Observational Study

. 2015 Oct;43(10):2076-84.

doi: 10.1097/CCM.0000000000001157.

Protocols and Hospital Mortality in Critically Ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

Collaborators, Affiliations

Collaborators

United States Critical Illness and Injury Trials Group-Critical Illness Outcomes Study Investigators:
Terence O'Keeffe, Coy Collins, Janice Liebler, Ali Ahoui, Anahita Nersiseyan, Usman Shah, Hidenobu Shigemitsu, Nanditha Thaiyananthan, Joe Hsu, Lawrence Ho, Juliana Barr, David Kaufman, Jonathan M Siner, Mark D Siegel, Greg S Martin, Craig Coopersmith, Micah Fisher, David Gutteridge, Mona Brown, Sang Lee, Apryl Smith, Greg S Martin, Kenneth Leeper, Mona Brown, Greg S Martin, Sushma Cribbs, Annette Esper, Mona Brown, David Gutteridge, Olufunmilayo Dosunmu, Zubair Hassan, Jing Liu, Bart Ridder, Melanie Atkinson, Aimee Draftz, Jackie Durgin, Yelena Rikhman, Jessica Scheckel, Mary Walthers, Gerald Luger, Carol Downer, Ruxana T Sadikot, Kamran Javaid, Daniel Rodgers, Vibhu Sharma, Jon Sevransky, William Checkley, Romer Geocadin, David J Murphy, Dale Needham, Adam Sapirstein, Steven Schwartz, Glenn Whitman, Brad Winters, Addisu Workneh, Sammy Zakaria, Anthony Martinez, Fran Keith, Steven Johnson, Dan Herr, Giora Netzer, Carl Shanholtz, Arabela Sampaio, Jennifer Titus, Michael Eberlein, Leo Rotello, Jennifer Anderson, Sajid Shahul, Valerie Banner-Goodspeed, Michael Howell, Sabina Hunziker, Victoria Nielsen, Jennifer Stevens, Daniel Talmor, Namrata Patil, Lisa Chin, Michael Myers, Stanthia Ryan, Joseph Bander, Pauline K Park, James M Blum, Vivek Arora, Kristin Brierley, Jessica DeVito, Julie Harris, Elizabeth Jewell, Deborah Rohner, Kathleen B To, Sharon Dickinson, Brian W Pickering, Jyothsna Giru, Rahul Kashyap, Naman Trivedi, Timothy Dwyer, Kyle Brownback, Steven Chang, Zaza Cohen, Frank Italiano, Zeeshan Kahn, Amee Patrawalla, Denise Gonzales, Paul Campbell, David Chong, Matthew Baldwin, Luke Benvenuto, Natalie Yip, Steven M Pastores, Anthony Pietropaoli, Kathleen Falkner, Timothy Bouck, Ann Marie Mattingly, Peter E Morris, Lori S Flores, Abid Butt, Mark Mazer, Kelly Jernigan, Patrick Wright, Sarah Groce, Jeanette McLean, Arshena Overton, Jorge A Guzman, Mohammed Abou El Fadl, Tonya Frederick, Gustavo Cumbo-Nacheli, John Komara, James M O'Brien, Naeem Ali, Matthew Exline, Jeffrey Hoag, Daniela Albu, Pat McLaughlin, Jeffrey Hoag, Emil Abramian, John Zeibeq, Meeta Prasad, Scott Zuick, Richard D Fremont, Chinenye O Emuwa, Victor C Nwazue, Olufemi S Owolabi, Bryan Cotton, George Hart, Judy Jenkins, Todd W Rice, Timothy D Girard, Margaret Hays, Susan Mogan, Imo P Aisiku, Samuel Brown, Colin Grissom, Russ Miller 3rd, Anita Austin, Heather Gallo, Naresh Kumar, Maryann Putman, Joanne Ondrush

