Continulus Critical Care Nursing: Recent Episodes
Continulus
This show accompanies the 'Critical Care Global Classroom' - fortnightly lectures delivered by leading global experts in Critical Care Nursing.
Take a dive into the latest evidence-based best-practice, with leading researchers and speakers.
The audio from each lecture will be released here shortly after the live lecture.
Visit www.continulus.com/lectures for more information.
Paediatric sepsis remains one of the leading causes of preventable mortality for children. Global incidence exceeds 50% for the neonatal and paediatric population, with up to one third developing ongoing, sometimes lifelong sequelae. Early recognition and management is key to optimising outcomes, however can be difficult to recognise in the early stages. Paediatric sepsis is not isolated to the Emergency Department, but rather a journey that begins at home and encompasses the multidisciplinary team and families. This session will contextualise the many elements of paediatric sepsis and provide you with the tools to ensure your patient arrives at the emerald city.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Hemodynamic monitoring in a critical care setting is very important to the individualized care of the patient. Using heartrate and blood pressure is not enough to determine patients preload, afterload and contractility needs. Utilizing hemodynamics of some sort (non-invasive, less – invasive) can really better outcomes in the critical care patient. It is essential though if you are utilizing hemodynamic monitoring at the bedside that you understand what the numbers mean and how you can better implement care at the bedside.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Learning objectives for this talk:
- Discuss strategies for the timely treatment of the septic patient based on the evidence
- Review the 2021 Guidelines for Sepsis and Septic Shock
- Understand the importance
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This presentation will provide an overview of delirium such as the definition of delirium, types of delirium, risk factors of delirium and the current clinical guidelines for delirium care in ICU setting. The challenges and barriers to implement delirium assessment among critical care nurses are discussed. The delirium care education program and strategies are highlighted as well as the utilisation of the delirium prediction model in ICU clinical practice is also presented in this presentation.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Learning objectives for this talk:
- Contrast use of human-centred co-design in healthcare with other co-design approaches
- Describe common principles and methods for co-design
- Appraise factors expected to influence the success of human-centred co-design in a busy hospital setting
- Critique the relevance of human-centred co-design to knowledge translation and implementation science
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Learning objectives for this talk:
- Contrast use of human-centred co-design in healthcare with other co-design approaches
- Describe common principles and methods for co-design
- Appraise factors expected to influence the success of human-centred co-design in a busy hospital setting
- Critique the relevance of human-centred co-design to knowledge translation and implementation science
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Learning objectives for this talk:
- Contrast use of human-centred co-design in healthcare with other co-design approaches
- Describe common principles and methods for co-design
- Appraise factors expected to influence the success of human-centred co-design in a busy hospital setting
- Critique the relevance of human-centred co-design to knowledge translation and implementation science
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This presentation describes the patient care priorities when receiving a post-operative cardiac surgery from the operating room. Newer surgical approaches are listed followed by a description of outcome predications based on two scoring systems. The effects of cardiopulmonary bypass are described. Standards for routine care of the post-operative patients are presented. Complications are provided along with the recommendations for resuscitation should cardiac arrest occur.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This presentation provides an overview of critical care nurse transition. It summarizes theoretical perspectives that provide useful lenses to understand transition in nursing practice. A brief overview of synthesis studies on new nurse and new graduate nurse transition into critical care is provided. Additionally, a recent longitudinal study with a cohort of new graduate nurses hired into an IC is discussed. Recommendations that may be useful to consider for the recruitment and retention of nurses into critical care is also highlighted.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Learning objectives for this talk:
- Discuss instruments that capture frailty and identify a vulnerable population
- Review the evidence of frailty and its impact on outcomes following critical illness
- Outline opportunities to improve care of individuals assessed as frail in the ICU
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
In this lecture, you will learn about best practice guidelines informing the management of pain in the critically ill adult. The updated definition of pain, its prevalence and challenges in the adult population in the intensive care unit (ICU) are described. A stepwise approach to pain assessment in the patient unable to self-report is presented and various valid pain assessment tools are introduced along with new developments. Pain management guiding principles based on a multimodal analgesia approach are also discussed.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Bloodstream infections (BSI) are the most deadly healthcare associated infections, and 35% of these are caused by intravenous (IV) therapy through various types of IV catheter [1] . Such ‘catheter-associated BSI (CABSI)’ substantially increase risk of death, prolong ICU and hospital stay, and healthcare costs. Nurses are responsible for many aspects of catheter insertion, management, troubleshooting, and removal. To prevent CABSI, we must deny microorganisms entry into the blood via both the: (1) catheter insertion site, and (2) internal catheter lumen. This presentation reviews the concept of CABSI, core fundamentals of infection prevention, and reviews recent evidence from large randomised controlled trials.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
In this talk, I will discuss a paradigm shift in thinking about oral health and care in the intensive care unit (ICU) i.e. what goes wrong and how we should intervene. I will discuss the oral microbiome, dysbiosis, the chlorhexidine controversy, and expert/patient recommendations for the delivery of an oral care bundle including toothbrushing. I will emphasize recent evidence about de-adopting oral chlorhexidine use and implementing an oral care bundle.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This presentation describes the patient care priorities when receiving a post-operative cardiac surgery from the operating room. Newer surgical approaches are listed followed by a description of outcome predications based on two scoring systems. The effects of cardiopulmonary bypass are described. Standards for routine care of the post-operative patients are presented. Complications are provided along with the recommendations for resuscitation should cardiac arrest occur.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
The importance of the neurologic assessment for patients in the intensive care unit cannot be overstated. All patients are at risk for neurologic deterioration, whether from a primary neurologic process, or from metabolic complications associated with systemic organ failure. Notable change in the level of consciousness during serial neuro exams is the most sensitive indicator of neurologic decline. Nurses performing a thorough neurologic assessment will examine consciousness and cognition, language and speech, the cranial nerves, and movement and sensation. Although the neurologic assessment can be complicated, using a standardized approach allows the rapid identification of neurologic decline allowing for rapid intervention to prevent further neurologic deterioration.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Sternal Wound Infections (SWI) are one of the major complication post-surgical interventions that have a negative effect on LOS, health costs morbidity and mortality. This is why it’s important that an early active surveillance program is put in place in all cardiothoracic surgical units. A task force must analyze cause of infections and put forth all the guidelines and recommendation on the prevention of SWI as well as having a clear knowledge on how to classify infections according to the CDC definitions .Our hospital experience has shown that standardization of processes is of fundamental importance, that active surveillance plays a key role in monitoring implemented measures and promote changes as well as keeping staff attention high. A multimodal and multidisciplinary approach is highly recommended.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Learning objectives for this talk:
- Describe the factors that contribute to loss of skin integrity for patients in the ICU
- Discuss appropriate pressure injury/ulcer staging and risk assessment
- Implement evidence-based strategies in the ICU to assist in improving patients’ skin integrity
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
In this presentation, Dr Gillian Ray-Barruel reviews the evidence-based nursing actions for CVAD insertion, maintenance, and safe removal in the ICU patient, including potential complications that may occur. Recent evidence is also discussed to enable nurses to question their own local practice for infusion management.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Low-flow oxygen therapy devices are often the first choice when giving supplemental oxygen to critically ill patients. Ensuring the oxygen is administered in a timely and appropriate way, using the right device, is an important aspect of care. This presentation provides an overview of basic oxygen therapy principles, describes the indications for and care requirements of nasopharyngeal oxygen catheters, nasal prongs and simple face mask devices. Importantly, a practical algorithm for the management of mild-moderate hypoxaemia is provided, so that, where possible, the simplest, most effective form of therapy can be given.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
The topic of neonatal resuscitation is vast and complicated. These 3 short lectures are aimed at providing a snapshot of 1. the normal birth process; 2. how this process can be interrupted and the impact on the newly born (especially the preterm neonate); and 3. a step by step review of resuscitation of the newborn at birth.
