Jenny B Hobbs MD Chief of Medicine Rounds June 2, 2009
|
|
|
- Norma McKinney
- 5 years ago
- Views:
Transcription
1 Jenny B Hobbs MD Chief of Medicine Rounds June 2, 2009
2 Daily interruption of sedation has been shown to decrease duration of mechanical ventilation (MV) Sedation interruption protocols have been widely implemented The effectiveness of sedative interruption outside of research settings remains unclear HMC patients can be quite delirious for days to weeks following MV
3 After implementation of our sedation protocol, what proportion of eligible patients actually receive an interruption of sedation? When sedative interruption is performed, is it done according to protocol? What are the reasons that sedative interruption is not performed in every eligible patient?
4 Emphasis on bolus dosing rather than gtt - lorazepam up to 4mg IV q15min, morphine up to 10mg IV q10min Sedation interruption only for those on gtts If pt sedated (Ramsay score >3): Stop sedative & analgesic gtts qam until Ramsay 1-3, or pain/vent problems After interruption, bolus & resume gtt at 50% prior rate If pt at goal (Ramsay 1-3): Reduce gtt rate by 50% Discontinue gtt if rate is already low
5 Must have new MD order to hold sedation interruption each day Acceptable conditions for holding sedation interruption: Hemodynamically unstable on pressors Significant desats NOT assoc w/turns on FiO2 >80%, PEEP >15 Unstable ICP (freq spikes >15min or consistent ICP>25)
6 Retrospective chart review Setting: all HMC ICU s Inclusion: On MV for >24h during Nov 06 or May 07 On continuous sedative and/or analgesic gtt at 9AM on Day 2, 4, and/or 8 of MV Exclusion: bolus sedation only Full implementation of sedation interruption: stopping gtts entirely for any length of time, and restarting at 50% or less of prior dose
7 CLINICAL CHARACTERISTICS Total eligible patients 115 Male (%) 65 Age (mean [SD]) 45 (16) Type of service: (%) Medicine 27 Surgery 45 Neurology/Neurosurgery 28
8 DAY 2 DAY 4 DAY 8 Number eligible Sedative interruption: (N, [% of total]) Ordered 60 (63) 39 (70) 26 (81) Attempted 63 (66) 36 (65) 18 (56) Fully implemented 26 (27) 11 (20) 6 (19) Duration of sedative interruption, minutes (median [IQR]) 60 (25-110) 60 (30-143) 50 (42-60)
9 DAY 2 DAY 4 DAY 8 Number eligible Sedative interruption: (N, [% of total]) Ordered 60 (63) 39 (70) 26 (81) Attempted 63 (66) 36 (65) 18 (56) Fully implemented 26 (27) 11 (20) 6 (19) Duration of sedative interruption, minutes (median [IQR]) 60 (25-110) 60 (30-143) 50 (42-60)
10 DAY 2 DAY 4 DAY 8 Number eligible Sedative interruption: (N, [% of total]) Ordered 60 (63) 39 (70) 26 (81) Attempted 63 (66) 36 (65) 18 (56) Fully implemented 26 (27) 11 (20) 6 (19) Duration of sedative interruption, minutes (median [IQR]) 60 (25-110) 60 (30-143) 50 (42-60)
11 DAY 2 DAY 4 DAY 8 Number eligible Sedative interruption: (N, [% of total]) Ordered 60 (63) 39 (70) 26 (81) Attempted 63 (66) 36 (65) 18 (56) Fully implemented 26 (27) 11 (20) 6 (19) Duration of sedative interruption, minutes (median [IQR]) 60 (25-110) 60 (30-143) 50 (42-60)
12
13 Day 2 (N=37) Day 4 (N=25) Day 8 (N=12) Total Sedation not stopped Analgesia not stopped Sedation restarted at >50% prior rate Analgesia restarted at >50% prior rate Data not recorded
14 Small sample size Single institution study Lack of detailed information available about patients level of agitation during and after sedative interruption Inconsistent documentation
15 Significant variability in practice, even within a single institution with a well-defined protocol. Full implementation occurred in less than 25% of eligible patients Improved documentation necessary to better understand reasons for incomplete implementation Efforts should be made to improve knowledge and practices of staff Larger study population needed to evaluate outcomes and differences in practice between medical services/nursing floors
