KC, Malhotra A, Bistrian BR (2001) Endocrine and metabolic dysfunction syndromes in the critically ill. Crit Care Clin 17:107–124PubMedCrossRefGoogle Scholar
  126. 127.
    Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367PubMedCrossRefGoogle Scholar
  127. 128.
    Vanhorebeek I, Langouche L, Van den Berghe G (2006) Glycemic and nonglycemic effects of insulin: how do they contribute to a better outcome of critical illness? Curr Opin Crit Care 11:304–311CrossRefGoogle Scholar
  128. 129.
    Van den Berghe G, Wouters PJ, Bouilllon R et al (2003) Outcome benefit of intensive insulin therapy in critically ill: insulin dose versus glycemic control. Crit Care Med 31:359–366PubMedCrossRefGoogle Scholar
  129. 130.
    Langouche L, Van den Berghe G (2006) Glucose metabolism and insulin therapy. Crit Care Clin 22:119–129PubMedCrossRefGoogle Scholar
  130. 131.
    Malhotra A (2006) Intensive insulin in intensive care. N Engl J Med 354:16–17CrossRefGoogle Scholar
  131. 132.
    Angus DC, Abraham E (2005) Intensive insulin therapy in critical illness (Editorial). Am J Resp Crit Care Med 172:1358–1359PubMedCrossRefGoogle Scholar
  132. 133.
    Langouche L, Vander Perre S, Wouters PJ et al (2007) Effect of intensive insulin therapy on insulin sensitivity in the critically ill. J Clin Endocrinol Metab 92:3890–3897PubMedCrossRefGoogle Scholar
  133. 134.
    Lemiengre J, de Casterle BD, Van Craen K et al (2007) Institutional ethics policies on medical end-of-life decisions: a literature review. Health Policy 83:131–143PubMedCrossRefGoogle Scholar
  134. 135.
    Virnig B (2007) Institutional care at the end of life. Med Care 45:916–917PubMedCrossRefGoogle Scholar
  135. 136.
    Bellini C, Petignat C, Francioli P et al (2007) Comparison of automated strategies for surveillance of nosocomial bacteremia. Infect Control Hosp Epidemiol 28:1030–1035PubMedCrossRefGoogle Scholar
  136. 137.
    Gastmeier P (2007) Evidence-based infection control in the ICU (except catheters). Curr Opin Crit Care 13:557–562PubMedCrossRefGoogle Scholar
  137. 138.
    Etchells E, Sharpe G, Walsh P et al (1996) Bioethics for clinicians: 1. Consent. CMAJ 155:177–180PubMedGoogle Scholar
  138. 139.
    Levine RJ (1991) Informed consent: some challenges to universal validity of the Western model. Law Med Health Care 19:207–213PubMedGoogle Scholar
  139. 140.
    Blackhall LJ, Murph ST, Frank G et al (1995) Ethnicity and attitudes toward patient autonomy. JAMA 274:820–825PubMedCrossRefGoogle Scholar
  140. 141.
    Azoulay E, Chevret S, Leleu G et al (2000) Half of the family of intensive care unit patients experience inadequate communications with physicians. Crit Care Med 28:3044–3049PubMedCrossRefGoogle Scholar
  141. 142.
    Ely EW, Margolin R, Francis J et al (2001) Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 29:1370–1379PubMedCrossRefGoogle Scholar
  142. 143.
    Dyson M (1999) Intensive care unit psychosis, the therapeutic nursing-patients relationship and the influence of the intensive care setting: analyses of interrelating factors. JAMA 286:2703–2710Google Scholar
  143. 144.
    Sulmasy DP, Haller K, Terry PB (1994) More talk, less paper: predicting the accuracy of substituted judgments. Am J Med 96:432–438PubMedCrossRefGoogle Scholar
  144. 145.
    Davis N, Pohlman A, Gehalback B et al (2003) Improving the process of informed consent in the critically ill. JAMA 289:1963–1968PubMedCrossRefGoogle Scholar
  145. 146.
    Clark PA (2007) Intensive care patients’ evaluations of the informed consent process. Dimens Crit Care Nurs 26:207–226PubMedCrossRefGoogle Scholar
  146. 147.
    Salzman JG, Frascone RJ, Godding BK (2007) Implementing emergency research requiring exception from informed consent, community consultation, and public disclosure. Ann Emerg Med 50:448–455, 455.e1-4PubMedCrossRefGoogle Scholar
  147. 148.
    Sakka SG (2007) Assessing liver function. Curr Opin Crit Care 13:207–214PubMedCrossRefGoogle Scholar
  148. 149.
