Table 2 Indications for testing used in guidance-based interventions

Blum et al.

[40]

2015

ABG

Guidance locally established

Not otherwise specified: re-evaluation of pre-existing indications for testing (change in ventilator settings, respiratory or cardiac event, routine testing, metabolic event, pre- and postintubation, pre- and postextubation, follow-up on abnormal test results, unreliable pulse oximetry data, altered mental status) based on “evidence-based review of the literature”

Cahill et al. (C.A.)

[41]

2018

Not otherwise specified

Not otherwise specified

Not otherwise specified

Della-Volpe et al.

[42]

2014

ABG

Guidance locally established

Exclusions: age < 18, acute stroke, VBG;

Indications:

1° Hemodynamic instability;

2° Oxygenation (sat < 88% AND decrease > 5% from baseline);

3° Suspected metabolic acid/base abnormality;

4° Respiratory distress (with one of: -accessory muscle use, -altered mental status, -respiratory rate increase, -diaphoresis, -cyanosis);

5° Ventilation changes (change in MODE, change in PEEP, change in minute ventilation, change in FiO₂, daily ABG, weaning trial ABG, postextubation ABG);

6° Post-op initial ABG;

7° Other

Dhanani et al.

[74]

2018

FBC;

COAG (INR/PT, aPTT, FIB);

CHEM (BUN, CREAT, electrolytes, LFT, CA, MG, P);

Guidance locally established

1° Daily testing: FBC, BUN, electrolytes;

2° Twice weekly: FBC (appears twice), CHEM 20;

3° Coagulation only as required (order individual tests);

4° Drug levels (not otherwise specified): reduce rate of monitoring if at stable levels

Fresco et al. (C.A.)

[43]

2016

Not otherwise specified

Not otherwise specified

Not otherwise specified

Hall et al. (C.A.)

[138]

2016

Not otherwise specified

Not otherwise specified

Not otherwise specified

Han et al.

[139]

2014

CA, CL, MG, P

Guidance locally established

1° CL: presence of acidosis on ABG, HCO3 < 20 mEq/L, to calculate presence of anion gap;

2° MG: clinical evidence of poor nutrition, prolonged non-per os (NPO) status, heavy diuresis;

3° P: clinical evidence of poor nutrition, prolonged non-per os (NPO) status;

4° CA: use of blood products outside perioperative setting, suspicion for multiple endocrinopathies

Iosfina et al. (C.A.)

[79]

2013

FBC;

BUN, electrolytes, CREAT

Guidance locally established

Not otherwise specified

Kotecha et al.

[46]

2017

COAG (n.o.s.);

LFT, MG, P, LACT, TROP

Guidance locally established

1° Always appropriate: BMP, FBC;

2° MG: volume loss, arrythmia, receiving repletion;

3° P: receiving repletion, malnutrition, diabetic ketoacidosis, hyperphosphatemia from renal disease;

4° LFT: abnormal liver function tests, liver disease or injury, hepatotoxic medication;

5° COAG: bleeding, coagulopathy, on anticoagulation, planned procedure;

6° LACT: sepsis, suspected mesenteric ischemia, trending initial elevated level;

7° TROP: myocardial injury, active ischemia

Kumwilaisak et al.

[47]

2008

ABG;

CHEM (n.o.s.), GLU, CARD (n.o.s.);

COAG (n.o.s.);

Guidance locally established

1° Routine daily laboratory tests include FBC, NA, K, CL, CO2, MG, P, BUN, CREAT, GLU;

2° ABG and COAG are not routine;

3° Biomarkers of myocardial injury include CK-MB at baseline, TROP T at baseline, 8 and 16 h;

4° Plans for laboratory testing are discussed at the time of each patient’s rounds;

5° All tests require a written order in the POE. In emergencies, nurses can send tests according to their best judgment; such tests are later discussed with the house officer and an order is entered at that time

Leydier et al. (C.A.)

[48]

2016

Not otherwise specified.

Not otherwise specified

Not otherwise specified

Litton et al.

[87]

2020

FBC;

COAG (INR/PT, aPTT);

CHEM (BUN, electrolytes, MG, CA, LFT, ABG, CRP, PCT, TROP)

Guidance locally established

Not otherwise specified: “The pre-intervention ICU guideline involved conducting a routine panel of diagnostic tests on admission to ICU in addition to scheduled daily (morning) tests, unless otherwise directed by the training team. Post-intervention, the guideline was changed for admission and daily testing, so that only diagnostic tests deemed clinically indicated and explicitly suggested by the treating ICU team were requested.”

Lo et al. (L.Ed.)

[77]

2020

MG

Guidance locally established

1° Suspected hypomagnesemia with plans to replete in the setting of renal failure;

2° Optional in suspected hypermagnesemia

Martinez-B. et al.

[88]

2017

ABG

Guidance locally established

1° Should an ABG be drawn ?