16 Terri Hough (Research mentor) Veena Karir (Coauthor) Scott Weigle Internal Medicine Residency program Arch Shaw Foundation NIH K grant
KICU Spontaneous Awakening Trial (SAT) Questionnaire
KICU Spontaneous Awakening Trial (SAT) Questionnaire Please select your best answer(s): 1. What is your professional role? 1 Staff Nurse 2 Nurse Manager 3 Nurse Educator 4 Physician 5 Medical Director
Ventilator-Associated Event Prevention: Innovations
Ventilator-Associated Event Prevention: Innovations Michael J. Apostolakos, MD Professor of Medicine Director, Adult Critical Care University of Rochester Mobility/Sedation in the ICU Old teaching: Keep
Interaction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico
Interaction between Sedation and Weaning: How to Balance Them? Guillermo Castorena MD Fundacion Clinica Medica Sur Mexico Balance is not that easy! Weaning Weaning is the liberation of a patient from
Sedation and delirium- drugs and clinical management
Sedation and delirium- drugs and clinical management Shannon S. Carson, MD Associate Professor and Chief Division of Pulmonary and Critical Care Medicine University of North Carolina Probability of transitioning
Improving the Management of Pain, Agitation, and Delirium (PAD) in the Intensive Care Unit: Translating Evidence Into Practice
Improving the Management of Pain, Agitation, and Delirium (PAD) in the Intensive Care Unit: Translating Evidence Into Practice Christine M. Groth, Pharm.D., BCCCP NYS Partnership for Patients September
PHYSICIAN'S ORDERS Mark in for desired orders. If is blank, order is inactive. VENTILATOR SEDATION / ANALGESIC / DELIRIUM ORDER
Nursing Daily awakenings PHYSICIAN'S ORDERS Mark in for desired orders. If is blank, order is inactive. VENTILATOR SEDATION / ANALGESIC / DELIRIUM ORDER Do not perform daily awakenings: Rationale: Daily
PICU Sedation Holidays. Jorge G. Sainz MD FAAP Medical Director PICU Medical Director Transport
Jorge G. Sainz MD FAAP Medical Director PICU Medical Director Transport jsainz@elpasochildrens.org 1. Define sedation holiday. Objectives 2. Review differences between adult and pediatric sedation in ICU
Randomized controlled trial of interrupted versus continuous sedative infusions in ventilated children
Feature Articles Randomized controlled trial of interrupted versus continuous sedative infusions in ventilated children Kunal Gupta, MD; Vipul K. Gupta, MD, DNB; Jayashree Muralindharan, MD; Sunit Singhi,
Sedation and Analgesia in the Critically Ill
12th Congress of the World Federation of Societies of Intensive and Critical Care Medicine August 29 (Sat.) September 1 (Tue.), 2015 COEX, Seoul, Korea ONE STEP FURTHER: THE PURSUIT OF EXCELLENCE IN CRITICAL
9/28/2016. 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
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
DRUG AND TREATMENT Intubation Phase Notify Therapy for STAT intubation Medications SUB Rapid Sequence Induction (SUB)* ***Reminder: Order SUB Rapid Sequence Induction (SUB) on a separate form*** lidocaine
Sedation Hold/Interruption and Weaning Protocol ( Wake-up and Breathe )
PROTOCOL Sedation Hold/Interruption and Weaning Protocol ( Wake-up and Breathe ) Page 1 of 6 Scope: Population: Outcome: Critical care clinicians and providers. All ICU patients intubated or mechanically
Can 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
Withdrawal of Care in the ICU
Withdrawal of Care in the ICU Arlene Bobonich, MD Director, Inpatient Palliative Medicine PinnacleHealth System WHO IS DRIVING THE BUS? WHERE IS THE BUS GOING? HOW DO YOU GET OFF THE BUS? WHO GETS THROWN
From the Department of Pharmacy (JM, CAF) and Department of Pulmonary and Critical
PrintClose Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay * Author(s): Marshall, John PharmD; Finn, Christine A.
