FAST HUGS BID

FAST HUGS BID is a daily ICU checklist mnemonic used to ensure that no essential aspect of critical care is missed. It is widely adopted in modern ICU practice and aligns with principles from Society of Critical Care Medicine, ventilator bundles, and sepsis care bundles.

🅵 — Feeding (Nutrition)

Goal: Early, adequate nutrition to prevent catabolism and ICU-acquired weakness

 Current Guideline-Based Approach

• Start enteral nutrition (EN) within 24–48 hours (if hemodynamically stable)
• Prefer enteral over parenteral nutrition (PN)

 Caloric Targets

• Acute phase: 20–25 kcal/kg/day
• Protein: 1.2–2.0 g/kg/day (↑ in burns, sepsis, trauma)

 When to Use PN

• If EN contraindicated or not tolerated after 5–7 days

🅰 — Analgesia

Pain control is priority before sedation(Analgosedation” strategy (analgesia first)

 Preferred Approach

• Opioid-based analgesia
• Fentanyl (hemodynamically stable)
• Morphine (avoid in renal failure)

 Monitoring

• Use Behavioral Pain Scale (BPS) or CPOT

🆂 — Sedation

 Targets

• Light sedation (unless indicated otherwise)
• RASS target: -2 to 0

 Preferred Drugs

• Propofol (short-acting, rapid titration)
• Dexmedetomidine (less delirium, cooperative sedation)

 ICU Protocol

• Daily sedation interruption (SAT)
• Avoid benzodiazepines (↑ delirium risk)

🆃 — Thromboprophylaxis

• ICU patients = high risk of VTE

 Pharmacological

• LMWH (preferred)
• UFH (if renal failure)

 Mechanical

• IPC / GCS if bleeding risk

 Contraindications

• Active bleeding
• Severe thrombocytopenia

🅷 — Head-of-bed Elevation

 Standard

• Elevate 30–45°

 Benefits

• Prevents ventilator-associated pneumonia (VAP)
• Reduces aspiration risk

🆄 — Ulcer Prophylaxis

 Stress Ulcer Risk Factors

• Mechanical ventilation >48h
• Coagulopathy
• Shock

 Drugs

• PPI (pantoprazole)
• H2 blockers (less commonly used)

 Caution

• Overuse → ↑ pneumonia, C. difficile

🅶 — Glycemic Control

 Target (Guidelines)-140–180 mg/dL (recommended range)

 Avoid-Tight control (<110) → hypoglycemia risk

 Method-IV insulin infusion with protocolized monitoring

🆂 — Spontaneous Breathing Trial (SBT)

 Daily Assessment

• Readiness to wean from ventilator

 Criteria

• Hemodynamic stability
• Adequate oxygenation (FiO₂ ≤40%, PEEP ≤5–8)

 Method

• T-piece or low pressure support

🅱 — Bowel Care

 Problems in ICU

• Ileus
• Constipation due to opioids

 Management

• Stool softeners, laxatives
• Early enteral feeding

🅸 — Indwelling Catheters

 Daily Review

• Foley catheter
• Central lines
• Arterial lines

 Goal

• Remove ASAP → prevent infections (CLABSI, CAUTI)

🅳 — De-escalation of Antibiotics

 Core Principle

• Start broad → narrow based on cultures

 Steps

• Daily review of cultures
• Stop unnecessary antibiotics
• Follow antimicrobial stewardship

 Importance

• Prevents resistance
• Reduces toxicity

Many ICUs now expand FAST HUGS BID with:

➕ D — Delirium Monitoring

• Use CAM-ICU
• Avoid benzos, promote sleep

➕ E — Early Mobilization

• Passive → active → ambulation
• Prevent ICU-acquired weakness

➕ F — Family Communication

• Essential for ethical ICU care

 FAST HUGS BID — ICU BEDSIDE ROUNDS PROFORMA

 PATIENT IDENTIFICATION

• Name: __________________________
• Age/Sex: ________________________
• ICU ID/Bed No.: ________________
• Date/Time: _____________________
• Primary Diagnosis: __________________________________
• Day of ICU Stay: __________
• Ventilated: ☐ Yes ☐ No

🅵 — FEEDING

• Route: ☐ Oral ☐ NG ☐ NJ ☐ PEG ☐ TPN
• Calories prescribed: __________ kcal/day
• Calories received (last 24h): __________
• Protein intake: __________ g/day
• Feed tolerance: ☐ Good ☐ Poor
• Aspiration risk: ☐ Yes ☐ No

🅰 — ANALGESIA

• Pain score (BPS/CPOT): __________
• Analgesic used: __________________
• Adequacy: ☐ Yes ☐ No
• Breakthrough pain: ☐ Yes ☐ No

🆂 — SEDATION

• Sedation score (RASS): __________
• Target RASS: __________
• Sedative drug: __________________
• Daily sedation interruption: ☐ Done ☐ Not done
• Delirium (CAM-ICU): ☐ Positive ☐ Negative

🆃 — THROMBOPROPHYLAXIS

• Pharmacological: ☐ LMWH ☐ UFH ☐ Not given
• Mechanical: ☐ IPC ☐ GCS ☐ Not used
• Contraindication present: ☐ Yes ☐ No

🅷 — HEAD-UP POSITION

• Head elevation: ☐ 30–45° ☐ Not adequate

🆄 — ULCER PROPHYLAXIS

• Indicated: ☐ Yes ☐ No
• Drug: ☐ PPI ☐ H2 blocker ☐ None

🅶 — GLYCEMIC CONTROL

• Blood glucose range (last 24h): __________
• Insulin: ☐ Infusion ☐ SC ☐ None
• Target achieved (140–180 mg/dL): ☐ Yes ☐ No

🆂 — SPONTANEOUS BREATHING TRIAL (SBT)

• Eligible for SBT: ☐ Yes ☐ No
• SBT done today: ☐ Yes ☐ No
• Outcome: ☐ Passed ☐ Failed
• Ventilator settings: __________________

🅱 — BOWEL CARE

• Bowel movement: ☐ Yes ☐ No
• Constipation: ☐ Yes ☐ No
• Laxatives/stool softeners: ☐ Yes ☐ No

🅸 — INDWELLING DEVICES

🅳 — DE-ESCALATION (ANTIBIOTICS)

• Current antibiotics: __________________
• Day of therapy: __________
• Culture results: __________________
• De-escalation possible: ☐ Yes ☐ No
• Stop antibiotics: ☐ Yes ☐ No

➕ ADDITIONAL ICU CARE ELEMENTS

DELIRIUM

• CAM-ICU: ☐ Positive ☐ Negative
• Non-pharmacological measures: ☐ Yes ☐ No

 EARLY MOBILIZATION

• Mobility level: ☐ Passive ☐ Active ☐ Ambulation
• Physiotherapy: ☐ Yes ☐ No

 FAMILY COMMUNICATION

• Updated today: ☐ Yes ☐ No
• Issues discussed: __________________