Less Is More in the ICU: Resuscitation, Oxygenation and Routine Tests

Abstract

The intensive care unit (ICU) was initially developed in the 1950s to treat patients who required invasive respiratory support and hemodynamic resuscitation. Since the beginning, ICU medicine has focused on maintaining sufficient arterial blood flow and oxygenation to provide adequate tissue oxygen delivery to forestall or reverse organ failure. Over time, ICU medicine became more intensive, with the administration of many diagnostic tests and monitors, invasive procedures, and treatments, often with scant evidence of benefit associated with them. An alternative perspective holds that ICU patients may represent a group of patients that is especially vulnerable to iatrogenic harm. We outline a case that presents common ICU dilemmas and discusses current data that propose that "less is more" when making key diagnostic or therapeutic choices in the ICU. Further, we assert that providers should skeptically consider common ICU interventions, trying to account for the potential unintended consequences of interventions. Finally, we suggest that the guiding principle of ICU medicine should be primum non nocere: in delicate situations, it may be better not to do something, or even to do nothing, rather than risk causing harm.

Oxygenation Saturation Index Predicts Clinical Outcomes in ARDS

“…2,21,23 Furthermore, repeated blood draws in the ICU setting contribute to iatrogenic anemia, need for blood transfusions, increased risk of infection, and higher cost of care. 29 Aside from decreasing harm, saturation-based measurements are continually available in almost all hospital settings, including relatively resource-poor ones such as developing countries. Rice et al 21 and others have described the role that saturation-based measurements play in the diagnosis of ARDS, 22 and our study showed that saturation-based measurements are useful not only for diagnosis but also for prognostication.…”

Development of Compartment Syndrome after Radial Artery Puncture in a Patient with Acute Hypoxemic Respiratory Failure due to COVID-19

“…ABG sampling can provide essential information in critically ill patients with hypoxemia or hypercapnia, but it must be used judiciously; overtesting can lead to patient harm through procedure-related complications, false-positive results leading to more invasive and costly testing and iatrogenic anemia from frequent blood draws [ 17 ]. Less is often more in the ICU [ 18 ].…”

A Modificatory Screening Protocol for ARDS in Patients with Respiratory Support Based on SpO2 and FiO2

“…The establishment of the Berlin definition in 2012 made the diagnosis and classification of ARDS more accurate and standardized [12] . However, repeated blood draws in the ICU environment may lead to iatrogenic anemia, the need for blood transfusions, an increased risk of infection, and an increase in hospital costs [13] . In addition, as mentioned earlier, many underdeveloped regions and countries may lack the conditions for arterial blood gas.…”