Disclosure. 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,
Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium
Online Data Supplement Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility (ABCDE) Bundle Authors-Michele C. Balas, Eduard
Goals for sedation during mechanical ventilation
New Uses of Old Medications Gina Riggi, PharmD, BCCCP, BCPS Clinical Pharmacist Trauma ICU Jackson Memorial Hospital Disclosure I do not have anything to disclose Objectives Describe the use of ketamine
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available ONLY at: BMC-B BMC-D BMC-N BMC-S Intubation Phase Notify Therapy for STAT intubation SUB Rapid Sequence Induction(SUB)* ***The above subphase is available at the end of the powerplan under the
Canadian Practices for the Treatment of Delirium. Lisa Burry, BScPharm, PharmD
Canadian Practices for the Treatment of Delirium Lisa Burry, BScPharm, PharmD Disclosures & Acknowledgements Conflicts of interest: None Acknowledgements: our patients and the clinical staff that supported
Extreme arousal, irritability, excess motor activity driven by internal sense of discomfort such as disease, pain, anxiety and delirium
Agitated patient in ICUapproach & management Arjun Srinivasan Agitation Extreme arousal, irritability, excess motor activity driven by internal sense of discomfort such as disease, pain, anxiety and delirium
OSCAR & 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
Wean Earlier and Automatically with New Technology (The WEAN Study): A Multicentre, Pilot Randomized Controlled Trial
Wean Earlier and Automatically with New Technology (The WEAN Study): A Multicentre, Pilot Randomized Controlled Trial Karen E. A. Burns MD, MSc, Maureen O. Meade MD, MSc, Martin R. Lessard MD, Lori Hand
Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Admission Criteria Clinical Practice Policy
Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Admission Criteria Clinical Practice Policy Original Date: 04/2011 Purpose: To specify physiologic criteria for appropriate
Do benzos, opioids, or strong anticholinergics cause delirium? Lisa Burry
Do benzos, opioids, or strong anticholinergics cause delirium? Lisa Burry Delirium in the ICU Occurs in up to 85% of MICU/SICU MV patients 20-50% of lower severity ICU patients develop delirium Hypoactive
Caring For the ICU Boarder. Kami M. Hu, MD Depts of Emergency & Internal Medicine University of Maryland SOM
Caring For the ICU Boarder Kami M. Hu, MD Depts of Emergency & Internal Medicine University of Maryland SOM I have no relevant financial relationships with the manufacturer(s) of any commercial product(s)and/or
ICU Delirium in Infants & Children: Cause for Concern or False Alarm. Objectives
ICU Delirium in Infants & Children: Cause for Concern or False Alarm Peter (Pete) N. Johnson, Pharm.D., BCPS, BCPPS, FPPAG Associate Professor of Pharmacy Practice University of Oklahoma College of Pharmacy
Neuromuscular 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
Implementation of a Delirium Screening Tool in a Pediatric Intensive Care Unit
Implementation of a Delirium Screening Tool in a Pediatric Intensive Care Unit BY: ABBY WACHHOLTZ, BSN, RN, PEDIATRIC ACUTE CARE DNP STUDENT Disclosures I have no disclosures. 1 Objectives 1. Recognize
Successful implementation of a pediatric sedation protocol for mechanically ventilated patients*
Successful implementation of a pediatric sedation protocol for mechanically ventilated patients* Kristina H. Deeter, MD; Mary A. King, MD, MPH; Debra Ridling, CCRN; Gretchen L. Irby, PharmD; Anne M. Lynn,
Kendiss Olafson MD FRCPC MPH Section of Critical Care University of Manitoba
