Five new recommendations were developed to reduce waste and enhance value in the practice of critical care, according to a recent study published in the journal Critical Care Medicine.

In 2014, the Society of Critical Care Medicine helped create the original “Choosing Wisely” for Critical Care recommendations, and 5 years later, a multidiscipline task force convened to identify the “Next Five.” The taskforce conducted a literature search for articles about reducing waste and enhancing value in critical care medicine, focusing on articles published after the initial “Choosing Wisely” series of recommendations. Practices assessed to add no value to critical care were grouped by category. Results were ranked by the Society of Critical Care Medicine membership to determine importance.

The initial literature search yielded 13 “Don’t” statements, which were reduced to 8 by the taskforce. Ranking of the remaining 8 yielded the 5 updated “Choosing Wisely” recommendations below:

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  • Do not retain catheters and drains in place without a clear indication.
  • Do not delay liberation from mechanical ventilation.
  • Do not continue antibiotic therapy without evidence of need.
  • Do not delay mobilizing patients in intensive care unit.
  • Do not provide care that is discordant with the patient’s goals and values.

“Five new recommendations to reduce waste and enhance value in the practice of critical care address invasive devices, proactive liberation from mechanical ventilation, antibiotic stewardship, early mobilization, and providing goal-concordant care,” the study authors wrote. “The success of this initiative will be judged by the extent of recommendation implementation and the impact of those recommendation on both care cost and outcomes.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Zimmerman JJ, Harmon LA, Smithburger PL, et al. Choosing wisely for critical care: the next five. Crit Care Med. 2021;49(3):472-481. doi:10.1097/CCM.0000000000004876