What is guideline-recommended, general knowledge or clinical practice?
Educational work by a pre-medical student — not medical advice. Not a clinical protocol, prescription, or patient handout, and not for patient care. See DISCLAIMER.
Reviewed 28 October 2026. This page classifies the ICU/CTICU care, laboratory and equipment examples. It separates direct source recommendations from general knowledge and from the authored case applications. A supported recommendation is not the same as one standardized regimen for all patients.
Labels used beside the examples
| Label | Meaning |
|---|---|
| Guideline recommendation | A source explicitly recommends or suggests the stated action. Strong, conditional and ungraded statements are identified separately, with population limits. |
| Consensus guidance | The source gives consensus recommendations; no GRADE strength or international-standard status is invented. |
| General clinical knowledge | Source-supported physiology, diagnostic interpretation, equipment function or measurement limitations. This is not a treatment protocol. |
| Context-dependent clinical practice | A choice or care sequence depends on the actual condition, procedure, trajectory, goals, available expertise and local protocol. |
| Synthetic example | Fictional patient, numerical result or original decision tree illustrating an application. It is not an observed case or a society-prescribed regimen. |
In this repository, the standardized element of the author-created case format is documentation and organization. Clinical recommendations below have only the authority and scope of their named sources; this classification does not declare a legal standard of care.
Verified recommendation groups
The public source sections were checked for the statements summarized below. IDs match notes in the examples. Full wording, evidence discussion and patient eligibility remain in the linked source.
| ID | Scoped statement | Source classification / location | Public source |
|---|---|---|---|
| G01 | Self-report/behavioral pain assessment. Reliable self-report; behavioral assessment when self-report is unavailable and behaviors can be observed. | Guideline statement — ungraded; Pain Assessment statements | PADIS18 |
| G02 | Pain assessment and treatment before sedation. Pain and sedation remain separate assessments. | Guideline good-practice statement; Pain Assessment good-practice statement | PADIS18 |
| G03 | Assessment-driven stepwise pain/sedation approach. Approach is recommended; the fictional regimen is not prescribed by the guideline. | Guideline recommendation — conditional; Protocol-Based Pain Management; moderate certainty | PADIS18 |
| G04 | Acetaminophen adjunct. Adjunct to opioid therapy in critically ill adults. | Guideline recommendation — conditional; Pain Acetaminophen; very low certainty | PADIS18 |
| G05 | Postoperative ketamine adjunct. Selected postsurgical ICU adults when reducing opioid consumption. | Guideline recommendation — conditional; Pain Ketamine; very low certainty | PADIS18 |
| G06 | Neuropathic agent with opioids for neuropathic pain. Neuropathic pain indication. PADIS 2018 separately and conditionally suggests a neuropathic agent with opioids after cardiovascular surgery (low certainty); neither is a routine adjunct for every acute pain presentation. | Guideline recommendation — strong; Neuropathic Pain Meds; moderate certainty | PADIS18 |
| G07 | Against routine IV lidocaine adjunct. ICU opioid-adjunct context; not a blanket statement about all lidocaine indications. | Guideline recommendation — conditional against routine use; Pain Lidocaine; low certainty | PADIS18 |
| G08 | Dexmedetomidine over propofol in the defined priority setting. Mechanically ventilated ICU adults when light sedation and/or delirium reduction are highest priorities. | Guideline recommendation — conditional; Sedation Dexmedetomidine; moderate certainty | PADIS25 |
| G09 | Induction hypnotic when NMBA is used. Critically ill adult intubation; paralysis does not establish unconsciousness. | Guideline best-practice statement; Induction Agent Use | RSI |
| G10 | NMBA with sedative-hypnotic induction. The guideline RSI population; not a standalone drug-choice recipe. | Guideline recommendation — strong; NMBA Use; low certainty | RSI |
| G11 | Specific preoxygenation strategies. Different suggestions for anticipated difficult laryngoscopy, severe hypoxemia or inability to tolerate oxygenation interfaces. | Guideline recommendation — conditional; Preoxygenation and Med-Assisted Preoxygenation; low/very low certainty | RSI |
| G12 | Waveform CO2 and exclusion of esophageal tube placement. PUMA explicitly describes consensus guidance, not international standards; do not assign a GRADE strength here. | Consensus guidance; Summary recommendations and disclaimer | TUBE |
| G13 | Plateau pressure, tidal volume, PEEP/auto-PEEP assessment. Assessment recommendations, not a universal ventilator prescription. | Guideline recommendation — strong; Recommendations 1–4; high certainty | VENTASSESS |
