Essential Components and Parameters for ICU Review of Systems During Rounding
Use a structured, systems-based checklist approach covering 6-20 discrete items (median 17) to ensure comprehensive assessment of all organ systems, with mandatory daily evaluation of respiratory, cardiovascular, neurological, hepatic, renal, and coagulation function using standardized scoring tools like SOFA-2. 1, 2, 3
Core Organ System Assessment Framework
The review of systems during ICU rounds must systematically evaluate six critical organ systems, as this approach directly impacts mortality prediction and treatment decisions 1, 4:
Respiratory System
- PaO2/FiO2 ratio to quantify oxygenation status (normal ≥400 mmHg; severe dysfunction <100 mmHg with mechanical ventilation) 4
- Ventilator settings and parameters including mode, tidal volume, PEEP, and FiO2 for all intubated patients 2
- Waveform capnography availability and monitoring—absence or change of capnograph waveform is the primary "airway red flag" 3
- Readiness for liberation from mechanical ventilation assessed daily 2
- Serial assessment of respiratory mechanics and gas exchange 5
Cardiovascular System
- Mean arterial pressure (MAP) with target ≥70 mmHg 4
- Vasopressor requirements quantified (dopamine, norepinephrine, epinephrine doses) 4
- Heart rate and blood pressure documented at each assessment 2
- Adequacy of tissue perfusion and oxygen delivery 5
Neurological System
- Glasgow Coma Scale score for objective neurological assessment 4
- Delirium screening using the 8-item ICDSC performed daily on all ICU patients 1, 2, 3
- Orientation aids, communication improvements, and environmental modifications implemented 2
- Sleep quality and sedation levels 2
Hepatic System
- Bilirubin levels measured (normal <20 μmol/L or <1.2 mg/dL; severe dysfunction >204 μmol/L or >12.0 mg/dL) 1, 4
Renal System
- Creatinine levels tracked (normal <110 μmol/L; severe dysfunction >440 μmol/L or >5.0 mg/dL) 4
- Urine output monitored (severe dysfunction <200 mL/day) 4
- Renal replacement therapy needs and parameters 1
Coagulation System
- Platelet count assessed (normal ≥150 × 10³/μL; severe dysfunction <20 × 10³/μL) 4
- Screen for sepsis-induced coagulopathy when SOFA score ≥2 4
Infection and Sepsis Surveillance
- SOFA score calculation on admission and every 48 hours—an increase of ≥2 points with documented or suspected infection defines sepsis and triggers immediate broad-spectrum antibiotics within 1 hour 1, 4
- Central line necessity assessment with daily evaluation for removal to prevent CLABSIs 1, 2
- Ventilator-associated pneumonia prevention bundle implementation documented 2
- Temperature monitoring as critical parameter 2, 5
- Microbiology findings review 6
Additional Critical Parameters
Vital Signs and Monitoring
- Oxygen saturation continuously tracked 2
- Respiratory rate documented 2
- Enhanced capacity for invasive and noninvasive monitoring 7
Medication and Nutrition
- Medication administration and patient response to treatments 2
- Medication history review for potential interactions 2
- Allergy documentation and previous adverse reactions 2
- Nutritional delivery adequacy and blood glucose control 5
Mobility and Functional Status
- Early mobilization efforts documented, ideally started within first few days in ICU 2
- Type of mobilization performed (passive, assisted, or active exercises) 2
Implementation Strategy
Conduct rounds using a multidisciplinary team including physicians, nurses, pharmacists, and respiratory therapists at consistent daily times 3, 8:
- Use standardized checklist format with explicitly defined roles for each team member 1, 8
- Implement goal-oriented approach with daily goals sheet to improve team communication 2, 8
- Consider electronic integration with EHR when possible for dynamic, patient-specific modification 1, 2
- Ensure median adherence rate of 73-91% through proper training and "checklist champions" 1, 3
Documentation Requirements
- Patient demographics, admission date/time, and reason for ICU admission 2
- Baseline health status for comparison during treatment 2
- Family conferences and information shared with family members 2
- Complications related to mechanical ventilation or other interventions 2
- Surgical procedures and findings 6
Critical Pitfalls to Avoid
- Never skip delirium screening—the 8-item ICDSC must be completed daily on all ICU patients 3
- Never conduct rounds without waveform capnography available for intubated patients 3
- Never fail to document when vital signs cannot be obtained 2
- Never omit medication history that could interact with current treatments 2
- Never ignore clinical context—SOFA and other scoring tools augment but do not replace clinical judgment 4
- Avoid interruptions during rounds (median of 2 interruptions per round, only 17% related to urgent decisions) 6
- Address information retrieval gaps proactively, particularly microbiology findings (10% commonly missing) and surgical procedures (6% commonly missing) 6