Early Rehabilitation in the ICU: Do We Still Need Chest Physiotherapy?
|
|
- Arron Barnett
- 6 years ago
- Views:
Transcription
1 Early Rehabilitation in the ICU: Do We Still Need Chest Physiotherapy? Michelle Kho, PT, PhD Assistant Professor, School of Rehabilitation Science, McMaster University Adjunct Assistant Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University November 12, 2013
2 Financial Interest Disclosure I have no conflict of interest. Funding Canadian Institutes of Health Resarch
3 Overview of today s talk A resource issue Review of evidence Practical considerations
4 We have a potentially serious supply and demand problem in Canada: Landry et al., Human Resources for Health 2007, 5:23.
5 And in the United States: Zimbleman et al., PM R. 2010;2(11):
6 Projected incidence of non-cardiac surgery, mechanically ventilated adults 40% Needham et al., Crit Care Med (3):574-9.
7 Prospective 1 and 5-year follow-up study of 109 ICU survivors Setting: 4 Canadian ICUs Population: Adult patients with ARDS Clinical Course ICU Admission ICU Discharge Outcomes: Primary 6 minute walk test Pulmonary function tests Health-related quality of life 6 minute walk distance 3 months 6 months 12 months N= m 49% predicted N= m 64% predicted N= m 66% predicted 60 months N= m 76% predicted Herridge et al, NEJM :683-93;Herridge et al., NEJM :
8 Prospective 1 year study of 545 ICU survivors Setting: 41 US ICUs Population: Adult pts with ARDS in NHLBI EDEN RCT Clinical Course ICU Admission ICU Discharge Outcomes: Primary SF-36 (V2) Physical function domain Secondary Physical, psychological, & cognitive function; quality of life; employment status Mean (SD) ICU LOS: 14(12); Hospital LOS: 22(16) Outcomes Norms 6 months 12 months SF-36 Physical Function 82(9) 51(32) 55(32) SF-36 Mental Health 76(3) 64(26) 65(25) Substantial PTSD 26% (122/514) 23% (107/487) Employed 52% (116/223) 52% (116/223) Needham et al., BMJ :f1532.
9 Emerging evidence base for early ICU mobility RCT: PT and OT started within 1.5 days of intubation improves independence at hospital discharge Main difference: 19.2 minutes/ day during MV Lancet : RCT: In-bed cycling started ICU day 14 improved 6-minute walk test distance at hospital discharge Crit Care Med (9): Question: What is ICU mobility practice in Canada?
10 Early ICU Rehab in Canada Canadian survey of ICU mobilization practices Rigorous survey of academic ICUs 311 respondents (117 PTs, 194 MDs), 71% response 68% rated early mobilization very important or crucial Reported PT practice: Average 7.2 hours/ day Average caseload 6 ICU + 10 ward patients 83% frequently or routinely provided chest PT After 5:00 pm or on weekends, priority is chest PT, not mobility Koo, KY Open Access Dissertations and Theses. Paper 7499.
11 What is the evidence for chest physiotherapy in patients receiving mechanical ventilation?
12 Terminology: What is chest physiotherapy? percussion vibration suctioning Ventilator hyperinflation All are interventions to improve respiratory function, which can be delivered by a registered physiotherapist or other members of the critical care team.
13 Methodological assessment (AMSTAR) 1. A priori design 2. Duplicate study selection & extraction 3. Comprehensive literature search 4. Use of grey literature 5. List of included and excluded studies 6. Characteristics of included studies AMSTAR reference: 7. Quality assessment of included studies (not GRADE) 8. Incorporation of quality considered in analysis 9. Appropriate pooling? N/A 10.Publication bias assessed N/A 11.Conflict of interest stated Stiller. Chest (3):
14 Results: Multimodality respiratory physiotherapy 18 clinical studies 5 randomized clinical trials 9 randomized crossover trials 1 systematically allocated controlled trial 1 historical controlled trial 2 observational studies Of the 5 RCTs excluded pts w/ pleural effusions, untreated pneumothorax, neuromuscular weakness Stiller. Chest Sep;144(3):
15 Description of RCTs Author Population Intervention Comparison Main Outcomes Patman et al., 2001 / Australia Post-op cardiac surgery MV <24h Positioning, MH, thoracic & arm exs (n=101) No PT during intubation (n=109) # PT Rx while intubated; postop pulmonary complications Patman et al., 2009 / Australia Acquired brain injury >24 h MV Targeted positioning, MH 6x30min q24h until weaned (n=72) General positioning, MH (n=72) 1 : VAP 2 : LOS, MV duration, mortality Barker et al / UK Acute lung injury & MV 1: 1 Rx of positioning, 6 MH breaths, (n=7); 17 min 2: Routine care (n=5); 5 min 3: Positioning (n=5); 15 min Oxygenation, dynamic compliance, & hemodynamics MH = manual hyperinflation; VAP = ventilator-associated pneumonia; LOS = length of stay All groups received suctioning Stiller. Chest Sep;144(3):
