One guideline may not fit all: Tailored evidence may improve critical care delivery

The overall objective of critical care is to restore patients with life-threatening illnesses to health states aligned with their individual values while avoiding burdensome therapies. Burdensome therapies include treatments or interventions that are intolerable to the patient or that are unlikely to result in a health state acceptable to the patient. To achieve critical care’s objectives, clinicians must integrate clinical data with diagnosis- or disease-based evidence to determine an individual patient’s likely diagnosis, prognosis, and expected response to specific treatments. But clinicians must also assess the value the patient places on possible resulting health states and the interventions required to achieve those outcomes. Clinical practice guidelines and evidence-based clinical pathways guide care for common critical care syndromes (e.g., sepsis and acute respiratory distress syndrome). Yet, there is widespread recognition that critically ill patients, even with the same critical illness syndrome, constitute a highly heterogeneous population. As such, uniform application of clinical recommendations based on diagnosis may fail to account for variation in individual patients’ likely outcomes, given their baseline health and personal values.

Katharine E Secunda, Joanna L Hart