Emphasis is given to the equipment required, new ideas in neonatology and the important steps when resuscitating the newly born compared to an adult or paediatric patient.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
The topic of neonatal resuscitation is vast and complicated. These 3 short lectures are aimed at providing a snapshot of 1. the normal birth process; 2. how this process can be interrupted and the impact on the newly born (especially the preterm neonate); and 3. a step by step review of resuscitation of the newborn at birth.
Emphasis is given to the equipment required, new ideas in neonatology and the important steps when resuscitating the newly born compared to an adult or paediatric patient.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
The topic of neonatal resuscitation is vast and complicated. These 3 short lectures are aimed at providing a snapshot of 1. the normal birth process; 2. how this process can be interrupted and the impact on the newly born (especially the preterm neonate); and 3. a step by step review of resuscitation of the newborn at birth.
Emphasis is given to the equipment required, new ideas in neonatology and the important steps when resuscitating the newly born compared to an adult or paediatric patient.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
The purpose of this talk is to review suitable charting and prescription orders sheets for fluid balance and fluids use, and see new innovations in preventing positive fluid balance and for waste fluid management.
Learning objectives for this talk:
- To review some key history for fluids used to provide CRRT in the ICU
- To understand prescribing CRRT and the precision necessary for fluid removal
- To appreciate errors and adversity associated with inadequate fluid balance
- To review the concepts of fluid removal and fluid regulation in the critically ill
- To link the above key objectives to lower resource settings and clinical care broadly
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Learning objectives for this talk:
- To have an overview of post-operative care of Liver Transplant patients
- To identify early post-operative complications in Liver Transplant patients
- To have an awareness of specific treatments based on aetiology for Post Liver Transplant patients
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Learning objectives for this talk:
- To have an overview of post-operative care of Liver Transplant patients
- To identify early post-operative complications in Liver Transplant patients
- To have an awareness of specific treatments based on aetiology for Post Liver Transplant patients
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
To manage the complexity of trauma resuscitation, a systematic team-based and process-focused approach are needed to rapidly identify and treat life-threatening injuries and minimize team errors. Critical care nurses are an integral part of the resuscitation team so this presentation will provide a trauma resuscitation update. Whilst the primary survey is the mainstay of initial trauma care there has been a change of approach when managing ‘circulation’ with a focus on damage control resuscitation.
Damage control resuscitation will be the main focus of the presentation. Other updates will also be highlighted including the management of the vulnerable geriatric population and surgical rib fixation. Finally, Relational Coordination and its importance in supporting team coordination and performance will be discussed.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
If you are looking to understand the basics in regards to nutrition support in the ICU and the provision of enteral nutrition this is the session for you. It will cover briefly the role and importance of nutrition in critically illness, the assessment of route of feeding and the evidence in relation to energy and protein requirements and how this relates to a nutrition prescription in clinical practice. This session will also highlight some key papers, which will provide a greater understand of critical care nutrition if you are interested in doing further reading on this topic.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
A summary of the ABCDEF bundle - what are the components, how is it implemented and what are the impacts?
Learning objectives for this talk:
- Introduction of SCCM's ICU liberation bundle
- Understanding of post intensive care syndrome (PICS)
- Review of the benefits of ICU liberation bundle implementation
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Evidence supports those errors and poor quality are often the result of faulty system or processes versus individual behavior and are impacted by the work culture. Critical care nurses and the multidisciplinary unit team is in an excellent position to lead, participate and design the necessary changes required in their unit to meet the patient safety and quality. As nurses, the largest group of professionals within a unit environment, we must accept responsibility for the work cultures we create.
Organizational structure and unit culture will shape clinical practice and determines whether we will be successful at creating a culture of safety. How do we create a value change and develop an environment that fosters professional growth and enthusiasm towards change, reduction of error and quality improvement? This session will focus on outlining the problem and discussing front-line strategies to enhance nurses feeling of personal power, teamwork, communication, and professional ownership in shaping a safe and quality focused culture.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
The lecture on “Recognition of the Deteriorating Child” presents a systematic method for the clinical assessment of the paediatric patient. The systematic approach highlights the difference between paediatric and adult assessment due to the difference in paediatric physiology.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This presentation discusses the effect of muscle wasting on recovery in survivors of critical illness and presents the potential role that nutrition may play in attenuating this muscle loss. Literature on nutrition delivery and muscle mass or functional outcomes will be presented, and the potential implications on clinical practice discussed.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
As technology and medicine progresses so do our options for care. But how does doing ‘what we can’ impact the ‘doing what is right’? How often do pressures related to the job cause us to act in ways that are inconsistent with our ethical values? How does that impact us and what can we do to minimise its effect?