Affiliation

¹ 1Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, GA. 2Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD. 3Department of Anesthesia, Mayo Clinic, Rochester, MN. 4Department of Anesthesiology, Stanford University, Palo Alto, CA. 5Division of Pulmonary and Critical Care, Intermountain Medical Center and University of Utah, Salt Lake City, UT. 6Division of Pulmonary and Critical Care, UCLA, Los Angeles, CA. 7Division of Pulmonary and Critical Care Medicine, Columbia University Medical Center, New York, NY. 8Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT. 9Division of Pulmonary and Critical Care, Meharry Medical College, Nashville, TN. 10Division of Allergy, Pulmonary, and Critical Care Medicine and Center for Health Services Research at the, Vanderbilt University School of Medicine, Nashville, TN. 11Division of Pulmonary and Critical Care, Drexel University, Philadelphia, PA. 12Department of Surgical Critical Care, University of Maryland, Baltimore, MD. 13Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, PA. 14Division of Pulmonary Critical Care and Sleep Medicine, University of Southern California, Los Angeles, CA. 15Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio State University, Columbus, OH. 16Department of Surgery, University of Arizona, Tucson, AZ. 17Division of Acute Care Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI. 18Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY. 19Department of Surgery, Division of Thoracic Surgery, Division of Trauma, Burn & Critical Care, Brigham and Women's Hospital, Boston, MA. 20Division of Pulmonary and Critical Care Medicine, University of Rochester, Rochester, NY. 21INOVA Fairfax Hospital, Falls Church, VA. 22Suburban Hospital, Bethesda, MD. 23Department of A

PMID: 26110488
PMCID: PMC5673100
DOI: 10.1097/CCM.0000000000001157

Observational Study

Protocols and Hospital Mortality in Critically Ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

Jonathan E Sevransky et al. Crit Care Med. 2015 Oct.

. 2015 Oct;43(10):2076-84.

doi: 10.1097/CCM.0000000000001157.

Collaborators

United States Critical Illness and Injury Trials Group-Critical Illness Outcomes Study Investigators:
Terence O'Keeffe, Coy Collins, Janice Liebler, Ali Ahoui, Anahita Nersiseyan, Usman Shah, Hidenobu Shigemitsu, Nanditha Thaiyananthan, Joe Hsu, Lawrence Ho, Juliana Barr, David Kaufman, Jonathan M Siner, Mark D Siegel, Greg S Martin, Craig Coopersmith, Micah Fisher, David Gutteridge, Mona Brown, Sang Lee, Apryl Smith, Greg S Martin, Kenneth Leeper, Mona Brown, Greg S Martin, Sushma Cribbs, Annette Esper, Mona Brown, David Gutteridge, Olufunmilayo Dosunmu, Zubair Hassan, Jing Liu, Bart Ridder, Melanie Atkinson, Aimee Draftz, Jackie Durgin, Yelena Rikhman, Jessica Scheckel, Mary Walthers, Gerald Luger, Carol Downer, Ruxana T Sadikot, Kamran Javaid, Daniel Rodgers, Vibhu Sharma, Jon Sevransky, William Checkley, Romer Geocadin, David J Murphy, Dale Needham, Adam Sapirstein, Steven Schwartz, Glenn Whitman, Brad Winters, Addisu Workneh, Sammy Zakaria, Anthony Martinez, Fran Keith, Steven Johnson, Dan Herr, Giora Netzer, Carl Shanholtz, Arabela Sampaio, Jennifer Titus, Michael Eberlein, Leo Rotello, Jennifer Anderson, Sajid Shahul, Valerie Banner-Goodspeed, Michael Howell, Sabina Hunziker, Victoria Nielsen, Jennifer Stevens, Daniel Talmor, Namrata Patil, Lisa Chin, Michael Myers, Stanthia Ryan, Joseph Bander, Pauline K Park, James M Blum, Vivek Arora, Kristin Brierley, Jessica DeVito, Julie Harris, Elizabeth Jewell, Deborah Rohner, Kathleen B To, Sharon Dickinson, Brian W Pickering, Jyothsna Giru, Rahul Kashyap, Naman Trivedi, Timothy Dwyer, Kyle Brownback, Steven Chang, Zaza Cohen, Frank Italiano, Zeeshan Kahn, Amee Patrawalla, Denise Gonzales, Paul Campbell, David Chong, Matthew Baldwin, Luke Benvenuto, Natalie Yip, Steven M Pastores, Anthony Pietropaoli, Kathleen Falkner, Timothy Bouck, Ann Marie Mattingly, Peter E Morris, Lori S Flores, Abid Butt, Mark Mazer, Kelly Jernigan, Patrick Wright, Sarah Groce, Jeanette McLean, Arshena Overton, Jorge A Guzman, Mohammed Abou El Fadl, Tonya Frederick, Gustavo Cumbo-Nacheli, John Komara, James M O'Brien, Naeem Ali, Matthew Exline, Jeffrey Hoag, Daniela Albu, Pat McLaughlin, Jeffrey Hoag, Emil Abramian, John Zeibeq, Meeta Prasad, Scott Zuick, Richard D Fremont, Chinenye O Emuwa, Victor C Nwazue, Olufemi S Owolabi, Bryan Cotton, George Hart, Judy Jenkins, Todd W Rice, Timothy D Girard, Margaret Hays, Susan Mogan, Imo P Aisiku, Samuel Brown, Colin Grissom, Russ Miller 3rd, Anita Austin, Heather Gallo, Naresh Kumar, Maryann Putman, Joanne Ondrush