    Stadibauer V, Jalan R. Liver Failure Group (2007) Acute liver failure: liver support therapies. Curr Opin Crit Care 13:215–221CrossRefGoogle Scholar
  149. 150.
    O’Grady J (2007) Modern management of acute liver failure. Clin Liver Dis 11:291–303PubMedCrossRefGoogle Scholar
  150. 151.
    Powell-Tuck J (2007) Nutritional interventions in critical illness. Proc Nutr Soc 66:16–24PubMedCrossRefGoogle Scholar
  151. 152.
    Jefic D, Lee JW, Jefic D et al (2005) Utility of â-natriuretic peptide and N-terminal pro β-type natriuretic peptide in evaluation of respiratory failure in critically ill patients. Chest 128:288–295PubMedCrossRefGoogle Scholar
  152. 153.
    Povoa P, Coelho, Almeida E et al (2005) C-reactive protein as of infection in critically ill patient. Clin Microbiol Infect 11:101–108PubMedCrossRefGoogle Scholar
  153. 154.
    Povoa P, Coelho, Almeida E et al (2005) C-reactive protein as a marker of ventilâtor-associated pneumonia resolution: a pilot study. Eur Resp J 25:804–812CrossRefGoogle Scholar
  154. 155.
    Luyt CE, Guerin V, Combes A et al (2005) Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 171:48–53PubMedCrossRefGoogle Scholar
  155. 156.
    Miller B (2005) Procalcitonin and ventilator associated pneumonia: yet another breath of fresh air. Am J Respr Crit Care Med 171:2–3CrossRefGoogle Scholar
  156. 157.
    Ye SQ, Simon BA, Maloney JP et al (2005) Pre-B-cell colony-enhancing factor as a potential novel biomarker in acute lung injury. Am J Respir Crit Care Med 171:361–370PubMedCrossRefGoogle Scholar
  157. 158.
    Mishra J, Dent C, Tarabishi R et al (2005) Neutrophil gelatinase-asociated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 365:1231–1238PubMedCrossRefGoogle Scholar
  158. 159.
    Ngiam N, Post M, Kavanagh BP (2007) Early growth response factor-1 (EGR1) in acute lung injury. Am J Physiol Lung Cell Mol Physiol [Epub ahead of print]Google Scholar
  159. 160.
    Hall MW, Gavrilin MA, Knatz NL et al (2007) Monocyte mRNA phenotype and adverse outcomes from pediatric multiple organ dysfunction syndrome. Pediatr Res [Epub ahead of print]Google Scholar
  160. 161.
    Rincon F, Mayer SA (2007) Neurocritical care: a distinct discipline? Curr Opin Crit Care 13:115–121PubMedCrossRefGoogle Scholar
  161. 162.
    Wright WL (2007) Multimodal monitoring in the ICU: when could it be useful? J Neurol Sci 261:10–15PubMedCrossRefGoogle Scholar
  162. 163.
    Eid NH (2003) Human resources management nursing workload management system. Scholar
  163. 164.
    Gonçalves LA, Padilha KG, Cardoso Sousa RM (2007) Nursing activities score (NAS): a proposal for practical application in intensive care units. Intensive Crit Care Nurs [Epub ahead of print]Google Scholar
  164. 165.
    Bouhemad B, Zhang M, Lu Q, Rouby JJ (2007) Clinical review: bedside lung ultrasound in critical care practice. Crit Care 11:205PubMedCrossRefGoogle Scholar
  165. 166.
    Breitkreutz R, Walcher F, Seeger FH (2007) Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm. Crit Care Med 35(Suppl):S150–161PubMedCrossRefGoogle Scholar
  166. 167.
    Mathis G (2006) Ultrasound in pulmonary embolism: killing three birds with one stone. Pneumologie. 60:600–606PubMedCrossRefGoogle Scholar
  167. 168.
    Wang HP, Chen SC (2007) Upper abdominal ultrasound in the critically ill. Crit Care Med 35(Suppl):S208–215PubMedCrossRefGoogle Scholar
  168. 169.
    Murray CJ, Lopez A. (1996) The global burden of disease: comprehensive assessment of mortality and disability from diseases, Injuries and risk factors in 1990 and projected to 2020. Cambridge Harvard University pressGoogle Scholar
  169. 170.
    National Academy of Sciences/National Research Council, Division of Medical Sciences (1996) Accidental death and disability: the neglected disease of modern society. Washington DC, NAS/NRCGoogle Scholar
  170. 171.
    Erlam R (1993) Trauma Centres. British J Surg 80:1227–1228CrossRefGoogle Scholar
  171. 172.