16 Description of RCTs (cont d) Author Population Intervention Comparison Main Outcomes Templeton et al., 2007 / UK Pattanshetty et al / India Pattanshetty et al., 2011 / India NEW Med-Surg ICU >48 h MV ICU >48 h MV ICU >48 h MV Positioning, MH, rib springing, mobility BID (n=87)* Positioning, MH, chest vibration BID until weaned (n=50) Same as above; (n=87) Positioning, mobility BID (n=85)* MH BID until weaned (n=50) Same as above; (n=86) 1 : time to ventilator free 2 : LOS, mortality, VAP 1 : VAP 2 : LOS, mortality 1 : recovery rate 2 : LOS, VAP MH = manual hyperinflation; VAP = ventilator-associated pneumonia; LOS = length of stay All groups received suctioning *allowed rescue therapy for sudden sustained desaturation due to mucous plugging Stiller. Chest Sep;144(3): Pattanshetty et al., Indian J Med Sci. 2011;65(5):
17 GRADE = Grades of Recommendation Assessment, Development and Evaluation 2 part framework: 1. Quality of Evidence 2. Strength of recommendations Extent to which we are confident that an estimate of effect is correct. CMAJ 2003, BMJ 2004, BMC 2004, BMC 2005, AJRCCM 2006, Chest 2006, BMJ 2008
18 GRADE Quality assessment criteria Study design Quality of evidence Lower if Higher if Randomized trials High Study limitations (design and execution) Large effect (e.g., RR 0.5) Very large effect (e.g., RR 0.2) Moderate Inconsistency Evidence of dose-response gradient Observational studies Low Very low Indirectness Imprecision All plausible confounding would reduce a demonstrated effect Publication bias Slide from Schünemann/ Falck-Ytter
19 GRADE Quality Assessment Of 6 parallel group RCTs (n=816 patients), Most evidence low to very low quality ( ) Reasons for downgrading Imprecision (small sample sizes) Indirectness (differences in interventions) Inconsistent results Study design limitations Outcomes assessors not blinded to group Overall weaknesses in study reporting GRADE Interpretation: Our confidence in the effect is limited: The true effect may be substantially different from the estimate of the effect.
20 Results by patient population Author Population Main Results Patman et al., 2001 / Australia Patman et al., 2009 / Australia Barker et al / UK Post-op cardiac surgery MV <24h Acquired brain injury >24 h MV Acute lung injury & MV No difference in duration of MV, ICU or hospital LOS 1 : VAP no difference 2 : LOS, MV duration, mortality - no difference Oxygenation, dynamic compliance, & hemodynamics MH = manual hyperinflation; VAP = ventilator-associated pneumonia; all groups received suctioning
21 RCTs of routine chest PT for all patients receiving mechanical ventilation Outcome Duration of mechanical ventilation Ventilator-associated pneumonia # studies Summary of Results 3 1 study, time to ventilator free 4 d longer in group receiving chest PT (median 15 vs. 11; p=0.045) 3 No difference ICU LOS 2 No difference Hospital LOS 2 1 study, 3.2 days longer in group receiving chest PT (p=0.000) 1 study, no difference Mortality 2 1 study, lower in group receiving chest PT (12/50 vs. 25/51, p=0.007) 1 study, no difference
22 Strengths and Limitations of Data Strengths Published clinical trials Published systematic review Utilization-focused outcomes Limitations Applicability in Canadian setting Need more focused study of specific populations / indications Need more detailed intervention reporting Frequency, Intensity, Time, Type Need more patientspecific outcomes E.g., Function
23 Practical considerations
24 Based on best available evidence: Supply: Projected future shortage of PTs PT availability ~7 h/ day Demand: Increased demand for MV More ICU survivors at risk for post-icu sequelae What are the opportunity costs with limited resources and increased demands? Q: Should we offer routine chest physiotherapy for all MV patients? A: No Q: Do we still need chest physiotherapy in the ICU? A: It depends. Q: Should we abandon study of chest physiotherapy in the ICU? A: No field ripe for research in specific populations / indications; ideal for interdisciplinary teams
25 Summary of today s talk A resource issue Review of evidence khome@mcmaster.ca Practical considerations
PHYSIOTHERAPY IN INTENSIVE CARE: how the evidence has changed since 2000 Kathy Stiller Physiotherapy Department Royal Adelaide Hospital Adelaide South Australia Kathy.Stiller@health.sa.gov.au Aim review
More informationTime is Muscle. In this talk, I will address 3 ques7ons: School of Rehabilita?on Science Reaching Further
School of Rehabilita?on Science Reaching Further Time is Muscle Michelle Kho, PT, PhD Canada Research Chair in Cri?cal Care Rehabilita?on and Knowledge Transla?on McMaster University, Hamilton, ON Clinician
More informationRehabilitation after Critical Illness: What Should this Look Like?