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Principles, Hardware and Troubleshooting
This talk discusses the following:
Simple electric circuit: Pacemaker, connecting cables, pacing lead
If 'pacing' light flashing but no spikes: It's a connection issue
Fixed by restoring circuit:
-Check connections
-Replace bridging cable
-Convert to unipolar
-Replace lead
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This talk is about the most important aspects of resilience building in critical clinicians.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Sepsis affects over 30 million people worldwide every year with high morbidity and mortality. Knowledge of the best evidence-based practice for sepsis care is crucial for all healthcare professionals. The Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock were recently updated in 2021 with 93 recommendations for practice in 6 categories. This talk will review the background of the Surviving Sepsis Campaign and their goal in decreasing sepsis mortality. Along with a brief discussion of the recent 2021 guideline methodology, the recommendations most directly relevant to nursing practice will be outlined. Additional resources to sepsis care will also be provided.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Ischemic cardiogenic shock is a highly fatal diagnosis, and patient outcomes are associated with early recognition and prioritized evidence-based management. This presentation will review the risk factors and pathophysiology, highlight the diagnostic approach, and discuss the prioritized management of adult patients with ischemic cardiogenic shock.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This talk gives a brief overview of potential PK/PD changes in a critically
ill patient, assessing patients for pain and reviewing sedation.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
The integration of palliative care into the care of people with serious illnesses and injuries has been associated with an array of improved outcomes for patients and their family members. Incorporating palliative care into the critical care context is a relatively nascent approach but one that has been shown to contribute to better outcomes for patients who require critical care. This presentation will review the evolving role of palliative care in the ICU.
To watch the lecture, and learn more about the speaker, visit https://www.continulus.com
The nurse practitioner is an internationally recognised Advanced Practice Nurse role. Globally, NPs have been providing care in a range of specialities since the 1960s but the role is still uncommon in adult Intensive Care Units (ICU). This presentation discusses the nurse practitioner role, why the model works well in adult ICUs and a structured approach to determining the need, plan, implementation and evaluation of the role.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Critical illness can be a traumatic experience and impact the long-term outcomes of ICU survivors and their family caregivers. This talk focuses on the outcomes of family caregivers and provides clinical practice strategies to improve the family experience in the ICU and beyond. We also offer future directions for research, practice and policy.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This presentation aims to broaden understanding of the evidence base around staffing in ICU and what it means in practice. It touches on the broader safe staffing evidence base, the literature specific to ICU, including recent research. It looks at how evidence is measured, and some of the key tools and methods and briefly looks at surge planning, consequences for ICU nursing staff. Some important considerations and areas of focus for improvement are outlined for individual nurses and managers in charge of ICUs.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Gastrointestinal dysfunction occurs in up to 60% of intensive care patients and almost 20% suffer from three or more
gastrointestinal symptoms. Persistent GDF in this setting results in the enteral feed delivery of less than half of the estimated
caloric requirement in these patients putting them at risk of hospital-acquired acute malnutrition and adverse complications
including organ failure. The role of the gut in the genesis of organ failure has been recognised for decades. Gut injury occurs
in many intensive care patients, where splanchnic vasoconstriction is present to maintain perfusion of heart, lungs, kidney,
liver and brain. The intestine is extremely sensitive to ischaemia, and this results in hyperinflammatory response secondary
to gut hypoperfusion leading to mucosal atrophy, increase in intestinal permeability, bacterial overgrowth and
translocation. This prioritisation of blood flow away from the gut has consequences.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
It has been widely reported that research takes on average 17 years to be incorporated into routine clinical practice. Sadly, only about half of that research reaches widespread clinical usage. Shortening the interval would increase the translation rate of scientific advancements into health care improvements. This presentation will review the pipeline for research translation to improve health, differentiate implementation science from other implementation activities, identify different approaches for implementation in critical care, and lastly, to identify competencies and strategies to enhance knowledge translation.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This podcast will explain the serious problem of intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in the critically ill patient. At least 50% of critically ill patients have it. It has been identified as a cause of morbidity and mortality for our patients. Much has been written as to the medical and surgical treatment of this issue. This presentation will identify specific independent nursing interventions that can be done to diminish the effects of IAH and ACS. This talk is based on the international guidelines of the Abdominal Compartment Society (WSACS.org).
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
This podcast will provide the participant with an overview of clinical ethics principles, how to apply those principles and information important in caring for a patient at end of life. We will discuss a clinical ethics model that assists in gathering information so that clinicians can help patients and their family to make fully informed decisions regarding treatment.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Vasoactive medications, including inotropes and vasopressors, are used in the treatment of various shock states. Understanding the hemodynamic impact of shock on cardiac output, preload and afterload is important to identify the role of vasoactive medications. Through adrenergic and non-adrenergic mechanisms, inotropes increase myocardial contractility while vasopressors cause vasoconstriction of vascular smooth muscle. Studies evaluating vasopressors in shock have identified norepinephrine as a first-line therapy, especially in patients with septic shock. Vasoactive medication selection should be driven by the patient's presentation to achieve the desired hemodynamic effects while minimizing adverse effects.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
The presentation focuses on critical care nurse competence. Competence as a concept is defined in general and in critical care nursing specifically. The importance of examining competence from both patients’ and nurses’ perspectives is highlighted. Some examples of competency standards and frameworks, and their utilisation in clinical practice are presented. The role of experiential learning and future trends in competence development are discussed.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Sepsis impacts over 1.7 million Americans each year resulting in over 270,000 deaths (a death every 2 minutes). According to a Centers for Disease Control and Prevention (CDC) study, as many as 87% of sepsis cases begin outside of the hospital, so early identification and treatment in the post-acute setting is key to reducing morbidity and mortality in this population. Healthcare personnel in skilled nursing facilities play a significant role in early identification and treatment of sepsis. This presentation will overview sepsis, its pathophysiology, signs and symptoms and treatment within the context of skilled nursing and long term care (LTC). It will outline an early identification and treatment process for sepsis and how to incorporate it into usual work processes including communication strategies to providers that focus on action. Strategies for patient and family education will also be reviewed.