    American College of Surgeons Committee on Trauma (1983) Hospital and pre-hospital resources for optimal care of the injured patients. Bull Am Coll Surg 68:11–18Google Scholar
  172. 173.
    National Research Council. (1987) Confronting natural disasters: an international decade for natural disaster reduction. Washington DC, Academy pressGoogle Scholar
  173. 174.
    Office of US Foreign Disaster Assistance (1994) Disaster history: significant data and major disease worldwide, 1990. Present. Washington DC, Agency for International DevelopmentGoogle Scholar
  174. 175.
    Nathens AB, Brunet FP, Maier RV (2004) Development of trauma systems and effect on outcomes after injury. Lancet 363:1794–1801PubMedCrossRefGoogle Scholar
  175. 176.
    Rusnak M, Janciak I, Majdan M. Austrian Severe TBI Study Investigators (2007) Severe traumatic brain injury in Austria VI: effects of guideline-based management. INRO (International Neurotrauma Research Organisation), Vienna, Austria Wien Klin Wochenschr. 119:64–71Google Scholar
  176. 177.
    Lescot T, Abdennour L, Degos V (2007) Management of severe traumatic brain injury. Presse Med 36:1117–1126PubMedCrossRefGoogle Scholar
  177. 178.
    Graat ME, Choi G, Wolthuis EK et al (2006) The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low. Crit Care 10:R11PubMedCrossRefGoogle Scholar
  178. 179.
    Graat ME, Stoker J, Vroom MB, Schultz MJ (2005) Can we abandon daily routine chest radiography in intensive care patients? J Intensive Care Med 20:238–246PubMedCrossRefGoogle Scholar
  179. 180.
    Graat ME, Hendrikse KA, Spronk PE (2006) Chest radiography practice in critically ill patients: a postal survey in the Netherlands. BMC Med Imaging 6:8PubMedCrossRefGoogle Scholar
  180. 181.
    Müller-Forell W, Engelhard K (2007) Neuroimaging for the anesthesiologist. Anesthesiol Clin 25:413–439PubMedCrossRefGoogle Scholar
  181. 182.
    Jones DA, McIntyre T, Baldwin I (2007) The medical emergency team and end-of-life care: a pilot study. Crit Care Resusc 9:151–156PubMedGoogle Scholar
  182. 183.
    Dasta JF, Fuhrman TM, McCandles C (1995) Use of sedative and analgesics in a surgical intensive care unit. A follow-up and commentary. Heart Lung 2476–2478Google Scholar
  183. 184.
    Bair N, Bobek MB, Hoffman-Hogg L et al (2000) Introduction of sedative, analgesic, and neuromuscular blocking agent guidelines in a medical intensive care unit: physician and nurse adherence. Crit Care Med 28:707–713PubMedCrossRefGoogle Scholar
  184. 185.
    Berger JT, Rosner F (1996) The ethics of practice guidelines. Arch Intern Med 156:2051–2056PubMedCrossRefGoogle Scholar
  185. 186.
    Payen JF, Chanques G, Mantz J (2007) Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 106:687–695PubMedCrossRefGoogle Scholar
  186. 187.
    Park G, Lane M, Rogers S, Bassett P (2007) A comparison of hypnotic and analgesic based sedation in a general intensive care unit. Br J Anaesth 98:76–82PubMedCrossRefGoogle Scholar
  187. 188.
    Nguyen HB, Smith D (2007) Sepsis in the 21st century: recent definitions and therapeutic advances. Am J Emerg Med 25:564–571PubMedCrossRefGoogle Scholar
  188. 189.
    Cinel I, Dellinger RP (2007) Advances in pathogenesis and management of sepsis. Curr Opin Infect Dis 20:345–352PubMedCrossRefGoogle Scholar
  189. 190.
    Huang DT, Clermont G, Dremsizov TT, Angus DC (2007) Implementation of early goal-directed therapy for severe sepsis and septic shock: a decision analysis. Crit Care Med 35:2090–2100PubMedCrossRefGoogle Scholar
  190. 191.
    Rivers EP, Kruse JA, Jacobsen G et al (2007) The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock. Crit Care Med 35:2016–2024PubMedCrossRefGoogle Scholar
  191. 192.
    Nguyen HB, Corbett SW, Steele R (2007) Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med 35:1105–1112PubMedCrossRefGoogle Scholar
  192. 193.
    Berenholtz SM, Pronovost PJ, Ngo K ett al (2007) Core Sepsis Measurement Team. Developing quality measures for sepsis care in the ICU. Jt Comm J Qual Patient Saf 33:559–568PubMedGoogle Scholar
  193. 194.
