Analgesia and sedation are crucial for critically ill patients. In recent years, a comprehensive strategy featuring prioritized analgesia, light sedation, delirium screening and prevention, early mobility and sleep improvement has been formed. However, a concise and easy-to-operate flow chart still needs to be improved. We have developed a protocolized process for pain and agitation management for critically ill patients to provide a hands-on tool in clinical practice.

Pain and anxiety cause severe psychological stress and badly affect the outcome in intensive care unit (ICU) patients. Appropriate analgesia and sedation can meliorate pain and discomfort, reduce the risk of delirium and achieve the goal of organ protection. We must follow the sequence of assessment, analgesia and sedation. We also need to pay attention to non-pharmacologic interventions during analgesia and sedation. Setting up a complete and concise protocol can improve analgesia and sedation.

Continous renal replacement theraphy (CRRT) is a strategy of clinical treatment in critically ill patients. Due to the complex of CRRT and variety of patients′ condition, establishment of a feasible and standardized protocol to ensure CRRT practice is needed urgently. The protocolized care includes four steps. First, assessing the indication of CRRT; Second, CRRT prescription; Third, monitoring management and parameters adjustment, and Fourth, evaluating the optimal weaning timing of CRRT. In order to carry out the protocolized care of CRRT in clinical practice, we should follow the these four steps strictly based on patients′ condition. This standardized CRRT protocol will further make continuously quality improvement of homogeneous management.

Diagnosis and treatment of shock is the core of critical patient treatment. But problems such as fragile theoretical basis, lack of hemodynamics monitoring techniques and treatment protocols, and huge arbitrariness exist in primary hospitals. The target process of diagnosis and treatment for most of patients with shock in primary hospitals will contribute to the homogeneous management and improve the basic medical quality. Shock can be identified in early stage using three observationwindows: skin, kidney and alterations in consciousness, combining with hyperlactacidemia (>1.5mmol/L). The shock type can be identified with following protocol: screen and exclude obstructive shock, assess cardiac function and lung condition to determine cardiac shock, understand volume status and fluid responsiveness to identify hypovolemic shock and measure cardiac output to evaluate distributive shock. Meanwhile, it will contribute to better management of critical patients with shock at the primary level by the target process of shock treatment based on a concept of ladder application of lactic acid, central venous pressure, central venous oxygen saturation, and carbon dioxide partial pressure difference.

Invasive mechanical ventilation is one of the important therapies in acute respiratory distress syndrome (ARDS). At present, the clinical management of invasive mechanical ventilation for ARDS is still not standardized. Standardization of the invasive mechanical ventilation protocol will be helpful to improve the effect of mechanical ventilation and reduce mortality in ARDS. In this study, we performed a standardized protocol of invasive mechanical ventilation in patients with ARDS including the choice of artificial airway and initial ventilator mode, low tidal volume of lung protective strategy, adjunctive and rescue strategies, methods of deal with the hypercapnia after low tidal volume ventilation and weaning from the invasive ventilation.

Multi-trauma is the most common type of trauma leading to ICU admission, also with a higher mortality in early phase. The most challenging aspect in the management of multi-trauma in the acute phase is how to deal with the injury reasonablely and timely. The management of multi-trauma could be divided into 3 stages: initial ABC assessment and treatment, screening for the most life-threatening injuries and handling, systematic screening of the occult injury. Each of the stages must be clearly defined and the timing of the treatment in each stage should be completed without any delay. The priority of management, as well as the resuscitation for acute multi-trauma should be standardized,with a purpose to decrease the mortality and morbidity.

Infection is one of the major cause of death in critically ill patients. But in the process of diagnosis and treatment of severe infection, there are still some misconceptions that needs to be corrected. The goal of this protocol is to outline the clinical process of diagnosis-treatment-reassessment-adjustment for severe infection, and to standardize physician′s behavior based on the recent guidelines and consensus, so as to decrease the morbidity and bacterial resistance.