| G14 | FiO2, humidification and airway securement assessment. Recommendation strength differs from plateau-pressure/tidal-volume assessment. | Guideline recommendation — conditional; Recommendations 6, 9–10 and 15; low/very low certainty | VENTASSESS |
| G15 | HFNC over conventional oxygen in acute hypoxemic failure. Adults with acute hypoxemic respiratory failure; not every ICU condition. | Guideline recommendation — conditional; PICO 1 / Recommendation 1; moderate certainty | HFNC |
| G16 | Bilevel NIV for COPD-related respiratory acidosis. Acute or acute-on-chronic respiratory acidosis due to COPD exacerbation; assess suitability and deterioration. | Guideline recommendation — strong; COPD recommendations; high certainty | NIV |
| G17 | CPAP or bilevel NIV for cardiogenic pulmonary edema. Do not extrapolate directly to cardiogenic shock or acute coronary syndromes excluded from the supporting population. | Guideline recommendation — strong; Cardiogenic pulmonary edema recommendation; moderate certainty | NIV |
| G18 | SBT with or without pressure support; RSBI not required for readiness. Adult ventilator liberation; the exact case remains an application. | Guideline recommendation — conditional; Recommendations 1–2; moderate certainty | SBT |
| G19 | Standardized assessment for an appropriate daily SBT. Standardizing the assessment process is different from a fixed extubation time. | Guideline recommendation — conditional; Recommendation 3; very low certainty | SBT |
| G20 | Preventive NIV immediately after planned extubation. High extubation-failure risk, ventilated more than 24 hours and passed an SBT; patient-specific suitability still matters. | Guideline recommendation — strong; Question 3; moderate certainty | LIBERATE |
| G21 | Higher PEEP without recruitment maneuvers. ATS: moderate-to-severe ARDS. Other societies differ (for example, ESICM 2023 ARDS guideline, Grasselli et al., Intensive Care Med 2023;49:727-759, DOI); not a universal PEEP strategy. | Guideline recommendation — conditional; Question 4; low-to-moderate certainty | ARDS |
| G22 | Against prolonged recruitment maneuvers. Moderate-to-severe ARDS; separate from the higher-PEEP recommendation. | Guideline recommendation — strong against; Question 4; moderate certainty | ARDS |
| G23 | Blood cultures in possible/probable/definite sepsis. Adults with sepsis/septic shock; obtain promptly, ideally before antimicrobials without harmful delay. | Guideline recommendation — strong; Blood culture; low certainty | SEPSIS |
| G24 | Blood lactate in suspected sepsis. Interpret with clinical context, not as a complete diagnosis or automatic fluid instruction. | Guideline recommendation — conditional; Blood lactate; low certainty | SEPSIS |
| G25 | Creatinine/urine-output AKI definition. The 2012 KDIGO definition supports the fictional creatinine arithmetic; it does not diagnose etiology. | Guideline diagnostic definition — not graded; Recommendation 2.1.1 | AKI |
| G26 | RRT decision from context and trends. Clinical needs and trajectory rather than one creatinine/BUN number. | Guideline statement — not graded; Recommendations 5.1.1–5.1.2 | RRT |
| G27 | CRRT rather than standard intermittent RRT in instability. Hemodynamically unstable AKI patients requiring RRT; historical 2012 guidance, not universal modality superiority. | Guideline recommendation — conditional (2B); Recommendation 5.6.2 | RRT |
Laboratory examples
| Worked example | Classification | Public source |
|---|---|---|
| Postoperative bleeding and anemia | General clinical knowledge and context-dependent bleeding assessment; the fictional hemoglobin change is not a standardized transfusion trigger. | PBM |
| Carbon dioxide retention and acidemia | General clinical knowledge plus synthetic numerical interpretation; this is not a guideline-defined intubation or ventilator-adjustment threshold. | GAS, VENTASSESS |
| Oxygenation under defined support | General clinical knowledge/arithmetic; the P:F calculation is not a complete diagnostic criterion or treatment instruction. | GAS, ARDS |
| Lactate in sepsis or postoperative shock | Guideline recommendation G24 is conditional (low certainty) for measuring lactate in sepsis; interpretation and response in this case are context-dependent. | SEPSIS, HEMO |
| Kidney injury after major surgery | Guideline diagnostic definition G25 is not graded. The fictional creatinine change fits a definition component after context checks; the cause and management remain clinical assessments. | AKI, RRT |
| Potassium and rhythm/perfusion changes | General clinical knowledge and context-dependent urgent assessment. The fictional potassium value is not asserted to be one universal treatment threshold. | RRT, HEMO |
| New fever and a suspected source | Guideline recommendation G23 is strong (low certainty) for blood cultures in the stated sepsis population. Other source-directed investigations remain context-dependent; general fever guidance excludes severe immunocompromise. | FEVER, SEPSIS |
