Access Standards and Guidelines
The FICM works in conjunction with our sister organisations to ensure we provide you with key information and support on service provision standards and audit (with the Intensive Care Society), and Clinical Quality (with the Royal College of Anaesthetists).
Accurate prognostication in life threatening brain injury is difficult, particularly at an early stage. The eventual outcome for such patients is often death or survival with severe disability. Controlled studies to provide evidence to guide decision making are few and the risk of a ‘self-fulfilling prophecy’, with early prognostication leading to early WLST and death, continues to exist.
The Joint Standards Committee of the Faculty of Intensive Care Medicine and the Intensive Care Society convened a consensus group with representation from stakeholder professional organisations to produce this guidance. It recognised that the weak evidence base makes GRADE guidelines difficult to justify. We have made twelve practical, pragmatic recommendations we hope will help clinicians deliver safe, effective, equitable and justifiable care within a resource constrained NHS.
In the situation where patient centred outcomes are recognised to be unacceptable, regardless of the extent of neurological improvement, then early transition to palliative care without admission to ICU would be appropriate. This consensus statement is intended to apply where the primary pathology is DBI, rather than to the situation where DBI has compounded a progressive and irreversible deterioration in other life threatening co-morbidities.
For the purpose of this statement DBI is defined as 'any neurological condition that is assessed at the time of hospital admission as an immediate threat to life or incompatible with good functional recovery AND where early limitation or withdrawal of therapy is being considered'.
A decade ago, critical care units prepared medicines for infusion in a fashion determined by each individual unit and without reference to a central recommended list. As a consequence, there were a huge variety of compositions of medications and fragmentation in practice, with implications for training, use of language/terminology, efficient use of resources and lack of purchasing power to influence development of medicines manufactured in a ready-to-use format.
Subsequently, the Intensive Care Society consulted on and adopted a core set of standard medication concentrations which have now been in place since 2010. The addition of new medicines to the market place, combined with findings from more recent work that explores the extent of adoption of the standards, have revealed the need to update the list.
Version 2 now includes dexmedetomidine, adrenaline and a different phosphate presentation. An additional column now denotes route (central vs peripheral). We urge practitioners to review practice on their unit, and consider adoption of the standard concentrations wherever possible.