ICU Liberation with Dr. Kristina Betters & Dr. Brooke Light -- Part 1
Dec 2, 2024
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In this engaging discussion, Dr. Kristina Betters, a pediatric intensivist at Vanderbilt University, and aspiring intensivist Dr. Brooke Light explore crucial aspects of ICU liberation for children. They delve into the A to F ICU liberation bundle, sharing insights on personalized sedation strategies and pain management. A powerful case study showcases the recovery of a young boy, emphasizing family involvement and evidence-based practices. They also address the critical role of nursing staff and multidisciplinary teams in enhancing patient care and safety.
Implementing the A to F ICU liberation bundle, which includes pain management and family engagement, can significantly improve pediatric patient outcomes.
Utilizing effective sedation protocols in pediatric ICUs ensures safety, facilitates communication, and enhances overall quality of care for critically ill patients.
Deep dives
Understanding ICU Liberation
ICU liberation is a crucial framework aimed at mitigating the negative consequences that patients experience during their time in the ICU. This concept, initially derived from adult medicine, has been adapted for pediatric care and focuses on the implementation of evidence-based practices. ICU liberation consists of a bundle of care known as the A to F bundle, which includes components such as assessing and managing pain, sedation strategies, and family engagement. Recent pediatric studies have begun to validate elements of this bundle, demonstrating the potential benefits of such practices in improving patient outcomes.
Managing Pain and Sedation in Pediatric Patients
Effective pain management in intubated pediatric patients relies heavily on appropriate pain assessment methods. Standards recommend utilizing validated pain scales, alongside self-reporting when feasible, to assess the pain levels of patients unable to articulate their discomfort. The standard approach for sedation involves prioritizing analgesia before sedation, using opioids as the first-line treatment, and supplementing with alternatives like NSAIDs when clinically appropriate. Attention to the depth of sedation and minimizing prolonged exposure to sedatives, particularly drugs like midazolam, is vital in ensuring optimal recovery and reducing the risk of complications such as delirium.
The Role of Protocols in Clinical Practice
Implementing sedation protocols in pediatric ICUs can enhance the safety and effectiveness of patient care, providing healthcare providers with clear guidelines for managing sedation. These protocols offer a framework for standardized communication among multidisciplinary teams, which aids in the safe escalation of sedation levels based on patients' needs. Evidence suggests that adhering to sedation protocols can streamline treatment processes, especially in larger ICUs where constant adjustments are required due to varying patient conditions. Furthermore, actively involving nursing staff in the development and execution of these protocols is essential for improving patient outcomes and care quality.
The Importance of Family Engagement
Family-centered care is a cornerstone of pediatric medicine that aligns with the goals of the ICU liberation bundle. Engaging families not only supports their emotional needs but also empowers them to participate actively in the care of their children, which can lead to improved patient satisfaction and adherence to treatment plans. Effective communication with family members about their child's condition and care plan fosters trust and collaboration between families and healthcare providers. Recent discussions underscore the need for pediatric practices to continue evolving their frameworks to elevate family involvement and recognize their crucial role in the recovery process.
Kristina Betters, MD is an Associate Professor of Pediatrics in the division of Critical Care Medicine at Vanderbilt University and a pediatric intensivist at Monroe Carell Jr. Children’s Hospital. Dr. Betters' research interests are focused on early mobility, rehabilitation of the ICU patient, sedation, and delirium in critically ill children. She was an author of the 2022 SCCM PANDEM guidelines.
Brooke Light, MD is a pediatric resident physician at Prisma Health in Greenville, SC. Prior to residency, she completed her MD at the Medical University of South Carolina. She is (obviously) an aspiring pediatric intensivist, and we are so happy she reached out to coordinate this episode.
Learning Objectives:
By the end of this podcast, listeners should be able to discuss:
The rationale supporting the use of an ICU liberation bundle.
Key components of the A to F ICU liberation bundle.
An expert’s approach to implementing the A to F ICU liberation bundle
References:
Smith et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med. 2022 Feb 1;23(2):e74-e110.
Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF Bundle in Critical Care. Crit Care Clin. 2017 Apr;33(2):225-243.
Curley et al; RESTORE Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators Network. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial. JAMA. 2015 Jan 27;313(4):379-89.
Madden K, Wolf M, Tasker RC, Figueroa J, McCracken C, Hall M, Kamat P. Antipsychotic Drug Prescription in Pediatric Intensive Care Units: A 10-Year U.S. Retrospective Database Study. J Pediatr Intensive Care. 2021 Oct 22;13(1):46-54.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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