To watch the lecture, and learn more about the speaker, please visit https://www.continulus.com
Critically ill patients experience poor quality sleep including frequent awakenings and little restorative sleep. This talk outlines the specific characteristics of sleep during critical illness. Practical strategies and interventions to ameliorate the effect of the environment and ICU treatments are suggested.
As preceptors integrate neuroleadership principles of Dr. David Rock’s SCARF framework, intentional storytelling, and crisis resource management concepts into communication with students and fellow co-workers, learning culture is enhanced. As preceptors engage in this style of communication and support, they can improve retention and recruitment, promote psychological safety with students and fellow staff, and create an environment people want to work in. Practical examples for how to do this are provided to guide preceptor development. This ultimately translates into better working environments for staff and patients and families benefit in their outcomes and experience.
This presentation will briefly highlight some of the problems with the current ICU environment, and the impact this has on patients and staff. Some potential future design and technological improvements that are likely to be available in the near future for ICU staff to help improve patient care and support staff in delivering best care will be briefly discussed.
This lecture describes the problem of Post Intensive Care Syndrome (PICS), and how early rehabilitation in the ICU can begin to address this. Part 2 of this talk will focus on how to create a culture of rehabilitation in our ICUs, and real examples of translating the theory into practice will be presented to encourage interactive discussion.
This lecture describes the problem of Post Intensive Care Syndrome (PICS), and how early rehabilitation in the ICU can begin to address this. It will focus on early mobilization as a key aspect of ICU rehabilitation, and how this can be implemented in practice. Patient and family experiences of ICU rehabilitation will be explored.
This lecture will provide an overview of the physiological adaptions of pregnancy pertinent to critical care management. Our understanding of COVID-19 in pregnancy and the effects on the mother and baby will be summarised. Key elements of the care of pregnant women in ICU, including mechanical ventilation, prone positioning, assessment of fetal wellbeing and medical treatment will be discussed.
This lecture will provide an overview of the physiological adaptions of pregnancy pertinent to critical care management. Our understanding of COVID-19 in pregnancy and the effects on the mother and baby will be summarised. Key elements of the care of pregnant women in ICU, including mechanical ventilation, prone positioning, assessment of fetal wellbeing and medical treatment will be discussed.
There is a plethora of evidence-based practices in the ICU that can be implemented. This talk will review evidence-based practices for mechanically ventilated adults, what can prevent or support the ability to implement EBP, and then strategies for effective implementation from implementation science.
Critical illness can contribute to a decline in physical condition with many patients experiencing decreased physical functioning for months following recovery from critical illness. Muscle loss and reduced function contribute to this decline in physical function and there is potential for optimal nutrition in combination with early exercise to promote maintenance of muscle mass and function. Ensuring prescribed nutrition and mobilisation goals are met during the hospital stay is challenging and families can support and encourage patients with meeting these goals, so that the potential for physical recovery is optimised.
In this lecture, Catherine will outline a number of basic principles in pharmacokinetics and pharmacodynamics and how they relate to the critical care patient, most specifically in sepsis and septic shock. The lecture will combine PK-PD theory and clinical applications, with a focus on antimicrobials and sedative agents.
Anxiety is a common symptom experienced by patients who receive mechanical ventilation. This lecture covers the definitions and concepts, causes, clinical manifestations, and short- and long-term implications of unmanaged anxiety during mechanical ventilation. Differentiation between anxiety and other similar symptoms will be discussed. Current assessment and treatment methods for anxiety will be reviewed. Lastly, future considerations for clinical practice and strategies for meaningful engagement of patients and their informal caregivers in anxiety assessment and management will be presented.
During this presentation, logical steps to rhythm strip analysis will be recalled and applied to a rapid review of sinus, atrial, junctional and ventricular rhythms. The significance of each rhythm will be examined and potential interventions considered. The target audience includes nurses or health care providers seeking to refresh prior learning or increase confidence with ECG rhythm interpretation.
This presentation will discuss the epidemiology of burnout and its related concepts. We will also discuss how COVID-19 has affected clinicians, including nurses. We will also discuss the evidence-based strategies that individuals and organizations can potentially use to address burnout.
The purpose of this lecture is to provide attendees with the tools they will need to improve inter-disciplinary communication in healthcare, a primary source of patient safety errors and adverse events. Numerous examples from recent research will be provided so that attendees will leave the session with actionable information and insights that can be applied to their own practice.
Over the last two decades, there have been several landmark fluid resuscitation trials published. These trials have provided evidence that the type of intravenous fluids we choose for resuscitation can impact important patient-centred outcomes. This presentation will look at what we know from these trials focused on fluid resuscitation in sepsis and septic shock; specifically, an overview of the principles of fluid resuscitation, types of fluids, review the fluid resuscitation evidence and describe changes in fluid resuscitation practices over time.
In this presentation I will present the story of the rapid development, scaling and sustaining of the LifeLines virtual visiting philanthropic innovation over the pandemic. I will discuss the impact on family and clinicians of visiting restrictions necessitated by the pandemic. I will also highlight the growing body of evidence for virtual visiting including unanticipated benefits. Finally, I will discuss considerations for how to optimise the delivery of virtual visiting, both during ongoing visiting restrictions and as a routine option for ICU families.
There is no simple answer to the question of “should we treat fever and how?” Fever is a potent immune response that can be protective for some ICU patients, especially when therapeutic options are limited. Fever also comes at a significant metabolic cost, which critically ill patients may, or may not be able to tolerate. I will review the physiology of fever, discuss the costs, benefits of fever in adult critically ill populations, present available fever management strategies. While there is no simple answer, we can make more informed decisions about how and when to treat fever in critical illness.
The intensive care outreach nurse (ICON) is known by many names. Essentially, this is an ICU nurse with exceptional assessment, communication, problem solving and bedside teaching skills whose primary role is to respond to and support the bedside nurses (and doctors) caring for the deteriorating patient. Much is known about the benefits of such roles, but little is described regarding how to set them up. This talk focuses on the latter using a case study of how the role was implemented in the UAE into 4 teaching hospitals concurrently.