Kendiss Olafson MD FRCPC MPH Section of Critical Care University of Manitoba Outline Sedation in ICU Purpose/Goals Common Drugs Sedation delivery strategies Mobility in the ICU Weakness with critical illness
Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure. Supplement 2 Table of Contents
Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure Supplement 2 Table of Contents RESTORE Algorithm and Box-by-Box Instructions Page 1 of 2
SEDATION, AGITATION, DELIRIUM Daniel Lollar, MD
SEDATION, AGITATION, DELIRIUM Daniel Lollar, MD OVERVIEW Correctable causes of agitation Pain assessment opioids Agitation assessment BZNs, propofol, precedex comparisons Delirium haldol, antipsychotics
Delirium in Critically Ill Mechanically Ventilated Patients Enrolled in the SLEAP Multicenter Randomized Trial
Delirium in Critically Ill Mechanically Ventilated Patients Enrolled in the SLEAP Multicenter Randomized Trial Geeta Mehta MD, FRCPC And The SLEAP Investigators For the Canadian Critical Care Trials Group
9/15/2017. Conflict of Interest. Coordinating Spontaneous Breathing and Spontaneous Awakening* Overly Conservative Weaning Practices
Conflict of Interest Coordinating Spontaneous Breathing and Spontaneous Awakening* Richard H Kallet MS RRT FAARC, FCCM Respiratory Care Services Dept of Anesthesia & Perioperative Care University of California,
Summary of Delirium Clinical Practice Guideline Recommendations Post Operative
Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Intensive Care Unit Clinical Practice Guideline for Postoperative Clinical Practice Guidelines for the Delirium in Older Adults;
ICU Liberation for the Pharmacist. A. Kendall Gross, PharmD, BCPS, BCCCP Critical Care Pharmacist UCSF Medical Center
ICU Liberation for the Pharmacist A. Kendall Gross, PharmD, BCPS, BCCCP Critical Care Pharmacist UCSF Medical Center Disclosure No conflicts of interest to disclose Objectives o Outline the elements of
Critical Care Strategic Clinical Network Provincial ICU Delirium Framework
Pain assessed and documentation using validated tool (CPOT and NRS) Assess and document q4h and prn 100% of patients assessed for pain and documented q4h A: Assess, Prevent & Manage Pain Self Reporting
Sedation of the Critically Ill Patient
Buffalo theory of sedation It s a well known fact that a herd of buffalo can only move as fast as the slowest buffalo. And when the herd is hunted, it s the slowest and weakest ones at the back that are
Early Goal Directed Sedation In Critically Ill Patients
Early Goal Directed Sedation In Critically Ill Patients Yahya Shehabi, FCICM, FANZCA, EMBA Professor, Intensive Care Medicine Clinical School of Medicine, University New South Wales School of Epidemiology
Comparison of Procedural Sedation for the Reduction of Dislocated Total Hip Arthroplasty
ORIGINAL RESEARCH for the Reduction of Dislocated Total Hip Arthroplasty Jonathan E. dela Cruz, MD* Donald N. Sullivan, MD Eric Varboncouer, MD Joseph C. Milbrandt, PhD* Myto Duong, MD * Scott Burdette,
INTERRUPTION OF SEDATIVE INFUSIONS IN CRITICALLY ILL PATIENTS UNDERGOING MECHANICAL VENTILATION
DAILY INTERRUPTION OF SEDATIVE INFUSIONS IN CRITICALLY ILL PATIENTS UNDERGOING MECHANICAL VENTILATION JOHN P. KRESS, M.D., ANNE S. POHLMAN, R.N., MICHAEL F. O CONNOR, M.D., AND JESSE B. HALL, M.D. ABSTRACT
INPATIENT INTERVENTIONAL RADIOLOGY PLAN - Phase: Pre-Procedure Orders
- Phase: Pre-Procedure Orders DETAILS Patient Care Obtain Consent If one is not present on chart today. Vital Signs Per Policy Insert Peripheral Line T;N, Start IV on right side If left radial access is
Delirium in Critical Care. Recognition, Management, Research tasters. Dr Valerie Page Watford General Hospital
