Critical Care Scenarios Lightning rounds #8: Five things you’re getting wrong
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Oct 17, 2021 Brandon takes the reins to dispel five common misconceptions in critical care. He questions the effectiveness of diuretic infusions compared to intermittent boluses. The discussion includes the role of antipsychotic agents in treating ICU delirium, shedding light on their effectiveness. He also debates the merits of pressure control versus volume control in ventilation. Lastly, he highlights the importance of accurately interpreting troponin levels in patients with renal issues and emphasizes nuanced neurological assessments.
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Infusions Aren't More Potent Than Boluses
- Do not assume loop diuretic infusions work better than intermittent boluses.
- Use a drip only for practical reasons like hemodynamic stability or staffing, not because it is intrinsically more effective.
Don't Treat Delirium With Antipsychotics Expecting Cure
- Avoid using antipsychotics to 'treat' delirium expecting shorter duration or prevention.
- Use haloperidol or similar only to sedate dangerous, agitated patients when necessary, not to cure delirium.
Pressure Vs Volume Control: Variable Choice Not Superiority
- Pressure-control and volume-control assist-control modes only swap which variable you set; neither is universally superior.
- Set one variable and monitor the other, and pick the mode for practical reasons like patient comfort or institutional habit.