How detailed should an ICU SBAR be compared to floor nursing?

Significantly more detailed. ICU handoffs need to cover ventilator settings, drip rates and titration parameters, hemodynamic targets, organ-by-organ assessment, and hourly trends — not just current values. The incoming nurse needs to understand the trajectory and the ceiling for each intervention before calling the team.

Should I include vent settings in my ICU SBAR report?

Yes — always. Include the mode, rate, tidal volume, FiO2, PEEP, and the most recent ABG with the time it was drawn. Also include any recent changes to settings and the reason for the change. The incoming nurse needs this to evaluate whether the patient is trending toward extubation or deterioration.

How do I communicate vasopressor changes in an SBAR handoff?

Report the current drip, the rate, the trend (increasing or weaning), and the hemodynamic target the team is shooting for. For example: 'Norepinephrine at 12mcg/min, up from 8 at start of shift, target MAP above 65. Fellow aware, vasopressin to be added if norepi exceeds 15mcg/min.' This gives the incoming nurse the ceiling, the target, and the escalation plan.

ICU SBAR Example: Critical Care Shift Report

ICU handoffs are the highest-stakes communication event in nursing. A critical care patient can have 8-12 active drips, an invasive line in every vessel, and multiple organ systems in active failure — all of which the incoming nurse needs to absorb in minutes. SBAR provides the scaffolding to deliver this density without losing the thread.

The example below covers a ventilated sepsis patient on vasopressors — one of the most common and complex ICU scenarios. Pay attention to how organ systems are reported systematically and how titration parameters give the incoming nurse a clear action plan.

SBAR Example: Ventilated Sepsis Patient on Vasopressors

Situation

Mr. Okafor, bed 4, 68-year-old male, ICU day 3, admitted with pneumonia-related septic shock. Currently intubated on volume-controlled AC mode, on norepinephrine and vasopressin drips. He has been hemodynamically tenuous all shift — required norepi titration up twice. Lactic acid is trending down but renal function is worsening. Attending Dr. Shah is aware of the current status and plans to reassess on evening rounds at 2000.

Background

PMH: COPD (home 2L O2), CHF (EF 35%), Type 2 DM, CKD stage 3 (baseline Cr 1.6). Allergies: vancomycin (Red Man syndrome — pretreat with diphenhydramine and slow infusion). Access: R subclavian triple-lumen (day 2, dressing clean), 20g L forearm, R radial a-line. Foley draining scant concentrated urine. OG tube to low intermittent suction, minimal output. Antibiotics: meropenem 1g q8h + azithromycin 500mg daily (day 3 — sputum culture grew MSSA, sensitivities pending for de-escalation). Blood cultures from admission: 2/4 bottles grew gram-positive cocci, speciation pending. Procalcitonin trending down: 18 on admission, 9.2 yesterday, 5.4 today. Code status: DNR per patient's advance directive — full treatment including pressors and vent, but no chest compressions or defibrillation. POA is wife, updated this afternoon.

Assessment

Hemodynamics: BP 92/58 (MAP 69), HR 98 Afib with RVR (rate controlled compared to this AM — was 120s). Norepi at 14mcg/min (up from 10 at start of shift). Vasopressin at 0.04 units/min (fixed dose, started yesterday). CVP 12. Received 500mL LR bolus at 1400 for MAP drop to 60 — responded transiently.
Respiratory: Vent: AC, TV 450, RR 18, FiO2 45%, PEEP 8. Last ABG at 1600: pH 7.32, pCO2 38, pO2 82, HCO3 19, BE -6. SpO2 94%. Bilateral coarse breath sounds, suctioned for moderate thick yellow secretions x3 this shift. CXR this AM showed bilateral infiltrates, slightly improved from yesterday.
Renal: UO 10mL/hr last 4 hours (was 25mL/hr this AM). Cr 2.8 (up from 2.1 yesterday, baseline 1.6). BUN 48. K+ 5.1 — treated with 30g kayexalate PO via OG at 1500, recheck at 2000. Nephrology consulted, recommending CRRT if UO stays below 15mL/hr over next 6 hours.
Neuro: Sedated on propofol 30mcg/kg/min, RASS -2. Follows commands intermittently when lightened. Pupils 3mm equal and reactive.
Lactic acid: 3.1 (down from 4.8 at start of shift, 7.2 on admission). Trending appropriately.

Recommendation

Critical watch points overnight: (1) If MAP drops below 65 despite norepi at 15mcg/min, call fellow Dr. Nguyen to discuss phenylephrine as third pressor. (2) Recheck K+ at 2000 — if still above 5.0, repeat kayexalate and get stat EKG. (3) Strict I&O — if UO remains below 15mL/hr by midnight, page nephrology on call for CRRT initiation (dialysis catheter consent already signed by wife). (4) Next ABG at 2200 to reassess metabolic acidosis. (5) Meropenem due at 2200, azithromycin at 0600. (6) Blood culture speciation should result overnight — micro lab will call. (7) Propofol sedation holiday at 0600 for neuro check per unit protocol. No plan for extubation at this time. Wife plans to visit at 0800 — she is emotionally struggling, chaplain referral placed.

Why Organ-by-Organ Matters in ICU Handoffs

The Assessment section above is organized by organ system rather than as a single paragraph — hemodynamics, respiratory, renal, neuro. This is deliberate. In the ICU, each organ system has its own trajectory, its own team, and its own escalation thresholds. An incoming nurse needs to rapidly locate the information relevant to each system without scanning through a wall of text.

Notice how the Recommendation section is numbered. When you have 7 overnight action items for a single patient, a numbered list prevents anything from being lost. Each item includes the trigger, the action, and who to call — everything the night nurse needs without opening the chart.

Record Your ICU Handoff in 60 Seconds

ICU reports are information-dense. Instead of typing out vent settings, drip rates, and organ assessments, speak your brain dump into ShiftSBAR and get a structured, organ-by-organ SBAR report back instantly. It catches the details you might forget at hour 12 of a shift.