Delirium in Critical Care. Recognition, Management, Research tasters Dr Valerie Page Watford General Hospital What does it look like? Diagnosing delirium CAM-ICU CAM-ICU Feature 1: Acute onset of mental
Linee guida sul trauma cranico: sempre attuali? Leonardo Bussolin AOU Meyer
Linee guida sul trauma cranico: sempre attuali? Leonardo Bussolin AOU Meyer Vavilala MS, et al Retrospective multicenter cohort study Prehospital Arena ED OR - ICU Each 1% increase in adherence was associated
Vanderbilt University Medical Center Multidisciplinary Surgical Critical Care
Vanderbilt University Medical Center Multidisciplinary Surgical Critical Care PROTOCOLIZING AND MONITORING SEDATION, ANALGESIA AND DELIRIUM IN THE CRITICALLY ILL Introduction Critically ill patients are
Ventilated children are often sedated in order
Paediatrica Indonesiana Volume 5 January 0 Number Original Article Continuous sedation vs. daily sedation interruption in mechanically-ventilated children Henri Azis, Silvia Triratna, Erial Bahar Abstract
Frank Sebat, MD - June 29, 2006
Types of Shock Hypovolemic Shock Low blood volume decreasing cardiac output. AN INTEGRATED SYSTEM OF CARE FOR PATIENTS AT RISK SHOCK TEAM and RAPID RESPONSE TEAM Septic or Distributive Shock Decrease in
Rounds in the ICU. Eran Segal, MD Director General ICU Sheba Medical Center
Rounds in the ICU Eran Segal, MD Director General ICU Sheba Medical Center Real Clinical cases (including our mistakes) Emphasis on hemodynamic monitoring Usually no single correct answer We will conduct
POST-INTUBATION ANALGESIA AND SEDATION. August 2012 J Pelletier
POST-INTUBATION ANALGESIA AND SEDATION August 2012 J Pelletier Intubated patients experience pain and anxiety Mechanical ventilation, endotracheal tube Blood draws, positioning, suctioning Surgical procedures,
A comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia Engoren M, Luther G, Fenn-Buderer N
A comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia Engoren M, Luther G, Fenn-Buderer N Record Status This is a critical abstract of an economic evaluation that meets
Doug Paul, D.O. FACOS Medical Director, Trauma Services Kettering Health Network
Doug Paul, D.O. FACOS Medical Director, Trauma Services Kettering Health Network A paradigm shift (or revolutionary science) is, a change in the basic assumptions, or paradigms, within the ruling theory
Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/ Management, and Early Exercise/Mobility Bundle*
Feature Articles Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/ Management, and Early Exercise/Mobility Bundle* Michele C. Balas, PhD, RN, APRN-NP, CCRN 1 ;
REFERENCE GUIDE USING THE BISPECTRAL INDEX (BIS ) MONITORING SYSTEM FOR CRITICAL CARE
REFERENCE GUIDE USING THE BISPECTRAL INDEX (BIS ) MONITORING SYSTEM FOR CRITICAL CARE WHAT IS THE BIS MONITORING SYSTEM? The BIS brain monitoring system generates a processed EEG parameter that provides
Nicotine replacement therapy for agitation and delirium management in the intensive care unit: a systematic review of the literature
Kowalski et al. Journal of Intensive Care (2016) 4:69 DOI 10.1186/s40560-016-0184-x RESEARCH Nicotine replacement therapy for agitation and delirium management in the intensive care unit: a systematic
PRESCRIBING PRACTICE IN DELIRIUM. John Warburton Critical Care Pharmacist
PRESCRIBING PRACTICE IN DELIRIUM John Warburton Critical Care Pharmacist Learning outcomes Modifiable medication risk factors for delirium An appreciation of contributing factors modifiable with medicines
Management of Delirium in the ICU. Yahya Shehabi
Management of Delirium in the ICU Yahya Shehabi Hello! Doctor, your patient is CAM + ve Good morning Dr, Am one of the RC, Just examined Mr XXX he is CAM +ve Positive what? Sir replied RC: I meant he is
Sedation is a dynamic process.
