Skip to Main Content

++

  • Effective preventive health care interventions based on evidence from rigorous randomized trials are increasing.
  • Nonetheless, preventive strategies are applied suboptimally in many settings, particularly in the intensive care unit (ICU).
  • Potential reasons such strategies are not more broadly employed include clinician habit, lack of awareness of (or resistance to) new information, reliance on physiologic outcomes rather than on clinically important outcomes when interpreting evidence, and lack of self-efficacy of physicians who question whether the benefits observed in the research setting will be realized in the practice setting.
  • Another important, but underappreciated, reason for insufficient or delayed uptake of effective preventive strategies is the absence of reinforcements for preventive behavior in general.
  • A working environment that facilitates the implementation of preventive strategies is a powerful facilitator of change. A crucial first step in trying to improve preventive care in the ICU is to do an environmental scan to understand the practice of the unit and to characterize the culture of the unit.
  • The most effective strategies to implement behavioral change are interactive education rather than passive education, audit and feedback, reminders (manual or computerized), and involvement of local opinion leaders.

++

Effective preventive health care interventions based on evidence from rigorous randomized trials are increasing. Application of such randomized trial evidence in practice has great potential to decrease the morbidity and mortality rates of inpatients and outpatients. However, preventive strategies are applied suboptimally in many settings, particularly in the intensive care unit (ICU). This poses a serious problem because critically ill patients are at high risk of death not only from the condition that necessitated their admission to the ICU but also from the complications of critical illness.

++

Examples of well-documented underuse of interventions that have been demonstrated to decrease morbid complications of critical illness in randomized trials include prevention of venous thromboembolism,1 prevention of hyperglycemia,2 and prevention of pneumonia.3 Other interventions proved to prevent ICU mortality in patients with acute lung injury and sepsis such as lung protective ventilation strategies, use of corticosteroids, and activated protein C are also variably applied in practice, although mortality-reducing interventions are not the focus of this chapter.

++

In this chapter, we (a) present key clinical and behavioral issues relevant to preventive care for critically ill medical and surgical patients, (b) illustrate the gap between the evidence and its practical application, (c) underscore lost opportunities for prevention of morbidity by using several study designs, and (d) suggest strategies for improved analysis of, and increased attention to, prevention in the ICU.

++

The reasons clinicians fail to attend to prophylactic strategies supported by randomized trials may mirror those reasons that clinicians fail to apply valid evidence in practice, and the reasons that clinicians do not follow high-quality practice guidelines. Assuming that the evidentiary basis for the preventive strategy is valid and thus worth considering, there are many potential reasons for underuse of primary, secondary, or tertiary prevention, including clinician habit, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.