∟ Oxygenation

 → acute decompensation ? Yes = Draw ABG

 → intervention required ? Yes = Follow further interventions with SpO₂ if it correlates ± 3% with SaO₂

∟ Ventilation

 → acute decompensation or change of minute ventilation ? Yes = Draw ABG

 → intervention required ? Yes = Follow further interventions with ABG

∟ Acid–base

 → new or worsening acid–base disorder suspected ? Yes = Draw ABG

 → interventions required ? Yes = Follow further interventions with ABG

2° Do not draw an ABG if a disorder is not suspected or an intervention is not required;

3° Do not draw an ABG for spontaneous breathing trial;

4° Follow pulse oximetry after planned changes of FiO₂ or positive end-expiratory pressure;

5° Do not use venous blood gas as surrogates for ABG;

6° Consider removing arterial lines as soon as clinically indicated

Merkeley et al.

[78]

2016

FBC;

Electrolytes/renal panel (n.o.s.)

Guidance locally established

1° FBC: suspected anemia, suspected bleeding, suspected infection, suspected leucopenia, suspected thrombocytopenia, other (to be specified by physician);

2° Electrolytes/renal panel: suspected new electrolyte abnormalities, documented electrolyte abnormalities that are being corrected, suspected or ongoing kidney injury, other (to be specified by physician)

Musca et al.

[90]

2016

COAG (INR/PT, aPTT, FIB);

Not otherwise specified

1° On ICU admission: order screening coagulation profile if not done that day;

2° Significant bleeding: order coagulation profile as required;

3° New thrombocytopenia (< 50), liver failure or DIC before significant procedure: order coagulation profile once and then daily if abnormal;

4° Warfarin therapy with isolated high INR (> 1.3): INR only, daily or less when patient improving;

5° Heparin therapy with isolated high aPTT (> 42 s): aPTT only, as per heparin protocol, or daily or less if patient improving;

6° Coagulation profile abnormal but none of the above: consider ordering coagulation profile second daily or less if patient improving

Prat et al.

[49]

2009

FBC;

COAG (PT, aPTT, FIB, coagulation factors);

CHEM (electrolytes, BUN, CREAT, GLU, PROT, CA, P, TBIL, ALP, GGT, AST/ALT, TROP, CK, LACT);

ABG

Guidance locally established

1° FBC, PLT: upon admission in ICU only if not done in emergency ward or other hospital unit, during ICU stay once or two times a week (of if bleeding event is suspected);

2° PT, aPTT, FIB: upon admission in ICU when DIC or hepatic failure, during ICU stay once or two times a week (if heparin treatment once a day until aPTT ok and after 2–3 a week;

3° Coagulation factors (not otherwise specified): upon admission in ICU when DIC or hepatic failure, during ICU stay when vitamin K deficiency, DIC or suspected hepatic failure;

4° Electrolytes, BUN, CREAT: upon admission in ICU only if not done in emergency ward or other hospital unit, during ICU stay once a day if metabolic abnormalities (NA or K) or when renal failure and for other situations once or twice a week;

5° Urinary electrolytes: not upon admission in ICU except if severe hyponatremia, during ICU stay once a day when metabolic abnormalities or renal failure and in other situations once a week;

6° CA, P: upon admission in ICU when renal failure or denutrition, during ICU stay once a week or depending on clinical context (prolonged length of stay, parenteral nutrition, rhabdomyolysis);

7° ABG: not upon admission in ICU except if respiratory failure, during ICU stay one hour after intubation, once a day if pulmonary failure with FiO₂ > 60%, once every two days if pulmonary failure with FiO₂ < 60%, twice a week if no pulmonary failure;

8° TBIL, ALP, GGT, ALT/AST: upon admission in ICU if clinical context, during ICU stay if clinical context and once a week when parenteral nutrition or under mechanical ventilation;

9° TROP: if myocardial infarction suspected and when confirmed once a day until decrease;

10° CK: if rhabdomyolysis suspected and when confirmed once a day until level < 1500 IU/L;

11° LACT: in case of unexplained metabolic acidosis and two times a day in case of shock

Raad et al.

[85]

2017

Not specified

Guidance locally established

Not on indications for testing per se but on the urgency of tests requested: not otherwise specified

Shen et al.

[50]

2019

FBC with differential

Guidance locally established

(Trauma Burn ICU setting.)

Fresh trauma ?

 → NO = Follow unit protocol

 → YES = Switch from FBC with diff. to FBC no diff. for every 4–6 h. If patient stable at 48 h, discontinue current FBC order and order FBC with diff. for every 12 h. If patient not stable at 48 h, continue order of FBC no diff. for every 4–6 h until stabilization

Vezzani et al. (L.Ed.)

[51]

2013

CHEM (n.o.s.)

Guidance locally established

Not on indications for testing per se but on how to enhance appropriateness of testing:

1° Use specific panel (not otherwise specified) of tests for patients’ admission testing;

2° Do not practice bundling of multiple laboratory tests;

3° Order non-routine tests only on suspicion of disease, do not search for abnormal values to be corrected;

4° Once a year, examine testing practice in order to point out excessive or inappropriate test ordering that might be target for actions

Viau-Lapointe et al. (C.A.)

[91]

2018

COAG (n.o.s.);

LFT

Not otherwise specified

Not otherwise specified

Walsh et al. (C.A.)

[89]

2020

ABG

Guidance locally established

ABG testing is inappropriate if performed:

1° At regular (not otherwise specified) interval in stable patients;

2° At change of shift;

3° When taken concurrently with other blood tests;

4° In response to a decrease in ventilation or oxygen delivery;

5° After a treatment was ceased in a stable patient