19th Annual Mud Season Nursing Symposium Timothy R. Lyons, M.D. 26 March 2011 To allow patients to tolerate unpleasant procedures by relieving anxiety, discomfort or pain To expedite the conduct of a procedure
Pain management. Coleman Palliative Care Conference: February 2016 Josh Baru MD Stacie Levine MD
Pain management Coleman Palliative Care Conference: February 2016 Josh Baru MD Stacie Levine MD Case #1 61 yo man with history of Stage 3 colon cancer, s/p resection and adjuvant chemotherapy with FOLFOX
Sedation and Delirium Questions
Sedation and Delirium Questions TLC Curriculum William J. Ehlenbach, MD MSc Assistant Professor of Medicine Pulmonary & Critical Care Medicine Question 1 Deep sedation in ventilated critically patients
MORPHINE ADMINISTRATION
Introduction Individualised Administration Drug of Choice Route of Administration & Doses Monitoring of Neonates & high risk patients Team Management Responsibility Morphine Protocol Flow Chart Introduction
Elizabeth 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
Analgosedation: What Strategy is Best? Guillermo Castorena MD Fundación Clínica Médica Sur México
Analgosedation: What Strategy is Best? Guillermo Castorena MD Fundación Clínica Médica Sur México The facts Despite the efforts to optimize sedation and comfort of ICU s patients: More than 50% of patients
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOL USE OF PROPOFOL (DIPRIVAN) FOR VENTILATOR MANAGEMENT
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOL I. PURPOSE: To provide guidelines for the administration of Propofol, which is an anesthetic agent, indicated for the continuous intravenous
Delirium Monograph - Update, Spring 2014
Delirium Monograph - Update, Spring 2014 Since publication of the APM monograph on Delirium in January 2012, three structured reviews have been published adding data relevant to the practice of identification,
BIS Brain Monitoring for Critical Care
BIS Brain Monitoring for Critical Care The Bispectral Index (BIS ) is a processed EEG parameter that provides a direct measure of the effects of sedatives on the brain. The BIS monitoring value is represented
7/6/ ANNUAL MEETING BRINGING THE ABC(DEF) S TO THE ICU ICU TRIAD DISCLOSURE ICU TRIAD SEDATION AND ANALGESIA OBJECTIVES
ICU TRIAD BRINGING THE ABC(DEF) S TO THE ICU GINA RIGGI, PHARMD, BCPS, BCCCP CLINICAL HOSPITAL PHARMACIST- TRAUMA INTENSIVE CARE UNIT JACKSON MEMORIAL HOSPITAL MIAMI, FLORIDA Figure 1. Reade M and Finfer
Sleep in the ICU: helped by drugs? Yoanna Skrobik MD FRCP(c) MSc.