Rehabilitation after Critical Illness: What Should this Look Like? Margaret Herridge MD MPH Associate Professor of Medicine Interdepartmental Division of Critical Care University of Toronto Canadian Critical
More informationANWICU knowledge
ANWICU knowledge www.anwicu.org.uk This presentation is provided by ANWICU We are a collaborative association of ICUs in the North West of England. Permission to provide this presentation has been granted
More informationREHABILITATION OF PATIENTS MANAGED IN ICU
REHABILITATION OF PATIENTS MANAGED IN ICU RECOMMENDATIONS Safety to mobilize / exercise: on the website Recommendation 1 All critically ill patients nursed in ICU should be screened closely before active
More informationDIAGRAM OF THE PRESENTATION. Post ICU Rehabilitation. Effective strategies in ICU. During two last decades
1 1st European Conference on Weaning & Rehabilitation in Critically ill Patients INTERNATIONAL EARLY MOBILISATION NETWORK Post ICU Rehabilitation Serafeim N. Nanas Professor of Critical Care Medicine Evaggelismos
More information1. Screening to identify SBT candidates
Karen E. A. Burns MD, FRCPC, MSc (Epid) Associate Professor, Clinician Scientist St. Michael s Hospital, Toronto, Canada burnsk@smh.ca Review evidence supporting: 1. Screening to identify SBT candidates
More informationAcute Lung Injury/ARDS. Disclosures. Overview. Acute Respiratory Failure 5/30/2014. Research funding: NIH, UCSF CTSI, Glaxo Smith Kline
Disclosures Acute Respiratory Failure Carolyn S. Calfee, MD MAS UCSF Critical Care Medicine and Trauma CME May 30, 2014 Research funding: NIH, UCSF CTSI, Glaxo Smith Kline Medical advisory boards: Cerus
More informationCan Goal Directed Sedation Improve Outcomes?
Can Goal Directed Sedation Improve Outcomes? Yahya SHEHABI, FANZCA, FCICM, EMBA Professor and Program Director Critical care Monash Health and Monash University - Melbourne School of Medicine, University
More informationNew Surveillance Definitions for VAP
New Surveillance Definitions for VAP 2012 Critical Care Canada Forum Toronto Dr. John Muscedere Associate Professor of Medicine, Queen s University Kingston, Ontario Presenter Disclosure Dr. J. G. Muscedere
More informationAbstract: Introduction: Sumbla A 1, Rafaqat A 2, Shaukat A 3, Kanwal R 4, Janjua UI 5
Effectiveness of Manual Hyperinflation Therapy plus Postural Drainage and Suctioning To Prevent Ventilator Associated Complications Sumbla A 1, Rafaqat A 2, Shaukat A 3, Kanwal R 4, Janjua UI 5 Abstract:
More informationPhysiotherapy on the Intensive Care Unit. Information for patients, their family and carers
Physiotherapy on the Intensive Care Unit Information for patients, their family and carers A team of Specialist Physiotherapists works in the Intensive Care Units within the Oxford University Hospitals
More informationDisclosure. Hospira Pharmaceuticals. Unrestricted research funding Honoraria for CME education administered via France Foundation
Disclosure Hospira Pharmaceuticals Unrestricted research funding Honoraria for CME education administered via France Foundation Economics in Sedation: Responsible Use of the ICU Budget John W. Devlin,
More informationTHE USE OF HYPERINFLATION IN THE MANAGEMENT OF INTUBATED AND VENTILATED ADULT PATIENTS RECOMMENDATIONS
THE USE OF HYPERINFLATION IN THE MANAGEMENT OF INTUBATED AND VENTILATED ADULT PATIENTS RECOMMENDATIONS Recommendation 1 on website Hyperinflation (Ventilator or manual) might be included in the management
More informationLiberation from Mechanical Ventilation in Critically Ill Adults
Liberation from Mechanical Ventilation in Critically Ill Adults 2017 ACCP/ATS Clinical Practice Guidelines Timothy D. Girard, MD, MSCI Clinical Research, Investigation, and Systems Modeling of Acute Illness
More information(Non)-invasive ventilation: transition from PICU to home. Christian Dohna-Schwake
(Non)-invasive ventilation: transition from PICU to home Christian Dohna-Schwake Increased use of NIV in PICUs over last 15 years First choice of respiratory support in many diseases Common temporary indications:
More informationNIV in hypoxemic patients
