Access FICM guidelines & resources
These guidelines have been produced by the Faculty with the Intensive Care Society with the aim of providing the critical care community with up to date evidence based guidance and promoting high standards of care during the transfer of critically ill patients.
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.
Following discussion at the Board of the Faculty of Intensive Care Medicine, we 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.
Choosing wisely is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
By having discussions that are informed by the doctor, but taking into account what’s important to the patient too, both sides can be supported to make better decisions about care. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit.
The FICM has contributed to a list of forty treatments and procedures that are of little or no benefit to patients, which have been drawn up by the UK’s medical royal colleges.
See here for full details.
The Choosing Wisely website has a section for patients as well as clinicians.
The purpose is to provide an evidence-based framework for the management of adult patients with ARDS which will inform both key decisions in the care of individual patients and broader policy. The development process was based on the previous NICE approval process and has used GRADE methodology to review an extensive evidence base. We would like to thank all of those involved in bringing this guideline to fruition!
The full guideline and accompanying appendices can be found below:
This supplementary guidance is endorsed by the Faculty of Intensive Care Medicine, the Intensive Care Society Standards Committee and the NHS England Severe Respiratory Failure Network for adults and children older than 16 years. It should be used in conjunction with the Academy of Medical Royal Colleges (AoMRC 2008) A Code of Practice for the Diagnosis and Confirmation of Death and the forms for the Diagnosis of Death using Neurological Criteria endorsed by the Faculty of Intensive Care Medicine, Intensive Care Society and the National Organ Donation Committee.
The Faculty was delighted to co-fund and provide administrative support for this important development framework, which was completed as a joint project with the ICS. This framework is intended to facilitate the structured development and career progression of post registration Allied Health Professionals (AHP) working in a critical care environment. The scope covers four AHP therapies working with critically ill patients and their carers. These are: :
- Occupational Therapy
- Speech and Language Therapy