Sleep in the ICU: helped by drugs? Yoanna Skrobik MD FRCP(c) MSc. Conflicts of interest Member, SCCM Pain, Agitation and Delirium guidelines writing committee Vice-chair, SCCM Pain, Agitation, Delirium,
Ventilator Withdrawal: Procedures and Outcomes. Report of a Collaboration Between a Critical Care Division and a Palliative Care Service
954 Journal of Pain and Symptom Management Vol. 26 No. 4 October 2003 Clinical Note Ventilator Withdrawal: Procedures and Outcomes. Report of a Collaboration Between a Critical Care Division and a Palliative
Effects of Home Antipsychotic Reinitiation in ICU Patients with a History of Mental Illness
Effects of Home Antipsychotic Reinitiation in ICU Patients with a History of Mental Illness Gary Sweet, PharmD PGY-1 Pharmacy Practice Resident St. John Medical Center, Tulsa, OK Conflict of Interest Nothing
CASE PRESENTATION VV ECMO
CASE PRESENTATION VV ECMO Joshua Huelster, MD Fellow in Critical Care Medicine Department of Pulmonary and Critical Care Medicine Hennepin County Medical Center Disclosure There are no conflicts of interest
ANALGESIA AND SEDATION IN MECHANICAL VENTILATION
ANALGESIA AND SEDATION IN MECHANICAL VENTILATION Erik Stoltenberg, MD Abbott Northwestern Hospital February 27, 2018 DISCLOSURE Nothing to disclose AllinaHealthSystem 1 OBJECTIVE To apply knowledge of
Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients
Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit January 2013 Volume 41 Number 1 Society of Critical Care Medicine 本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時,
Neuroprotective Effects for TBI. Craig Williamson, MD
Neuroprotective Effects for TBI Craig Williamson, MD Neuroprotection in Traumatic Brain Injury Craig Williamson Clinical Assistant Professor Neurocritical Care Fellowship Director Disclosures I will discuss
Weaning and extubation in PICU An evidence-based approach
Weaning and extubation in PICU An evidence-based approach Suchada Sritippayawan, MD. Div. Pulmonology & Crit Care Dept. Pediatrics Faculty of Medicine Chulalongkorn University Kanokporn Udomittipong, MD.
Liberation 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
Jennifer Mando-Vandrick, PharmD, BCPS Clinical Pharmacist, Emergency Department Director, PGY2 Critical Care Pharmacy Residency Duke University
Jennifer Mando-Vandrick, PharmD, BCPS Clinical Pharmacist, Emergency Department Director, PGY2 Critical Care Pharmacy Residency Duke University Hospital Objectives Review pertinent pharmacotherapy common
Fighting the Fog A Collaborative Approach to Decreasing ICU Delirium
Fighting the Fog A Collaborative Approach to Decreasing ICU Delirium Kimberly Scherr NP Jennifer Barker RN Misericordia Hospital ICU Edmonton, AB CACCN Dynamics Sept 21, 2014 Delirium Delirium is an acute
Collaborative Regional Benchmarking Group (North of England, North Yorkshire & Humber and West Yorkshire)
Best Practice Guidance Sedation These recommendations are bound by the current evidence and best practice at the time of writing and so will be subject to change as further developments are made in this
Refractory Status Epilepticus in Children: What are the Options?
Refractory Status Epilepticus in Children: What are the Options? Weng Man Lam, PharmD, BCPS, BCPPS PICU Clinical Pharmacy Specialist Memorial Hermann Texas Medical Center November 11, 2017 Objectives 1.
(31189) Hypothermia Initiation Phase One
Hypothermia Initiation Phase One Diagnosis Allergies For hypothermia tracking purposes only. Please do not uncheck.- Required Cardiac Emergency Tracking For hypothermia tracking purposes only. Consults
Telemetry Overview Intern Conference 7/30/13
Telemetry Overview Intern Conference 7/30/13 Indications for Cardiac Monitoring Chest Pain MI Heart Failure Hemodynamically compromised patient Palpitations Syncope Electrolyte /metabolic abnormalities
The provision of adequate sedation and analgesia is a crucial
Review Article Sedation Guidelines, Protocols, and Algorithms in PICUs: A Systematic Review Ya Nee Poh, BSc(Hons) 1 ; Pei Fen Poh, BN 1 ; Siti Nur Hanim Buang, MB BCh, MRCPCH 2 ; Jan Hau Lee, MBBS, MRCPCH,
University of Mississippi Medical Center University of Mississippi Health Care. Pharmacy and Therapeutics Committee Medication Use Evaluation
University of Mississippi Medical Center University of Mississippi Health Care Pharmacy and Therapeutics Committee Medication Use Evaluation Cisatracurium (Nimbex ) and Vecuronium (Norcuron ) PURPOSE The
Part 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
ICU Delirium A Real Epidemic (or are we delirious)?