NIV in hypoxemic patients Massimo Antonelli, MD Dept. of Intensive Care & Anesthesiology Università Cattolica del Sacro Cuore Rome - Italy Conflict of interest (research grants and consultations): Maquet
More informationNeuromuscular Blockade in ARDS
Neuromuscular Blockade in ARDS Maureen O. Meade, MD, FRCPC Critical care consultant, Hamilton Health Sciences Professor of Medicine, McMaster University www.oscillatetrial.com Disclosures None Possible
More informationPro: Early use of VV ECMO for ARDS
Pro: Early use of VV ECMO for ARDS Kyle J. Rehder, MD, FCCP Associate Professor Division of Pediatric Critical Care Medicine Department of Pediatrics Duke Children s Hospital The ventilator is slowly killing
More informationTargeting depression after ARDS. Neill Adhikari Sunnybrook Health Sciences and University of Toronto 29 October 2012
Targeting depression after ARDS Neill Adhikari Sunnybrook Health Sciences and University of Toronto 29 October 2012 None Conflicts of interest Objectives Review epidemiology of depression after ARDS Review
More informationStrategies for Enhancing Sepsis Survivorship
Strategies for Enhancing Sepsis Survivorship Hallie Prescott, MD, MSc Ohio Hospital Association August 16, 2016 Disclosures I have no relevant financial conflicts of interest Key Funding NIH/NIGMS American
More informationWhat About All Those Critical Lines? Lines, catheters and drains can be accommodated, secured EVD line stationary bike
What About All Those Critical Lines? Lines, catheters and drains can be accommodated, secured EVD line stationary bike What About All Those Critical Lines?. Patient lines and drains can be accommodated
More informationOutcomes From Severe ARDS Managed Without ECMO. Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016
Outcomes From Severe ARDS Managed Without ECMO Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016 Severe ARDS Berlin Definition 2012 P:F ratio 100 mm Hg Prevalence:
More informationAPILOT SURVEY OF THE CURRENT SCOPE OF PRACTICE OF SOUTH AFRICAN PHYSIOTHERAPISTS IN INTENSIVE CARE UNITS
P ILOT S TUDY APILOT SURVEY OF THE CURRENT SCOPE OF PRACTICE OF SOUTH AFRICAN PHYSIOTHERAPISTS IN INTENSIVE CARE UNITS ABSTRACT: Objective: A pilot study was conducted to determine the current scope of
More informationCRITICALLY APPRAISED PAPER (CAP)
CRITICALLY APPRAISED PAPER (CAP) FOCUSED QUESTION Is early mobilization safe and more effective than usual care in promoting recovery and functional independence in clients in the intensive care unit (ICU)
More informationLandmark articles on ventilation
Landmark articles on ventilation Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity ARDS AECC DEFINITION-1994 ALI Acute onset Bilateral chest infiltrates PCWP
More informationChest physiotherapy in mechanically ventilated patients without pneumonia a narrative review
Review Article Chest physiotherapy in mechanically ventilated patients without pneumonia a narrative review Herbert D. Spapen, Jouke De Regt, Patrick M. Honoré Department of Intensive Care, Universitair
More informationCochrane-GRADE Workshop
Cochrane-GRADE Workshop Modena, June 2017 Holger Schünemann, Elena Parmelli, Sara Balduzzi Jane Noyes, Heather Munthe-Kaas, Claire Glenton Background / history of GRADE and GRADE CERQual Deep vein thrombosis
More informationRehabilitation within critical care
Rehabilitation within critical care Why consider Rehab on ITU? 110,000 people admitted to critical care units in England and Wales each year (ICNARC) 75% survive and are discharged home Long Term Effects
More informationOSCAR & OSCILLATE. & the Future of High Frequency Oscillatory Ventilation (HFOV)
& & the Future of High Frequency Oscillatory Ventilation (HFOV) www.philippelefevre.com What do we know already? Sud S et al. BMJ 2010 & Multi-centre randomised controlled trials of HFOV verses current
More informationPhysio At The Front-Line: Physio In A Rural ED
Physio At The Front-Line: Physio In A Rural ED Presented by David Sparshott Dubbo Base Hospital Physiotherapy Department Background Emergency Departments have, in the past, been synonymous with Doctors
More informationTransfusion for the sickest ICU patients: Are there unanswered questions?
