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Basic ICU

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Hokuto Nishioka

on 19 October 2012

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Transcript of Basic ICU

Basic ICU Hokuto Nishioka, MD Respiratory Cardiovascular Hemodyanmic Monitoring The Failing Heart Drugs Other topics Respiratory failure Noninvasive Mechanical Ventilation Mechanical Ventilation ARDS Better understanding of sepsis Be a physician Surviving Sepsis Campaign Sepsis But

Lessons from Activated Protein C, PROWESS-SHOCK

Still a need to recognize and treat sepsis early
Early resuscitation - crystalloids (SvO2)
Appropriate antibiotics
Incremental fluid boluses
Role for colloids
Norepinephrine first
No corticosteroids initially
Normalize lactate
Mechanical Ventilation Avoidance of iatrogenic lung injury

Lower tidal volumes
Optimize PEEP
Plateau pressures
Treatments and adjuncts

Avoiding increasing PEEP
Sedation - when to add and remove
Advance ventilator modes
Nitric oxide
Prone
ECMO Which patients
When to start
When not to start or when it is futile Weaning from the ventilator
Spontaneous breathing trials
Blood gases
Oxygen delivery and oxygen consumption Arterial line
Pulse pressure variation
SvO2
Central line
Pulmonary artery catheter
Volume status Earlier intervention in acute myocardial infarction
Echocardiography for diagnostic and monitoring
Diastolic dysfunction
Pulmonary hypertension
Right heart failure

ACLS Know your drugs
Epinephrine
Norepinephrine
Dobutamine
Dopamine
Vasopressin
Phosphodiesterase inhibitors
Vasoplegic syndrome Recognize the big topics in ICU
Describe advances in critical care medicine
Describe what has and has not worked in critical care medicine
Understand some challenges for the future Objectives Neurological Renal Delirium Early Mobilization Treatments Less is more Fluid balance RRT Acute Kidney Injury (cc) photo by theaucitron on Flickr (cc) photo by theaucitron on Flickr Now and the Future Other topics Markers Technology Communication Checklists and Protocols Nutrition Hematology Glucose (cc) photo by theaucitron on Flickr (cc) photo by theaucitron on Flickr Vincent JL et al. Critical Care 2010, 14:311
Dellinger RP et al. Intensive Care Med (2008) 34:17–60
The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000; 342:1301-1308
Bergeron, Intensive Care Med 2001
Jacobi J, et al., Crit Care Med 2002; 30:119-141
The NICE-SUGAR Investigators. N Engl J Med 367;12
References Intensive-care medicine or critical-care medicine is a branch of medicine concerned with the diagnosis and management of life threatening conditions requiring sophisticated organ support and invasive monitoring.
Wikipedia says EMR
Tele ICU
The Cloud Procalcitonin
N-gal
Genetic markers Imaging, ultrasound
PCI, IR, minimal invasive
Hemodynamic monitors Patients are getting older, more complex, and you will have more technology and information

Be humble, be skeptical Better understanding
AKIN
RIFLE Intermittent HD
CVVH
CVVHD
Ultrafiltration Less sedation
No paralysis Early thrombolytic therapy

Therapeutic cooling after cardiac arrest ICU neuropathy/myopathy
Prevention of thromboembolism and ileus CAM-ICU
ICDSC
RASS
Limit sedatives
Atypical antipsychotics Intensive glucose control
NICE-SUGAR Anemia
Transfusion therapy Enteral vs parenteral
Timing
Full transcript