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Table 1 Definition of intermediate care

From: Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial: study protocol, rationale and feasibility of a randomised multicentre trial

Observation Minimal monitoring levela Treatments goalsb Comments
Level of consciousness Every 8 h GCS: 15  
Respiratory rate Every second hour RR: 10 to 20 If the patient has stable vital signs the RR is not measured during nights
Oxygenation Continuous pulse oximetry SpO2 ≥94% Continuous pulse oximetry when the patient is supine or sitting in a chair. Discontinued during mobilisation
Blood pressure Every second hour MAP: 65 to 110 mmHg If the patient has stable vital signs the MAP is not measured during nights
Heart rate Continuous ECG monitoring HR: 50 to 100 Continuous ECG when the patient is supine or sitting in chair. Discontinued during mobilisation. Diagnostic ECG on indication. If arrhythmia or ischaemia is detected the treatment goals are adjusted to current recommendations
No ischemia
Diuresis Every hour ≥0.5 mL/kg/h During mobilisation the diuresis is summed every third hour
Temperature Every 8 h 36°C to 38°C  
Pain Visual Assessment Score Every 8 h VAS: 0 to 2 during rest No VAS scoring during sleep
   Epidural: Able to move both legs  
Central venous pressure Every 8 h 8 to 12 mmHg CVP and S cVO2 is only registered if there is a central venous catheter in place. The central venous catheter is removed when possible
Central venous oxygen saturation Every 8 h SpO2 ≥ 70%  
Standard blood samples Every 24 h Within normal reference values Hgb ≥4.5 mmol/L
Hgb ≥6.0 during sepsis or heart disease
Treatment (if needed) Maximal treatment level Treatments goals Comments
Single sympathomimetic drug support Continuously MAP: ≥65 mmHg  
Diuresis: ≥0.5 mL/kg/h
Oxygen therapy on open systems Continuously SpO2 ≥94% Unless contraindicated, oxygen therapy is discontinued when oxygenation is ≥94% without oxygen therapy. During nights: minimum 2 L supplemental oxygen is given
Positive Expiratory Pressure (PEP) therapy Assistance to PEP therapy: once per hour SpO2 ≥94% If the patient does not need assistance with PEP therapy, guidance in self-administration of PEP therapy must be available
Non-invasive ventilation Continuously Normocapnia and normoxic  
Volume / Fluid therapy Continuously MAP: ≥65 mmHg Fluid balance: Evaluation frequency in accordance with monitoring level and vital signs
Diuresis: ≥0.5 mL/kg/h
S cVO2 ≥70%
CVP: 8 to 12 mmHg
  1. During evening and night shifts: Staff specialist in anaesthetist/intensive care medicine on in-house duty and staff specialist in surgery on call.
  2. aThe minimal monitoring level is exceeded when necessary (for example, deterioration).
  3. bAll treatment goals are adjusted to the individual patient’s co-morbidities, physiological status and in the event of complications in agreement with current recommendations (for example, troponin T/I is measured when cardiac ischaemia is suspected).