Transfusion for the sickest ICU patients: Are there unanswered questions? Tim Walsh Professor of Critical Care Edinburgh University None Conflict of Interest Guidelines on the management of anaemia and
More informationNoninvasive Ventilation: Non-COPD Applications
Noninvasive Ventilation: Non-COPD Applications NONINVASIVE MECHANICAL VENTILATION Why Noninvasive Ventilation? Avoids upper A respiratory airway trauma system lacerations, protective hemorrhage strategy
More informationEarly and Structured Rehabilitation Team Collaboration. David McWilliams Clinical Specialist Physiotherapist - UHB
Early and Structured Rehabilitation Team Collaboration David McWilliams Clinical Specialist Physiotherapist - UHB Start early Moving through milestones Schweikert et al (2009) Increase frequency of higher
More informationLong-term impact & outcomes of neurological critical illness
Long-term impact & outcomes of neurological critical illness M. Elizabeth Wilcox, MD MPH Assistant Professor of Critical Care Medicine, University of Toronto Staff Physician, University Health Network
More informationEarly Mobility: The Experiences of Two ICUs
Early Mobility: The Experiences of Two ICUs Sharon Dickinson MSN, RN, ANP, ACNS-BC, CCRN Clinical Nurse Specialist SICU/Rapid Response Sarah Taylor MSN, RN, ACNS-BC Clinical Nurse Specialist TBICU University
More informationWashington, DC, November 9, 2009 Institute of Medicine
Holger Schünemann, MD, PhD Chair, Department of Clinical Epidemiology & Biostatistics Michael Gent Chair in Healthcare Research McMaster University, Hamilton, Canada Washington, DC, November 9, 2009 Institute
More information9/28/2016. Sedation Strategies in the ICU. Outline. ICU sedation. Recent clinical practice guidelines Top 10 myths A practical approach
Sedation Strategies in the ICU UW Medicine EMS and Trauma Conference Seattle, Washington September 26 th, 2016 C. Terri Hough, MD MSc Associate Professor of Medicine Division of Pulmonary and Critical
More informationApplication of Lung Protective Ventilation MUST Begin Immediately After Intubation
Conflict of Interest Disclosure Robert M Kacmarek Managing Severe Hypoxemia!" 9-28-17 FOCUS Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts I disclose
More informationBenefit of Selective Inspiratory Muscles Training on Respiratory Failure Patients
Available online at www.ijmrhs.com ISSN No: 2319-5886 International Journal of Medical Research & Health Sciences, 2017, 6(5): 49-54 Benefit of Selective Inspiratory Muscles Training on Respiratory Failure
More informationNutrition and Sepsis
Nutrition and Sepsis Todd W. Rice, MD, MSc Associate Professor of Medicine Vanderbilt University 2017 DNS Symposium June 2, 2017 Case 55 y.o. male COPD, DM, HTN, presents with pneumonia and septic shock.
More informationElizabeth Parsons, MD Senior Fellow, Division of Pulmonary & Critical Care Medicine University of Washington, Seattle WA
Elizabeth Parsons, MD Senior Fellow, Division of Pulmonary & Critical Care Medicine University of Washington, Seattle WA How do we define a good outcome after critical illness? Health-related quality of
More informationE1. Post hospital discharge follow-up services and rehabilitation programmes
A UK Survey of Rehabilitation Following Critical Illness: Implementation of NICE Clinical Guidance 83 (CG83) Following Hospital Discharge B Connolly 1, 2, 3 Clinical Research Fellow, A Douiri 4 Lecturer
More informationRecognizing and Correcting Patient-Ventilator Dysynchrony
2019 KRCS Annual State Education Seminar Recognizing and Correcting Patient-Ventilator Dysynchrony Eric Kriner BS,RRT Pulmonary Critical Care Clinical Specialist MedStar Washington Hospital Center Washington,
More informationNIV in COPD Acute and Chronic Use
NIV in COPD Acute and Chronic Use Dr C M Chu MD, MSc, FRCP, FCCP Consultant Physician Department of Medicine & Geriatrics United Christian Hospital, Hong Kong NIV in COPD I. AE-COPD/ARF II. III. Weaning
More informationAssessing perioperative risk
Assessing perioperative risk Chronic Obstructive Pulmonary Disease Dr. Michelle Caldecott Respiratory & Sleep Physician Epworth Healthcare Austin Health Impact of COPD on Postoperative Outcomes: Results
More informationOptimizing the Lung Transplant Candidate through Exercise Training. Lisa Wickerson BScPT, MSc Canadian Respiratory Conference April 25, 2014
Optimizing the Lung Transplant Candidate through Exercise Training Lisa Wickerson BScPT, MSc Canadian Respiratory Conference April 25, 2014 Conflicts of Interest None to declare Learning Objectives At
More informationCanadian Trauma Trials Collaborative. Occult Pneumothorax in Critical Care (OPTICC): Standardized Data Collection Sheet
Canadian Trauma Trials Collaborative STUDY CENTRE: Institution: City / Province: / Occult Pneumothorax in Critical Care (OPTICC): Standardized Sheet PATIENT DEMOGRAPHICS: First Name: Health record number