ICU Delirium A Real Epidemic (or are we delirious)? CCCF: Toronto October 2014 Jesse Hall MD University of Chicago Section of Pulmonary and Critical Care Medicine Faculty Disclosures Dr. Hall receives
ARDS Assisted ventilation and prone position. ICU Fellowship Training Radboudumc
ARDS Assisted ventilation and prone position ICU Fellowship Training Radboudumc Fig. 1 Physiological mechanisms controlling respiratory drive and clinical consequences of inappropriate respiratory drive
Overview of Presentation. Delirium Definition. Assessing & Managing ICU Delirium: What is the Evidence?
Assessing & Managing ICU Delirium: What is the Evidence? Dale Needham, MD, PhD Professor Pulmonary & Critical Care Medicine, and Physical Medicine & Rehabilitation Medical Director, Critical Care Physical
NIH Public Access Author Manuscript Crit Care Med. Author manuscript; available in PMC 2015 December 01.
NIH Public Access Author Manuscript Published in final edited form as: Crit Care Med. 2014 December ; 42(12): e791 e795. doi:10.1097/ccm.0000000000000660. Effectiveness of Implementing a Wake up and Breathe
Optimize 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
New approaches of sedation in critically ill patients.
New approaches of sedation in critically ill patients. Jean Mantz, MD, PhD Professor and Chair, Department of Anesthesia and Critical Care F- Paris Val de Seine University Hospitals Univ Paris Diderot,
Opioid reduction strategies in an academic tertiary medical center
Opioid reduction strategies in an academic tertiary medical center Terry Bosen, PharmD Medication Safety Program Director Vanderbilt University Medical Center Tennessee MME data per capita MME = Morphine
Where Emergency Medicine Meets Critical Care: Next Level Resuscitation
Where Emergency Medicine Meets Critical Care: Next Level Resuscitation Rob Green, BSc, MD, DABEM, FRCPC, FRCP(Edin) Professor, Dalhousie University Departments of Emergency Medicine,Critical Care Medicine
DELIRIUM IN ICU: Prevention and Management. Milind Baldi
DELIRIUM IN ICU: Prevention and Management Milind Baldi Contents Introduction Risk factors Assessment Prevention Management Introduction Delirium is a syndrome characterized by acute cerebral dysfunction
ICU Delirium and sedation: understanding their role in long-term patient outcomes. Yoanna Skrobik MD FRCP(c)
ICU Delirium and sedation: understanding their role in long-term patient outcomes Yoanna Skrobik MD FRCP(c) Conflicts of interest Member, SCCM Pain, Agitation and Delirium guidelines writing committee
BPG 06: Sedation. Patients receive appropriate sedation to meet their needs, optimising comfort and with minimal adverse effects.
Statement of Best Practice BPG 06: Sedation Patients receive appropriate sedation to meet their needs, optimising comfort and with minimal adverse effects. 1: Introduction Indication for sedation will
SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY
PS1006 SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT TITLE: PROPOFOL SEDATION PROTOCOL Job Title of Reviewer: Director, ICU :#: EFFECTIVE DATE: REVISED DATE: TYPE: 1/95 8/06, 5/09 DEPARTMENTAL INTERDEPARTMENTAL
Supplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Page VJ, Casarin A, Ely EW, et al. Evaluation
CRITICALLY APPRAISED PAPER (CAP)
CRITICALLY APPRAISED PAPER (CAP) Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., Kress, J.P. (2009). Early physical and occupational therapy in mechanically