| Bleeding/thrombosis balance with anticoagulation | General clinical knowledge and drug/device-specific practice; there is no universal assay or target across these therapies. | PBM, MCS |
| Anemia or dark urine during mechanical support | General clinical knowledge and specialist practice; no isolated marker establishes pump thrombosis. | MCS, LVAD |
| Fluid, electrolyte and acid-base needs during CRRT | Guideline statements G26 are not graded; CRRT preference in unstable patients (G27) is conditional, 2B. Monitoring and adjustment remain individualized. | RRT |
| A displayed number that conflicts with the patient | General measurement knowledge and official device-safety information, applied to fictional observations. | SPO2, GAS, LVAD |
Equipment basics
| Equipment | Classification | Public source |
|---|---|---|
| ICU ventilator | General equipment knowledge; patient-ventilator assessment recommendations G13–G14 have distinct strong/conditional grades. | VENTASSESS |
| Anesthesia workstation | General equipment knowledge from a clinical review; not a single standardized workstation configuration or operating sequence. | WORKSTATION |
| HFNC system | General equipment knowledge; the selected clinical indication G15 has conditional guideline support. | HFNC |
| Noninvasive positive-pressure system | General equipment knowledge; G16/G17 are strong recommendations in specific disease populations, not universal NIV use. | NIV |
| Airway devices and visualization equipment | General equipment knowledge and context-dependent airway planning; specific RSI statements G09–G11 and confirmation guidance G12 are separate. | RSI, TUBE |
| Waveform capnograph | Consensus guidance G12 supports airway-confirmation use; the source does not claim international standards. | TUBE |
| Pulse oximeter | General measurement knowledge and official FDA safety information; not a treatment protocol. | SPO2 |
| Arterial catheter/transducer | General clinical/measurement knowledge; selection and interpretation depend on the clinical setting. | HEMO |
| Central venous catheter | General clinical/measurement knowledge; selection and interpretation depend on the clinical setting. | HEMO |
| Pulmonary artery catheter | General clinical/measurement knowledge and selected specialist practice; not routine use for every ICU patient. | HEMO |
| Infusion or syringe pump | General equipment knowledge and official FDA risk-reduction guidance; device safeguards do not establish a clinical regimen. | PUMP |
| Pleural chest-drain system | General equipment knowledge and procedure-specific practice; pleural guidance is not a standardized cardiac mediastinal-drain protocol. | DRAIN |
| Temporary epicardial pacing system | General clinical/equipment knowledge and context-dependent specialist practice; the cited review explicitly rejects one correct pacing approach for every postoperative patient. | PACE |
| CRRT machine and circuit | General equipment knowledge; G27 is a conditional 2B modality recommendation for the stated unstable AKI population. | RRT |
| VV-ECMO circuit | General equipment knowledge and specialist selection; describing the circuit does not recommend it for every severe respiratory case. | VV |
| VA-ECMO circuit | General equipment knowledge and specialist selection; not a standardized response to any one pressure or lactate. | MCS |
| Intra-aortic balloon pump | General equipment knowledge and selected specialist practice; no universal survival-benefit or routine-use claim is made. | IABP |
| Durable LVAD | General equipment knowledge and specialist practice; a controller display is not a standardized management rule. | LVAD |
| Temporary left-sided microaxial pump | General equipment knowledge and selected specialist practice; no universal device-selection or adjustment protocol is implied. | MCS |
Patient narratives and visual trees
The 18 CTICU procedure pairs, 42 ICU topic pairs, and their integrated workups are synthetic examples. Their differential reasoning applies general clinical knowledge; proposed investigations and treatment choices are context-dependent practice. Their original diagrams organize that reasoning and are not standardized society algorithms. Exact guideline recommendations are labeled separately above; citing one does not convert an entire example into a guideline.
Corrections made during this check
- Corrected the ARDS sentence to distinguish higher PEEP without recruitment maneuvers from the separate recommendation against prolonged recruitment maneuvers.
- Specified the applicable NIV populations and the cardiogenic-pulmonary-edema recommendation’s shock/ACS limits.
- Specified the high-risk, more-than-24-hour ventilation and successful-SBT criteria for the cited preventive post-extubation NIV recommendation.
Machine-readable classification and source-location record · Public source register. This was a scoped source check and classification, not a complete appraisal of every guideline supplement/correction, independent clinical validation or revalidation of earlier manuscripts.