    Marik PE (2007) Steroids and adrenal insufficiency. Mechanisms and clinical consequences of critical illness associated adrenal insufficiency. Curr Opin Crit Care 13:363–369PubMedCrossRefGoogle Scholar
  194. 195.
    Oppert M, Schindler R, Husung C et al (2005) Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock. Crit Care Med 33:2457–2464PubMedCrossRefGoogle Scholar
  195. 196.
    Siraux U, De Backer D, Yalavatti D et al (2005) Relative adrenal insufficiency in patients with septic shock, comparison of low-dose and conventional corticotropin test. Crit Care Med 33:2479–2486PubMedCrossRefGoogle Scholar
  196. 197.
    Wiener J, Itokazu G, Nathan C et al (1995) A randomized, double-blind, placebo-controlled trial of selective digestive decontamination in a medical intensive care unit. Clin Infect Dis 20:861–867PubMedGoogle Scholar
  197. 198.
    Sanchez M, Mir N, Canton R et al (1997) The effect of topical vancomycin on acquisition, carriage and infection with methicillin-resistant Staphylococcus aureus in critically ill patients. A double-blind, randomised placebo controlled study. 37th ICAAC, Toronto, Canada. Abstract J-119:310Google Scholar
  198. 199.
    Liberati A, D’Amico R, Pifferi S et al (2004) Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane review. In: The Cochrane library, Issue I. John Wiley and Sons, Chichester, UKGoogle Scholar
  199. 200.
    de Jonge E, Schultz M, Spanjaard L et al (2003) Effects of selective decontamination of the digestive tract: a randomised, placebo controlled, double blind trial. Med Intens 26:52Google Scholar
  200. 201.
    Baines P, van Saene H (2004) Selective decontamination of the digestive tract and prevention of ventilator associated pneumonia. Ann Intern Med 141:577–578PubMedGoogle Scholar
  201. 202.
    Brun-Buisson C, Legrand P, Rauss A et al (1989) Intestinal decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients. Arch Surg 127:163–169Google Scholar
  202. 203.
    Arnow P, Caradang GC, Zabner R, Irvin ME (1996) Randomized controlled trial of selective digestive decontamination for prevention of infections following liver transplantation. Clin Infect Dis 22:997–1003PubMedGoogle Scholar
  203. 204.
    Stoutenbeek CP, van Saene HKF, Zandstra DF (1987) The effect of oral non-absorbable antibiotics on the emergence of resistant bacteria in patients in an intensive care unit. J Antimicrob Chemother 19:513–520PubMedCrossRefGoogle Scholar
  204. 205.
    Silvestri L, Milanese M, Oblach L et al (2002) Enteral vancomycin to control methicillin-resistant Staphylococcus aureus outbreak in mechanically ventilated patients. Am J Infect Control 30:391–399PubMedCrossRefGoogle Scholar
  205. 206.
    Stoutenbeek CP, Van Saene HK, Miranda DR, Zandstra DF (1983) A new technique of infection prevention in the intensive care unit by selective decontamination of the digestive tract. Acta Anaesthesiol Belg 34:209–221PubMedGoogle Scholar
  206. 207.
    Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF (1984) The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 10:185–192PubMedCrossRefGoogle Scholar
  207. 208.
    Silvestri L, van Saene HK, Sarginson RE, Gullo A (2007) Selective decontamination of the digestive tract and ventilator-associated pneumonia: we cannot let misinformation go uncorrected. J Intensive Care Med 22:181–182PubMedCrossRefGoogle Scholar
  208. 209.
    Silvestri L, van Saene HK, Gullo A, de la Cal MA (2007) Guidelines for prevention, diagnosis, and treatment of ventilator-associated pneumonia (VAP) in the trauma patient. J Trauma 62:1062–1064PubMedGoogle Scholar
  209. 210.
    Silvestri L, van Saene HK, Milanese M et al (2007) Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized controlled trials. J Hosp Infect 65:187–203PubMedCrossRefGoogle Scholar
  210. 211.
    Taylor N, van Saene HK, Abella A et al (2007) Selective digestive decontamination. Why don’t we apply the evidence in the clinical practice? Med Intensiva 31:136–145PubMedGoogle Scholar
  211. 212.
    Bryan-Brown CW, Dracup K (2003) More. Am J Crit Care 12:185–187PubMedGoogle Scholar
  212. 213.
    Batalden PB, Davidoff F (2007) What is quality improvement and how can it transform health care? Qual Saf Health Care 16:2–3PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • P. Murabito
    • 1
  • F. Rubulotta
    • 1
  • A. Gullo
    • 1
  1. 1.Department of Anaesthesia and Intensive Care“Policlinico” University HospitalCataniaItaly

Personalised recommendations