# ICU Bundle

# ICU Bundle
-- Fluids/Feeding: *** TEN unless ileus or escalating pressors; consider TPN if > 7 days
-- Activity: *** passive ROM, active ROM, sitting, standing, walking; can stand even if intubated, early mobilization linked to improved mortality
-- Sedation/Analgesia: *** RAAS goal - initial goal -2-3, if oxygenating well, go to 0-1
-- Thromboprophylaxis: *** lovenox vs heparin - depends on renal function; should get chemical ppx unless active bleed
-- Hyperoxia: *** goal to keep between 92-96%, if SpO2 >96%, discuss plan to wean
-- Ulcer PPx: *** PPI or H2 blocker okay; if intubated, shock, increased bleed risk, plt <50, INR >1.5, PTT >2x ULN
-- Glycemic Control: *** goal glucose 120-180, often basal-bolus, but insulin gtt if needed
-- Bowel Regimen: *** review last BM and current regimen - PRN vs standing senna, miralax, latulose, rifaximin, enema, etc
-- Indwelling Devices: *** remove CVC if no longer on pressors, remove A-line once low dose pressor and cuff BP reliable, remove foley if don’t need close I/O’s - prefer condom catheter and purewick 
-- De-Escalation: *** antibiotics, sedation, agitating components of care
-- Code Status: *** any plans for GOC conversations? 
-- Dispo: *** current ICU indication; ready for the floor?