Affiliation

¹ 1Division of Pulmonary, Allergy and Critical Care, Emory University, Atlanta, GA. 2Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD. 3Department of Anesthesia, Mayo Clinic, Rochester, MN. 4Department of Anesthesiology, Stanford University, Palo Alto, CA. 5Division of Pulmonary and Critical Care, Intermountain Medical Center and University of Utah, Salt Lake City, UT. 6Division of Pulmonary and Critical Care, UCLA, Los Angeles, CA. 7Division of Pulmonary and Critical Care Medicine, Columbia University Medical Center, New York, NY. 8Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT. 9Division of Pulmonary and Critical Care, Meharry Medical College, Nashville, TN. 10Division of Allergy, Pulmonary, and Critical Care Medicine and Center for Health Services Research at the, Vanderbilt University School of Medicine, Nashville, TN. 11Division of Pulmonary and Critical Care, Drexel University, Philadelphia, PA. 12Department of Surgical Critical Care, University of Maryland, Baltimore, MD. 13Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, PA. 14Division of Pulmonary Critical Care and Sleep Medicine, University of Southern California, Los Angeles, CA. 15Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio State University, Columbus, OH. 16Department of Surgery, University of Arizona, Tucson, AZ. 17Division of Acute Care Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI. 18Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY. 19Department of Surgery, Division of Thoracic Surgery, Division of Trauma, Burn & Critical Care, Brigham and Women's Hospital, Boston, MA. 20Division of Pulmonary and Critical Care Medicine, University of Rochester, Rochester, NY. 21INOVA Fairfax Hospital, Falls Church, VA. 22Suburban Hospital, Bethesda, MD. 23Department of A

PMID: 26110488
PMCID: PMC5673100
DOI: 10.1097/CCM.0000000000001157

Abstract

Objective: Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized ICUs have superior patient outcomes compared with less highly protocolized ICUs.

Design: Observational study in which participating ICUs completed a general assessment and enrolled new patients 1 day each week.

Patients: A total of 6,179 critically ill patients.

Setting: Fifty-nine ICUs in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study.

Interventions: None.

Measurements and main results: The primary exposure was the number of ICU protocols; the primary outcome was hospital mortality. A total of 5,809 participants were followed prospectively, and 5,454 patients in 57 ICUs had complete outcome data. The median number of protocols per ICU was 19 (interquartile range, 15-21.5). In single-variable analyses, there were no differences in ICU and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in ICUs with a high versus low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p = 0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between ICUs with high versus low numbers of protocols for lung protective ventilation in acute respiratory distress syndrome (47% vs 52%; p = 0.28) and for spontaneous breathing trials (55% vs 51%; p = 0.27).

Conclusions: Clinical protocols are highly prevalent in U.S. ICUs. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality.

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Figures

**Figure 2**
Number of ICUs by number of protocols.

**Figure 3**
Unadjusted log odds of hospital mortality and protocols (panel A) and adjusted relationship between hospital mortality and protocols (panel B).

See this image and copyright information in PMC

References

1. Ferrer R, Artigas A, Levy MM, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA. 2008;299(19):2294–2303. - PubMed
1. Needham DM, Colantuoni E, Mendez-Tellez PA, et al. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012;344:e2124. - PMC - PubMed
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Protocols and Hospital Mortality in Critically Ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

Collaborators

Affiliation

Protocols and Hospital Mortality in Critically Ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

Authors

Collaborators

Affiliation

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical