Critical Matters

Wesley Ely, a professor of medicine at Vanderbilt University and co-director of the CIBS Center, dives into the critical impact of delirium on ICU patients. He discusses innovative assessment methods like the CAM-ICU and highlights the long-term cognitive risks, including dementia, following ICU stays. Ely emphasizes non-pharmacological strategies to enhance patient environments and improve outcomes, such as natural light and physical activity. Communication during patient transitions is also crucial, advocating for structured care approaches to manage delirium effectively.

In this episode of Critical Matters, we discuss burnout in healthcare. Burnout is an increasing problem in critical care that impacts growing numbers of providers, nurses and healthcare professionals working in the intensive care unit. This episode is based on a webinar I presented on the topic followed by a panel discussion with physician leaders. Additional Resources: An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health Care Professionals: A Call for Action: https://bit.ly/2M1PGFq Why Doctors Hate Their Computers by Atul Gawande, MD: https://bit.ly/2JCw1uz Institute for Healthcare Improvement White Paper – Framework for Improving Joy in Work: https://bit.ly/2zHs16F

Dr. Ram Subramanian, Medical Director of Liver Transplantation at Emory School of Medicine, sheds light on the intricate management of critically ill patients with cirrhosis. He shares insights on navigating complications like hepatic encephalopathy and acute GI bleeds, highlighting proactive strategies for better outcomes. The conversation dives into transplant eligibility criteria and the importance of multidisciplinary approaches for patient care, emphasizing tailored interventions like TIPS and the role of support systems in improving patient survival.

In this episode of Critical Matters, we discuss the role of procalcitonin as a biomarker in lower respiratory tract infections and sepsis. Our guest is Dr. David Huang, the primary investigator in the recently published Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infections (ProACT) clinical trial. He discusses lessons learned from this very important study and offers insight into the use of procalcitonin in clinical practice. ADDITIONAL RESOURCES: Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infections (ProACT) clinical trial: https://bit.ly/2BTZNsf A meta-analysis evaluating the effect of procalcitonin-guided treatment on mortality in acute respiratory infections: https://bit.ly/2Un6Lgz FDA Executive Summary on Procalcitonin assay: https://bit.ly/2EiBN4r BOOKS MENTIONED IN THIS EPISODE: 7 Habits of Highly Effective People by Stephen R. Covey: https://amzn.to/2Ss0mPq Partners of the Heart by Vivien Thomas: https://amzn.to/2QC6vLP

Lung protective ventilation for ARDS includes the use of low tidal volumes, positive-end expiratory pressure (PEEP), and limiting of airway plateau pressure to minimize ventilator-induced lung injury. However, in the sickest subset of patients with ARDS hypoxemia may persist despite optimal lung protective strategies. In this episode of Critical Matters, we discuss salvage therapies for patients with refractory hypoxemia. Our guest is Dr. Robert Hyzy, Medical Director of the Critical Care Medicine Unit and Co-Chair of the Critical Care Committee at the University of Michigan Hospital.

Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure that affects approximately 200,000 patients each year in the United States, resulting in nearly 75,000 deaths annually. In this episode of Critical Matters, our guest Dr. R. Phillip Dellinger discusses the current management of patients with ARDS. Dr. Dellinger is a recognized thought leader in the field, a prolific author, an accomplished researcher, and the recipient of multiple awards for his contributions to critical care. ADDITIONAL RESOURCES: The PROSEVA clinical trial showed that in patients with severe ARDS prone position ventilation improved mortality: https://bit.ly/2Dp3LdS The ACURASYS clinical study showed that in patients with severe ARDS 48 hours of neuromuscular blockade was associated with improved mortality: https://bit.ly/2FqI7Zn The EOLIA study was stooped early for futility. However, many think that it still has important findings regarding the use of ECMO in severe ARDS: https://bit.ly/2QI1Cxu BOOKS MENTIONED IN THIS EPISODE: Evidence-Based Critical Care: A Case Study Approach: https://amzn.to/2PYeD8V

Dr. Stephen Lapinsky, a practicing intensivist and professor at the University of Toronto, delves into the unique critical care challenges faced by pregnant patients. He discusses the increased thromboembolic risks due to pregnancy-related coagulation changes and outlines diagnostic methods for conditions like DVT and PE. Lapinsky highlights the importance of tailored treatments, such as low-molecular-weight heparin, and emphasizes crucial airway management strategies. He also tackles the complexities of cardiac arrest management, providing insights on resuscitation techniques and the benefits of timely perimortem cesarean sections.

Dr. Stephen Lapinsky, a practicing intensivist and professor with expertise in critical illness during pregnancy, sheds light on the complexities of caring for critically ill pregnant patients. He discusses the unique challenges they face, including respiratory and cardiac physiologic changes that complicate ICU care. Lapinsky also elaborates on common ICU indications, the management of hypertensive disorders and obstetric hemorrhage, and the best practices for team coordination in critical situations. His insights are crucial for improving outcomes in maternal care.

John Devlin, a Professor at Northeastern University and lead author of the 2018 SCCM guidelines, dives into critical topics affecting ICU patients. He discusses the updated guidelines for pain, agitation, sedation, and sleep disruption, emphasizing individualized care. The conversation highlights innovative pain management strategies and the importance of early mobilization and sleep hygiene for recovery. Devlin also underscores the collaborative nature of care and how empowering patients can revolutionize ICU practices.

In this episode of Critical Matters, we explore the role of the intensivist in the management of patients with ventricular assist devices. Our guest is Dr. John Greenwood, a practicing intensivist who splits his clinical time between the Cardiac & Vascular ICU and the ED-ICU at the Hospital of the University of Pennsylvania. Additional Resources: Summary of information presented during the episode kindly provided by Dr. John Greenwood: https://bit.ly/2MJdfSa HeartWare Waveforms App for iPad: https://apple.co/2NpyQEr Articles Mentioned In This Episode: Pratt AK, Shah NS, Boyce SW. Left ventricular assist device management in the ICU. Crit Care Med. 2014;42(1):158-68: https://bit.ly/2MKr3M6 Sen A, Larson JS, Kashani KB, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care. 2016;20(1):153: https://bit.ly/2NoreC4