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Semin Respir Crit Care Med 2016; 37(01): 023-033
DOI: 10.1055/s-0035-1570358
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Kavitha Gopalratnam
1   Department of Internal Medicine, Bridgeport Hospital/Yale University School of Medicine, Bridgeport, Connecticut
,
Inga C. Forde
2   Section of Pulmonary, Critical Care & Sleep Medicine, Bridgeport Hospital/Yale University School of Medicine, Bridgeport, Connecticut
,
Jaclyn V. O'Connor
3   Saba University School of Medicine, Saba, Dutch Caribbean
,
David A. Kaufman
4   Section of Pulmonary & Critical Care Medicine, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations
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Publication History

Publication Date:
28 January 2016 (online)

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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.

Keywords

intensive care unit - iatrogenic injury - transfusions - resuscitation - arterial catheters - risk–benefit
 

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