Critical Care Presence

The care of critically ill patients is complex and challenging with the outcome highly dependent on the skill set of the critical care team. In virtually any critical care setting, there is an abundance of information available, yet the ability to process data and provide effectively organized and meaningful information is limited.

An important example is the assessment of work of breathing (WOB). Unrecognized WOB increase leading to respiratory muscle fatigue is a frequent cause of hospital cardiac arrest. We have developed a simple clinical scale to assess WOB at the bedside enabling healthcare providers to recognize and treat early WOB increase.^1,2

Our WOB scale was also useful to assess the need for intubation to initiate mechanical ventilation in patients with COVID-19 pneumonia² and is now available through the MAPI Research Trust and a webinar discussing respiratory failure and the WOB scale’s clinical usefulness.

The critical care presence extends beyond the walls of an intensive care unit (ICU). In our institution, we led the development and implementation of a highly effective system for early recognition of clinical deterioration outside the ICU based on Single Early Warning Signs (SEWS). Our SEWS system has a lower activation threshold, broader clinical scope, and faster response than systems based on vital signs point summation, such as the National Early Warning Score (NEWS), and is highly effective in preventing in-hospital cardiac arrests.³