5 unnecessary critical care procedures

Five routine critical care practices are sometimes unnecessary or even harmful to patients, according to an announcement by the American Association of Critical-Care Nurses (AACN).

The AACN, as part of the Critical Care Societies Collaborative, and the ABIM Foundation's Choosing Wisely initiative, which aims to create conversations between patients and healthcare providers regarding necessary procedures, have issued a list of recommendations to avoid such harmful, unnecessary care.

The recommendations are:

  1. Order diagnostic tests in response to specific clinical questions rather than at regular intervals.

  2. Don't transfuse red blood cells in hemodynamically stable, non-bleeding critically ill patients with a hemoglobin concentration greater than 7 mg/dL.

  3. Avoid parenteral nutrition in adequately nourished critically ill patients within the first seven days of a stay in an intensive care unit.

  4. Don't deeply sedate mechanically ventilated patients without a specific indication, and without daily attempts to lighten sedation.

  5. Offer patients at high risk for death or severely impaired functional recovery and their families the alternative of care focused entirely on comfort before continuing life support.

A 10-member team with representatives from internal medicine, surgery, anesthesiology, emergency medicine and critical care nursing disciplines compiled the list, according to the announcement. The recommendations add to the log of more than 220 tests and procedures that the teams identified as possibly unnecessary and harmful.

To learn more:
- here's the announcement
- read the recommendations (.pdf)