NEXT Debate: Decision-making under pressure. Beyond SOP

Vincent

The VIP approach for treating the unstable Patient: ventilate (oxygen!) – infuse (fluids!) – pump (drugs?) à VIP helps you to put together and never forget these very simple elements

SOSD for fluid administration – in which phase are we? : S (salvage) the unstable patient – give fluids; O (optimization)  e.g., passive leg raising to further assess need for fluids; S (stabilization); D (de-escalation) e.g., diuretics?

Spies

 

  • rational thinking – vs. survival approach “flight or fight”
  • key distinctions for decision making: structures (SOP) can help but staff must be trained for it
  • global thinking (guidelines) vs. local conditions (SOPs)

 

Kesecioglu

  • Don’t mix up guidelines (based on evidence, significant clinical impact but not mandatory) and SOPs (mandatory)

References:

Checklist on the ICU

SOPs for ARDS

NEJM WHO Checklist

 

by Julia Wagner