Key Performance Indicators in Intensive Care Medicine. A Retrospective Matched Cohort Study

Abstract

Expert panel consensus was used to develop evidence-based process indicators that were independent risk factors for the main clinical outcome parameters of length of stay in the intensive care unit (ICU) and mortality. In a retrospective, matched data analysis of patients from five ICUs at a tertiary university hospital, agreed process indicators (sedation monitoring, pain monitoring, mean arterial pressure [MAP] ≥ 60 mmHg, tidal volume [TV] ≤ 6 ml/kg body weight, peak inspiratory pressure [PIP] ≤ 35 cmH₂O and blood glucose [BG] ≥ 80 and ≤ 130 mg/dl) were validated using a prospective dataset of 4445 consecutive patients. After matching for age, sex and ICU, 634 patients were analysed. Logistic regression of the 634 patients showed that monitoring analgesia and sedation, MAP ≥ 60 mmHg and BG ≥ 80 mg/dl were relevant for survival. Linear regression of the 634 patients showed that analgesia monitoring, PIP ≤ 35 cmH₂O and TV ≤ 6 ml/kg were associated with reduced length of ICU stay. Linear regression on all 4445 patients showed analgesia, sedation monitoring, MAP ≥ 60 mmHg, BG ≥ 80 mg/dl and ≤ 130 mg/dl, PIP ≤ 35 cmH₂O and TV ≤ 6 ml/kg were associated with reduced length of ICU stay, indicating that adherence to evidence-based key process indicators may reduce mortality and length of ICU stay.