Why do we fail to deliver evidence-based practice in critical care medicine?

Abstract

Purpose of review The use of evidence-based practices in clinical practice is frequently inadequate. Recent research has uncovered many barriers to the implementation of evidence-based practices in critical care medicine. Using a comprehensive conceptual framework, this review identifies and classifies the barriers to implementation of several major critical care evidence-based practices. Recent findings The many barriers that have been recently identified can be classified into domains of the consolidated framework for implementation research (CFIR). Barriers to the management of patients with acute respiratory distress syndrome (ARDS) include ARDS under-recognition. Barriers to the use of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle for mechanically ventilated patients and the sepsis bundle include patient-related, clinician-related, protocol-related, contextual-related, and intervention-related factors. Although these many barriers can be classified into all five CFIR domains (intervention, outer setting, inner setting, individuals, and process), most barriers fall within the individuals and inner setting domains. Summary There are many barriers to the implementation of evidence-based practice in critical care medicine. Systematically classifying these barriers allows implementation researchers and clinicians to design targeted implementation strategies, giving them the greatest chance of success in improving the use of evidence-based practice.

Implementation of the ABCDEF Bundle for Critically Ill ICU Patients During the COVID-19 Pandemic: A Multi-National 1-Day Point Prevalence Study

“…However, this study also showed the low frequency to equip the specific protocol in each ICU, or 50% or less, which could be considered as one of the major barriers to be managed regardless of the presence of COVID-19. As many studies successfully showed a pivotal role for implementation or introduction of ICU care, this simple, but not time-or resource-consuming approach could be a key stimulus and should be routine in the ICU to facilitate efficient implementation of evidence-based approaches to ICU care (12,16,37,38). Tele-medicine, which is getting public interest and recommended in several elements such as elements E (39) and F (37,40), could be also an alternative to promote implementation instead of strict regulations regarding infection control or family visits.…”

Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review

“…There is still a significant gap in our understanding of how best to translate knowledge to practice in medicine, and we lack an effective framework for implementing clinical practice. Identified barriers to integration of evidence in the ICU include knowledge gaps, limited interdisciplinary collaboration, and complexity of care ( 47 ). Particularly in ARDS, the initial identification of ARDS is an important diagnostic step prior to initiating possible therapies ( 10 ).…”

Impact of high tidal volume ventilation on surfactant metabolism and lung injury in infant rats

“…In line with our results, in vivo and ex vivo adult rat studies examining the impact of high V T without PEEP on surfactant and lung function also demonstrated an impaired lung compliance accompanied by increased total surfactant pools in BALF. Further analyses of BALF revealed an elevated SA/LA ratio and poor surfactant surface tension lowering properties (31,44,45). LAs represent the biophysically active form and consist of TM, LBL, ML, and MV surfactant structures.…”