This talk will review current evidence on the prevalence and manifestations of post-intensive care (PICS) and post-sepsis syndrome (PSS) and will explore links with prolonged critical illness and post-COVID19 syndrome. Current advances in our understanding of the pathophysiology of PICS will be discussed, including the role of immune and macrophage dysfunction, as well as their implications for the management of PICS. Evidence on approaches to improve long-term outcomes after critical illness will be presented, and gaps in the literature and practice implications will be discussed.
Subarachnoid hemorrhage is a major cause of morbidity and mortality around the world. The rapid diagnosis and treatment of the underlying source are paramount to ensuring optimal patient outcomes. This lecture will overview the pathophysiology, risk factors, and immediate diagnostic/treatment priorities when caring for these patients. Utilizing case studies, a review of possible sequelae with pre-emptive and reactive medical interventions will occur.
The provision of end-of-life care remains a significant component of work in intensive care settings. Over the last decade, this area of practice has gained increased attention with a substantial increase in research, however, gaps remain. This presentation will focus on what is known and not known about end-of-life care in intensive care settings and provide recommendations to advance future practice and research.
This talk will review the current evidence about the benefits of interprofessional ICU teams to patient care and outcomes. We will review the integral team members, data that supports how they work together effectively and discuss gaps in our understanding to optimize ICU human resource investment and improve patient care and outcomes.
This talk will define hypoxia and the oxygen cascade and outline a programme of research carried out in healthy volunteers to further our understanding of hypoxia’s effect on human physiology. It will present some of the ongoing research focussed on optimising oxygen therapy and it will identify things to consider when caring for the hypoxic patient.
By the end of this lecture, the attendee will be able to:
- Discuss historical trends for patient management with ECMO
- Describe the physiological basis of ECMO therapy and oxygenation
- Review recently published data regarding the need for mechanical ventilation with ECMO therapy
By the end of this lecture, the attendee will be able to:
- Differentiate between VV and VA ECMO support
- Describe the impact of the COVID19 virus and the increased need for higher level support for patients
- Discuss recently published literature regarding outcomes with the use of ECMO therapy for COVID19 patients
In this talk I will discuss current thinking in terms of the epidemiology of weaning and current definitions i.e. who are we weaning. I will discuss weaning methods including spontaneous breathing trials, weaning protocols and automated weaning modes including the evidence supporting these weaning tools. I will highlight recent evidence on the role of non-invasive ventilation for weaning. Finally I will discuss weaning in patients experiencing prolonged mechanical ventilation.
The methods of co-design are not yet used extensively in healthcare. Using the example of recent work to enhance patient safety, this presentation illustrates adaptation and use of principles and strategies to undertake human-centered co-design to create a novel solution for a complex knowledge translation problem in acute healthcare.
This talk will address the impact of a critically ill child admitted to an adult ICU. The talk will cover the physical and psycho-social needs of children including the child’s family needs. Controversial issues will be discussed such as 24/7 visiting of parents, parental presence during invasive procedures and CPR, and shared decision-making with (difficult) parents of care and treatment options.
In this presentation, Acute kidney injury will be defined and discussed with regards to causes, mortality and how to detect it. Conventional biomarkers have been used to detect acute renal failure, such as urea and creatinine. New biomarkers will be discussed for detection of injury, as well as current treatment options.
In this programme, recent improvements in the understanding and treatment of sepsis will be presented, including how SARS-COV2 induces sepsis. A review of past therapies and the recent introduction of newer treatments for sepsis will be discussed. Updates from the Surviving Sepsis Campaign will be presented, as will recent studies that address the management of sepsis. Controversies in the treatment and identification of sepsis will be reviewed, as well as case studies using novel treatments in the care of the patient with sepsis. The emphasis on early identification and how to implement protocols in hospitals, from the ED and floor to the ICU will be highlighted. The program emphasises innovative learning strategies in an attempt to help the learner retain more information as well as make the program a more enjoyable event.
In the year of the nurse, it is important to remember a famous quote by Florence Nightingale; “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm”. In our current work cultures, some basic nursing care activities designed to prevent harm, are frequently seen as just tasks to be completed before the end of the shift or just one more project. With health care infections a worldwide problem we can make a difference in preventing the invasion or halting the spread of microorganisms by implementing basic care strategies to reduce the source of the infection. This session provides an in-depth examination of the science of bathing critically ill patients and the impact it has on infection. This session will seek to dispel any myths and address the evidence-based practice and provide suggestions for successful implementation leading to a change in care.
On any given day, Critical Care Nurses may be called upon to assist with or admit complex, critically injured polytrauma patients into the adult Critical Care Unit. It is essential that nurses possess a solid and accurate understanding of best practice trauma resuscitation principles. This session identifies current, evidence-based practice guidelines for Critical Care Nurses for the restoration of hemodynamic stability and avoidance of complications, following the admission of the adult polytrauma patient to Critical Care. The “ABCDE” approach to trauma patients, shock, oxygenation, ventilation, fluid resuscitation, coagulopathies, and damage-control surgery, is described and discussed.
Determining body fluid balance in critically ill patients is a major challenge, particularly where patients have required extensive resuscitation and/or have renal impairment. Fluid imbalance and overload, key consequences of severe acute kidney injury, can lead to an increase in patient morbidity and mortality. Nurses play a critical role in the assessment of fluid balance and the management of patient care interventions such as renal replacement therapy which allow significant manipulation of body fluid status and require diligent management to ensure effective fluid balance maintenance.
In this lecture, Dr. Chen will talk about how we can implement research evidence into clinical practice. This will include several concepts including implementing change, theoretical domains framework, and process evaluation. An exemplar will be given about implementing same-day discharge following percutaneous coronary intervention from Dr. Chen's doctoral study, together with current evidence for the practice.
Critical care practice is underpinned by policy and research which acknowledges the benefits of patient and family engagement in the intensive care unit. Engagement occurs across a continuum from low to high levels of engagement. In this session we will discuss how patient and family involvement in care delivery can be promoted, ways in which families might be engaged while their family member is in the ICU, the potential benefits to the patient, family and health professionals, and managing potential challenges. We will also discuss some novel approaches for more active family engagement and partnerships in the ICU.