More informationWhat are Appropriate End-points for Delirium Prevention/Treatment Studies
What are Appropriate End-points for Delirium Prevention/Treatment Studies Pratik Pandharipande, MD, MSCI Professor of Anesthesiology and Surgery Department of Anesthesiology Vanderbilt University School
More informationEarly Mobility and Walking Program for Patients in Intensive Care Units: Creating a Standard of Care
1 of 11 06/08/2009 12:52 www.medscape.com From American Journal of Critical Care Early Mobility and Walking Program for Patients in Intensive Care Units: Creating a Standard of Care Creating a Standard
More information7 Initial Ventilator Settings, ~05
Abbreviations (inside front cover and back cover) PART 1 Basic Concepts and Core Knowledge in Mechanical -- -- -- -- 1 Oxygenation and Acid-Base Evaluation, 1 Review 01Arterial Blood Gases, 2 Evaluating
More informationDisparities in the ICU: The Elderly? Shannon S. Carson, MD Associate Professor Pulmonary and Critical Care Medicine University of North Carolina
Disparities in the ICU: The Elderly? Shannon S. Carson, MD Associate Professor Pulmonary and Critical Care Medicine University of North Carolina Critical Care Is Care of the Elderly 15,757 consecutive
More informationBack to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill
Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill Joe Palumbo PGY-2 Critical Care Pharmacy Resident Buffalo General Medical Center Disclosures
More informationMoving from VAP to VAC
Moving from VAP to VAC Cindy Munro, PhD, RN, ANP-BC, FAANP, FAAN Associate Dean of Research and Innovation Professor College of Nursing Conflict of interest: No relationships with pharmaceutical companies,
More informationSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care
More informationRecovery trajectories following critical illness: Can we really modify them? Tim Walsh Professor of Critical Care, Edinburgh University
Recovery trajectories following critical illness: Can we really modify them? Tim Walsh Professor of Critical Care, Edinburgh University Considerations What is the problem? What is the current evidence
More informationInhaled nitric oxide: clinical evidence for use in adults
Inhaled nitric oxide: clinical evidence for use in adults Neill Adhikari Critical Care Medicine Sunnybrook Health Sciences Centre and University of Toronto 31 October 2014 Conflict of interest Ikaria provided
More informationOptimize vent weaning and SBT outcomes. Identify underlying causes for SBT failures. Role SBT and weaning protocol have in respiratory care
Optimize vent weaning and SBT outcomes Identify underlying causes for SBT failures Role SBT and weaning protocol have in respiratory care Lower risk of developing complications Lower risk of VAP, other
More informationIntroduction. Centers for Disease Control and Prevention (CDC),
When Prevention Fails: The Clinical and Economic Impact of Sepsis Introduction Healthcare-associated infections are one of the top 0 leading causes of death in the U.S. The US Centers for Disease Control
More informationInfection Control. Craig M Coopersmith, MD
Infection Control Craig M Coopersmith, MD Professor of Surgery Director, Surgical Intensive Care Unit Associate Director Emory Center for Critical Care Financial disclosure I have received grant support
More informationMechanical Ventilation in COPD patients
Mechanical Ventilation in COPD patients Θεόδωρος Βασιλακόπουλος Καθηγητής Πνευμονολογίας-Εντατικής Θεραπείας Εθνικό & Καποδιστριακό Πανεπιστήμιο Αθηνών Νοσοκομείο «ο Ευαγγελισμός» Adjunct Professor, McGill
More informationAdjunct Therapies for Pediatric ARDS: Where are the Data?
Adjunct Therapies for Pediatric ARDS: Where are the Data? Alexandre T. Rotta, MD, FCCM Professor of Pediatrics, Linsalata Family Endowed Chair in Pediatric Critical Care and Emergency Medicine Rainbow
More informationECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH
ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate Carolyn Calfee, MD MAS Mark Eisner, MD MPH June 3, 2010 Case Presentation Setting: Community hospital, November 2009 29 year old woman with
More informationThe Potential For Microbiome Modification In Critical Illness. Deborah Cook
The Potential For Microbiome Modification In Critical Illness Deborah Cook To review Objectives The microbiome & concepts about its modification during critical illness Interventions Predisposition to
More informationSedation Management AfteR Tracheostomy (SMART) study
Sedation Management AfteR Tracheostomy (SMART) study Koji Hosokawa, MD 1 Egi M., MD 2, Nishimura M., MD 3 1 Kyoto Prefectural Yosanoumi Hospital, Kyoto, Japan 2 Okayama, Japan, 3 Tokushima, Japan ANZICS
More informationFTS Oesophagectomy: minimal research to date 3,4