We demonstrate the feasibility of introducing a non-ventilatory intervention of prone positioning in the management of patients with moderate to severe ARDS, which has been applied and demonstrated in the Regional Intensive Care in South East Queensland. This strategy could be replicated and adopted in other similar ICU's who do not have the ability to provide Tertiary services, such as extra-corporeal life support. The advantage of this process is its easy applicability and rapid implementation, especially in this era of the COVID-19 Pandemic.
Is the spread of multi-drug resistant (MDRO) organisms a major problem in your patient care environment? Then consider designing a plan of attack using the latest evidence and implementation strategies to win the bug war. MDRO’s contribute to serious infections and higher mortality in acute and critically ill patients. This session will explore modes of transmission to outline a strategy for source control. Habitual care practices including bathing, oral hygiene, and handwashing will be examined closely as potential sources. An in-depth focus on the development of evidence-based care practices and protocols and the examination of resources and systems that support source control and reduce transmission will be discussed. Let’s eradicate the bugs together.
This talk examines key definitions relating to medication safety, including medication errors, adverse drug events, and adverse drug reactions. The talk also identifies the prevalence of medication errors, the outcomes and risk factors associated with medication errors in intensive care. After providing the context in which medication errors occur in intensive care, consideration is given to various interventions that have been shown to impact on reducing medication errors.
Patients continue to deteriorate. In this presentation, we will identify the context, the challenges, the solutions, and the future in relation to the nurse’s role in recognising and responding to patient deterioration.
Capnography has the unique ability to aid clinicians in assessing both ventilation and blood flow. In this program, a review of the physiology that allows exhaled CO2 to monitor ventilation and perfusion is presented. The emphasis in this program is using capnography to prevent over-sedation and monitoring of blood flow. Due to the ability to assess both ventilation and perfusion, capnography has been called the “15-second vital sign”. The use of capnography is likely to quickly grow throughout the hospital and even into pre-hospital settings.
A tour through common and not-so-common infections of the nervous system, with a focus on clinical presentation, treatment, and outcomes.
Contemporary approaches in healthcare simulation facilitate development or enhancement of clinical judgement, interprofessional practice and safe patient care. During this session, a range of simulation based education initiatives and applied pedagogy will be showcased. Reference to readily available, seminal resources will be provided. Opportunity for dialogue amongst participants and with the presenter may expand networks and lead to future collaborations.
This talk is focussed on abdominal-pelvic, or more specifically, junctional haemorrhage. It is all about bleeding that is too proximal for an extremity tourniquet but below the diaphragm. Pre-hospital (civilian), battlefield, and iatrogenic causes will be presented and discussed. Haemorrhage control strategies will be taught.
Prone positioning has been utilised to recruit alveoli to improve oxygenation while preventing complications of ventilator-induced lung injury in patients with ARDS for over 30 years. Recently with new studies, the use of prone positioning is now considered front line therapy and utilisation of the technique has increased significantly since COVID 19. With the mortality rate of the ARDS patient remaining at 40%, we need to implement evidence-based practices that work. This session discusses the physiological mechanisms of the prone position for reducing lung trauma and improving oxygenation. How a team can successfully build and implement a proning protocol is outlines. An exploration of the evidence used to define the patient likely to respond to prone positioning, identify the appropriate time to initiate therapy, and time spent in the prone position are discussed. Evidence-based strategies for turning and sustaining the patient in a prone position are outlined to ensure safety for the patient and healthcare worker. As practitioners, we have the potential to influence patient outcomes through a safe non-invasive positioning technique.
Practical evaluation and evidence-based management techniques for increased intracranial hypertension will be the focus of this lecture. Whether the neurologic system strikes fear in your heart or if you would describe yourself as a "neuro nerd", this lecture will have something for you! Pathophysiology of cerebral edema will lay the foundation for why increased intracranial pressure might occur. Building upon that groundwork, herniation syndromes, and exam findings will be reviewed, along with noninvasive exam techniques/technology which will enable early, bedside identification of increased intracranial pressure (IICP). Moving beyond a basic neurologic exam, advanced brain pressure, perfusion, and oxygenation technology will be described along with a review of guidelines to indicate the application of device implementation. With examination strategies reviewed, evidence-based practice guidelines will be utilized to support tier 1-5 intervention/management strategies. This information-filled lecture will leave the learner with the knowledge that can be applied at the bedside or support protocol development to enhance care outcomes in the malignant intracranial hypertensive patient.
The evidence on which we base decisions about nurse staffing in critical care units is sometimes not clear. The use of ratios (for example, nurse to patient ratio) is based on the assumption that patients with more organs failing require greater nursing resources. In the current climate, with increased demand on all health services, it is important to understand what impact any change in critical care nurse staffing might have on patients, family members, nurses, and the health service.
This talk will highlight current advances in the pathophysiology of ICU delirium, including neuroinflammation, oxidative stress, and dysregulation of circadian rhythms and HPA axis. Key pathophysiological mechanisms will be linked with current evidence-based recommendations for the assessment, prevention and treatment of ICU delirium, with emphasis on evidence on non-pharmacologic interventions. Data on epidemiology and approaches to improve long-term outcomes will be presented, and gaps in the literature and practice implications will be discussed.
The current Covid-19 pandemic has challenged not only entire hospital systems but also thousands of healthcare providers who are increasingly grappling with mental health difficulties such as anxiety and distress. This webinar aims to describe psychological challenges faced by health care providers, to provide a framework to understand these challenges and to provide practical insights and guidance to help optimize coping and enhance emotional functioning.
Evidence supports that we are in the midst of a significant nursing shortage and it is expected to worsen in the next ten years. One of the noteworthy factors contributing to nurses exiting the profession is burnout and job dissatisfaction. This session will focus on outlining the ingredients necessary for nurturing the person and the nurse. Skills regarding the ability to become an influencer to affect change within the workplace will be outlined. Each participant at the conclusion of the session will start creating a vitamin recipe for personal and professional success. It is only when the caregiver’s needs are adequately addressed will they most effectively be able to help the patient and their families and feel good about being a nurse. Create your own vitamin recipe for personal and professional success.
In this talk, we will explore why sedation in ICU patients is important, what the links are to outcomes and the challenges of optimising sedation. We will then discuss the different strategies that have been used to optimise sedation practice and the evidence of the effectiveness of each of these strategies. This discussion will enable you to develop ideas of how you might lead change in sedation practice in your own ICU.
End-of-life care in critical care is a challenging topic that can cause distress to both families and staff. During this lecture, we will aim to discuss the role of end-of-life care in the critical care environment and common challenges and possible strategies for solutions for nursing staff. We will also spend time discussing a detailed systemic approach for implementing the withdrawal of life-sustaining therapies to better prepare nurses to feel more comfortable and confident in providing this vital care.
Critical Care Nurses are assuming greater responsibility in management and care of patients receiving mechanical ventilation. This session focuses on the foundational aspects of mechanical ventilation that is essential for every Critical Care Nurse to know and understand. How the mechanical ventilator delivers breaths (volume vs. pressure), compliance and resistance, ventilator settings, peak and plateau pressures, and initiating mechanical ventilation, are highlighted. Current best practice strategies for ventilating the adult patient with Acute Respiratory Distress Syndrome (ARDS), will also be reviewed. This session aims to assist Critical Care Nurses to become more familiar with mechanical ventilation, thereby enhancing patient outcomes.
Using electrical therapy for defibrillation, cardioversion and pacing can be intimidating at the bedside. This webinar will provide practical tips and strategies for successful use of energy for all these situations. In addition, newer evidence for vagal manoeuvres for SVT will also be discussed.
Despite limited evidence, chlorhexidine oral care is used worldwide in the prevention of intubation-related pneumonia as it is recommended by leading health institutions. Recent research, however, questions the safety of this practice with a trend towards increased mortality in meta-analyses and a solid association with mortality in a large hospital-wide cohort study.
This session disruptively addresses burnout and resiliency in healthcare workers. An evidence-based evaluation of the causes of stress and burnout and strategies for resilience are discussed, including the role of emotional intelligence. Emotional intelligence can be learned and emotional intelligence assessment tools highlight many of the skills required to minimize burnout and reduce the need to resilience. Gumby serves as an example of how we can bend and always return to our true form.
Intravenous fluid therapy is one of the most common interventions in acutely ill patients. Each day, over 20% of patients in intensive care units (ICUs) receive intravenous fluid resuscitation and more than 30% receive fluid resuscitation during their first day in the ICU. Virtually all hospitalized patients receive intravenous fluid to maintain hydration and as diluents for drug administration. Until recently, the amount and type of fluids administered was based on a theory described over 100 years ago, much of which is inconsistent with current physiological data and emerging knowledge. Despite their widespread use, various fluids for intravenous administration entered clinical practice without a robust evaluation of their safety and efficacy. High-quality, investigator-initiated studies have revealed that some of these fluids, notably hydroxyethyl starch and other synthetic colloids, have unacceptable toxicity; as a result, several have been withdrawn from the market whereas others, controversially, are still in use. The belief that dehydration and hypovolaemia can cause or worsen kidney and other vital organ injury has resulted in liberal approaches to fluid therapy and the view that fluid overload and tissue oedema are ‘normal’ during critical illness; this is quite possibly harming patients. Increasing evidence indicates that restrictive fluid strategies might improve outcomes. For generic use, a buffered salt solution such as Plasmalyte or Hartmanns (Lactated Ringers) is a safe first choice. In patients with septic shock not responding to crystalloid resuscitation, albumin is a rationale second choice. Although the evidence is less clear, normal saline should be the first choice for a patient with acute brain injuries; albumin in a hypotonic carrier fluid is contra-indicated for such patients. There is no role for hydroxyethyl starch solutions is acutely or critically ill patients and their continued use harms patients.
Pressure injuries are one of the most frequently occurring, painful, costly yet preventable adverse events in hospitals. Intensive care patients have major risk factors in developing pressure injuries including immobility, poor perfusion, and vasopressor medication infusions. Multi-faceted interventions, also known as programs or care bundles, are recommended to prevent pressure injuries. However, clinicians often face the challenge of not knowing how to implement these programs or care bundles. In this lecture, we discuss current research evidence on the interventions and implementation strategies on pressure injury prevention in intensive care patients.
We have our differences, but clinicians, administrators, policy-makers, and health care funders share a common core goal: to provide the best possible care to patients and to improve that care continuously. The tools they use differ, and may even appear to be in conflict. Clinical research seeks to determine in as rigorous a manner as possible, which of several options yields better patient-centered clinical results and to disseminate these findings to clinicians. Administrators use quality improvement tools to ensure that accepted best practice approaches are routinely applied in clinical care. Research focuses on a small population of patients, requires their informed consent prior to engagement, is funded from sources outside of the provision of care, and determines whether one of two or more approaches is better. Quality improvement implements conclusions of variable scientific rigour across a broad group of patients, assumes benefit and so does not seek consent, is funded from clinical funds, and focuses on clinician compliance rather than patient benefit. Evolving research designs such as the stepped wedge cluster trial or the platform trial provide a mechanism to bridge the gulf between research and quality improvement and to ensure that new knowledge that benefits patients is incorporated rapidly into clinical care.
The use of ECMO therapy is increasing in today’s critical care environment, so this course is designed to be a basic introduction to extracorporeal membrane oxygen support therapy or ECMO. We will discuss the What, How, Why and When of implementing ECMO therapy as well as common complications encountered during ECMO. Case Studies will be incorporated as well as discussion differentiating between ECLS and ECPR. The information provided will be based upon the ExtraCorporeal Life Support Organization (ELSO) recommendations for best practice with ECMO support.
Does feeding make a difference to critically ill patients….or not? There remains considerable variability in nutrition support practice for the critically ill despite the availability of numerous guidelines to support our practice. The complexity of the metabolic response to critical illness, coupled with patient heterogeneity, means that a one-size-fits-all approach to nutrition support is unlikely to work and that not all patients will benefit equally from nutrition interventions. We also lack clarity on the best way to determine nutritional requirements and there are insufficient data to specify the amount of protein and/or calories that patients should receive. All of these factors contribute to uncertainty regarding the benefits and best practices in relation to nutrition. Nevertheless, we know that if we don’t feed patients they do poorly. We also know that the practices of critical care nurses who manage the delivery of nutrition can have a significant impact on nutrition adequacy both in ICU and during recovery in the ward. Think about what you can do to make a difference to nutrition intake for patients recovering from critical illness.