Fast Track Programme in patients undergoing Oesophagectomy: A Single Centre 5 year experience Sullivan J, McHugh S, Myers E, Broe P Department of Upper Gastrointestinal Surgery Beaumont Hospital Dublin,
More informationARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013
ARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013 Pauline K. Park MD, FACS, FCCM University of Michigan School of Medicine Ann Arbor, MI OVERVIEW New Berlin definition of ARDS
More informationUpdate in Critical Care Medicine
Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update
More informationAlcohol interventions in secondary and further education
National Institute for Health and Care Excellence Guideline version (Draft for Consultation) Alcohol interventions in secondary and further education NICE guideline: methods NICE guideline Methods
More informationprolonged bed rest and inactivity EARLY REHABILITATION IN THE ICU:
Mortality and ARDS EARLY REHABILITATION IN THE ICU: MOVE IT or LOSE IT Progress of Intensive Care Medicine has resulted in significantly improved survival of cri:cally ill pa:ents. Rik Gosselink Dept Rehabilita>on
More informationCritical Appraisal Practicum. Fabio Di Bello Medical Implementation Manager
Critical Appraisal Practicum Fabio Di Bello Medical Implementation Manager fdibello@ebsco.com What we ll talk about today: DynaMed process for appraising randomized trials and writing evidence summaries
More informationVentilatory Management of ARDS. Alexei Ortiz Milan; MD, MSc
Ventilatory Management of ARDS Alexei Ortiz Milan; MD, MSc 2017 Outline Ventilatory management of ARDS Protected Ventilatory Strategy Use of NMB Selection of PEEP Driving pressure Lung Recruitment Prone
More informationProlonged Mechanical Ventilation
Prolonged Mechanical Ventilation Shannon S. Carson, MD Associate Professor and Chief Pulmonary and Critical Care Medicine University of North Carolina AJRCCM 2010 Projected Growth of Prolonged Acute MV
More informationCardiorespiratory Physiotherapy Tutoring Services 2017
VENTILATOR HYPERINFLATION ***This document is intended to be used as an information resource only it is not intended to be used as a policy document/practice guideline. Before incorporating the use of
More informationSurgery Grand Rounds. Non-invasive Ventilation: A valuable tool. James Cromie, PGY 3 8/24/09
Surgery Grand Rounds Non-invasive Ventilation: A valuable tool James Cromie, PGY 3 8/24/09 History of mechanical ventilation 1930 s: use of iron lung 1940 s: First NIV system (Bellevue Hospital) 1950 s:
More informationICU-Acquired Weakness Therapy Considerations
ICU-Acquired Weakness Therapy Considerations Journal of Physiotherapy 63 (2017) 4 10 Journal of PHYSIOTHERAPY journal homepage: www.elsevier.com/locate/jphys Invited Topical Review Physiotherapy management
More informationAcute NIV in COPD and what happens next. Dr Rachael Evans PhD Associate Professor, Respiratory Medicine, Glenfield Hospital
Acute NIV in COPD and what happens next Dr Rachael Evans PhD Associate Professor, Respiratory Medicine, Glenfield Hospital Content Scenarios Evidence based medicine for the first 24 hrs Who should we refer
More informationICU Early Mobilization at UCSF
ICU Early Mobilization at UCSF Critical Care Medicine & Trauma Conference San Francisco, CA June 5, 2010 Presented by Heidi Engel, PT, DPT Heidi.Engel@ucsfmedctr.org Can We Do Better? Herridge MS. Mobile,
More informationPart 2 of park s Ventilator and ARDS slides for syllabus
Part 2 of park s Ventilator and ARDS slides for syllabus Early Neuromuscular Blockade Question 4 The early use of cis-atracurium in severe ARDS is: A. Contraindicated in patients with diabetes B. Associated
More informationMechanical Ventilation in COPD patients
Mechanical Ventilation in COPD patients Θεόδωρος Βασιλακόπουλος Καθηγητής Πνευμονολογίας-Εντατικής Θεραπείας Εθνικό & Καποδιστριακό Πανεπιστήμιο Αθηνών Νοσοκομείο «ο Ευαγγελισμός» Adjunct Professor, McGill
More informationMOVE IT or LOSE IT EARLY REHABILITATION IN THE ICU: Deconditioning Inactivity. Rik Gosselink, PT,PhD Dept Rehabilitation Sciences KU Leuven
Deconditioning Inactivity Eal functioning Retained secretions Lung collaps Weaning EARLY REHABILITATION IN THE ICU: Deconditioning Inactivity MOVE IT or LOSE IT Rik Gosselink, PT,PhD Dept Rehabilitation
More informationCardiopulmonary Physical Therapy. Haneul Lee, DSc, PT
Cardiopulmonary Physical Therapy Haneul Lee, DSc, PT Airway Clearance Techniques Breathing Exercise Special Considerations for Mechanically Ventilated Exercise Injury Prevention and Equipment provision
More informationAnalgesia for chest trauma - RVI
Analgesia for chest trauma - RVI Northern Network Initial Management Patients with blunt chest trauma will be managed in a standard fashion within the context of the well established trauma systems at
More informationWhat can we learn from the AVERT trial (so far)?
South West Stroke Network Event, 29 th April, 2015 What can we learn from the AVERT trial (so far)? Peter Langhorne, Professor of stroke care, Glasgow University Disclosure PL was AVERT investigator and
More informationNeonatal Respiratory Physiotherapy. Nicky Hawkes Advanced Respiratory Physiotherapist Oct 2011
Neonatal Respiratory Physiotherapy Nicky Hawkes Advanced Respiratory Physiotherapist Oct 2011 Respiratory Physiotherapy?..Not just percussion! Assessment of baby s respiratory status and deciding what
More informationCopyright GRADE ING THE QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS NANCY SANTESSO, RD, PHD
GRADE ING THE QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS NANCY SANTESSO, RD, PHD ASSISTANT PROFESSOR DEPARTMENT OF CLINICAL EPIDEMIOLOGY AND BIOSTATISTICS, MCMASTER UNIVERSITY Nancy Santesso,
More informationTRAJECTORY OF NEUROMUSCULAR RECOVERY AFTER CRITICAL ILLNESS
TRAJECTORY OF NEUROMUSCULAR RECOVERY AFTER CRITICAL ILLNESS Prof. Nicola Latronico Director, Department of Anesthesia, Critical Care and Emergency University of Brescia, Italy THE MAIN QUESTION RECOVERY
More informationDeterminants of quality: Factors that lower or increase the quality of evidence
Determinants of quality: Factors that lower or increase the quality of evidence GRADE Workshop CBO, NHG and Dutch Cochrane Centre CBO, April 17th, 2013 Outline The GRADE approach: step by step Factors
More informationRESPIRATORY COMPLICATIONS AFTER SCI
SHEPHERD.ORG RESPIRATORY COMPLICATIONS AFTER SCI NORMA I RIVERA, RRT, RCP RESPIRATORY EDUCATOR SHEPHERD CENTER 2020 Peachtree Road, NW, Atlanta, GA 30309-1465 404-352-2020 DISCLOSURE STATEMENT I have no
More informationUpdate on bronchiectasis guidelines. James Chalmers MD, PhD, FRCPE, FERS University of Dundee, UK
Update on bronchiectasis guidelines James Chalmers MD, PhD, FRCPE, FERS University of Dundee, UK University of Dundee Bronchiectasis guidelines 2017 2010 2006 2008 2015 2015 Currently valid guidelines
More informationAnaemia in the ICU: Is there an alternative to using blood transfusion?
Anaemia in the ICU: Is there an alternative to using blood transfusion? Tim Walsh Professor of Critical Care, Edinburgh University World Health Organisation grading of the severity of anaemia Grade of
More informationHandling Common Problems & Pitfalls During. Oxygen desaturation in patients receiving mechanical ventilation ACUTE SEVERE RESPIRATORY FAILURE
Handling Common Problems & Pitfalls During ACUTE SEVERE RESPIRATORY FAILURE Pravit Jetanachai, MD QSNICH Oxygen desaturation in patients receiving mechanical ventilation Causes of oxygen desaturation 1.
More informationResponse of Mechanically Ventilated Respiratory Failure Patients to Respiratory Muscles Training
Med. J. Cairo Univ., Vol. 82, No. 1, March: 19-24, 2014 www.medicaljournalofcairouniversity.net Response of Mechanically Ventilated Respiratory Failure Patients to Respiratory Muscles Training AMANY R.
More information5.4 Strategies to optimize delivery and minimize risks of Enteral Nutrition: Body position January 31 st, 2009
5.4 Strategies to optimize delivery and minimize risks of Enteral Nutrition: Body position January 31 st, 2009 Recommendation: Based on 1 level 1 and 1 level 2 study, we recommend that critically ill patients
More informationPre-op Clinical Triad - Pulmonary. Sammy Pedram, MD FCCP Assistant Professor of Medicine Pulmonary & Critical Care Medicine March 16, 2018
Pre-op Clinical Triad - Pulmonary Sammy Pedram, MD FCCP Assistant Professor of Medicine Pulmonary & Critical Care Medicine March 16, 2018 Disclosures none Case Mr. G is a 64 year-old man who presents to
More informationACUTE RESPIRATORY DISTRESS SYNDROME
ACUTE RESPIRATORY DISTRESS SYNDROME Angel Coz MD, FCCP, DCE Assistant Professor of Medicine UCSF Fresno November 4, 2017 No disclosures OBJECTIVES Identify current trends and risk factors of ARDS Describe
More informationQuality of Life after. A Critical Illness: A review of the literature
1 Quality of Life after A Critical Illness: A review of the literature 1998 2003 by Harriet Adamson BN MAdEd A Thesis submitted in fulfillment of the requirements for the degree Master of Nursing (Honours)
More informationHips & Knees Priority Action Team
Hips & Knees Priority Action Team Current State Data Refresh September 5, 27 Overview Population Profile Health Status Utilization of Hip & Knee Total Joint Services 1 1 Population Profile 2 SouthWest
More informationLung Day University of Washington. June 17, Translating Data Into Practice in the MICU. Richard K. Albert, M.D.
Lung Day 2011 University of Washington June 17, 2011 Translating Data Into Practice in the MICU Richard K. Albert, M.D. Chief of Medicine Denver Health Professor of Medicine University of Colorado Adjunct
More informationDisclosures. Learning Objectives. Mechanical Ventilation of Infants with Severe BPD: An Interdisciplinary Approach 3/10/2017
Mechanical Ventilation of Infants with Severe BPD: An Interdisciplinary Approach Steven H. Abman, MD Professor, Department of Pediatrics Director, Pediatric Heart Lung Center University of Colorado School
More information