The aim of this lecture is to enhance knowledge on the use of pain assessment tools in the ICU, and on the clinical significance of systematic pain assessment, and to promote understanding of how the neural circuitry of nociception perpetuates increased pain levels in critically ill patients. The majority of critically ill patients experience moderate to severe pain. Pain may also persist after ICU discharge and shift to chronic pain, and is also implicated in the post-intensive care syndrome. Despite guidelines, implementation and use of validated tools to assess pain in routine ICU practice appears to be inconsistent.
Do you feel like you have implemented all the evidence, but you're still not getting the expected results? You are not alone. CLABSI's and CAUTI's remain a significant contribution to patient harm and financial losses. The problem may call for a different approach. Quality implementation science tells us that substantial practice and process variation can lead to lower quality and higher cost. It makes sustainability almost impossible. The first step in this journey is a dissection of both physician and nursing practices and processes, then the application of laser target strategies. This session focuses on key practice areas where significant variation has been identified through a national frontline consultation experience. Innovative assessment techniques and evidence-based approaches are outlined to address both insertion and maintenance related central lines and indwelling urinary catheters. The challenge of incorporating new evidence into practice lies in altering routinized behavior and current culture to support new care practices. Leave with a plan for your organizations breakthrough to achieve zero in CLABSI's and CAUTIs.
Susan provides a comprehensive review of traumatic brain injury. Injury identification, with associated evidence-based treatment strategies, will provide learners with practical tools to support patient care. The lecture will begin with a review of the mechanism of injury and primary and secondary trauma assessments. Following this, an overview of primary brain injury will occur where associated CT scan imaging will be utilized to enhance participant learning. Pathophysiology of secondary brain injury will be provided followed by strategies to minimize its sequelae. Brain herniation syndromes, intracranial pressure evaluation, and management techniques will be presented along with miscellaneous items such as deep vein thrombosis, feeding, and temperature management strategies to support optimal TBI patient outcomes. Throughout the course, evidenced-based, nursing treatment strategies will be provided to support rapid identification and practical care management that can be applied in global care settings.
Approximately 1/3 of survivors of critical illness experience psychological compromise during recovery. Although the pattern of this compromise varies for individual patients, we can monitor and minimise factors in ICU that might make this worse for patients, and also improve our care to reduce problems during recovery.
Interventions to be delivered within ICU that might be of benefit include sedation minimisation, sleep improvement, early mobility and psychological support. Interventions to be considered after ICU include information provision and follow-up support.
Outcomes from in-hospital cardiac arrest remain dismal, about 25%. Preventing an arrest is the ultimate goal for hospitalized patients. However, this is not always possible & understanding the components of resuscitation that make a difference should be the focus.
This lecture will focus on the top 5 things to focus on in cardiac arrest: high-performance CPR, early & effective defibrillation, feedback to teams & team training and post-arrest temperature control.
Incorporating these components will likely increase the patient’s chance of survival.
This lecture will explore the critical issues associated with errors occurring within the ICU setting, including the prevalence, nature and contributing factors. In addition, the talk will explore the impact of errors for patients, clinicians and healthcare organisations.
The direct consequences for the error maker or 'second victim' will be discussed, with specific focus also on their support needs following an error event.
This lecture presents evidence-based information about the diagnosis, reperfusion treatment, and prevention of acute ischaemic stroke. The discussion will centre on nursing clinical localization diagnostic skills, the availability and utility of computed tomographic (CT) technology, and nursing’s role in the development of systems of care that support stroke management. Specific topics will include intravenous alteplase and thrombectomy treatments, rapid emergency department management paradigms, the evolution of prehospital treatment on mobile stroke units, and the importance of primary and secondary stroke prevention.
Critically ill patients are at high risk for developing a life-threatening infection such as bloodstream infection or pneumonia. These infections might lead to sepsis and multiple organ failure. Adequate antimicrobial therapy is essential to optimize the chances of survival. Three key issues in this regard are (i) a first antimicrobial dose administered as soon as possible after the onset of the septic episode, (ii) an empiric antimicrobial spectrum covering the causative pathogens, and (iii) adequate dosing. However, efficient dosing is problematic because of pathophysiological changes associated with critical illness affects the pharmacokinetics of mainly hydrophilic antimicrobials. And the preparation and administration of antibiotics may also negatively impact the efficiency of therapy. Therefore nurses must be aware of some points of interest in order to optimize antibiotic therapy.
There is no magic bullet that will reduce the mortality rate of the ARDS patients. It is the early and consistent applications of evidence-based supportive therapies that results in improve short and long-term outcomes. Understanding the ARDS Berlin definition that differentiates the syndrome based on severity of hypoxemia to be mild, moderate or severe, helps the experienced nurse target the correct supportive care. Our knowledge of the diffuse injury to the alveoli and capillary membranes caused by inflammatory mediators and ventilator-induced injury helps for greater understanding of the clinical signs/symptoms and why certain therapies support the ARDS patient better. Due to the complexity of the patient, it is critical that the skilled frontline nurse have a user-friendly structure (8 P’s) to trigger implementation of evidence based care practices. The goal is to PREVENT further injury of the lung, reduce ventilator-associated events and physical and cognitive decline. The team must utilize evidence-based ventilator strategies (PEEP) while ensuring adequate volume for the heart to work at maximum efficiency (PUMPS & PIPES) to help deliver oxygen to the tissue. The critical care nurse plays a key role in minimizing oxygen demand and balancing brain recovery through appropriate use of sedation and paralytic agents (PARALYSIS). The timing and implementation of the prone position (POSITIONING) can determine its effectiveness on oxygenation and prevention of lung injury. Once prone position is no longer useful, early progressive is critical to improve long-term cognitive and functional ability. Appropriate nutrition (PROTIEN) to promote healing and reduce inflammation is an essential component of the care plan. Incorporating evidence based (Protocols) such as the ABCDEF can impact overall outcomes in the ICU patient. It takes all our knowledge and skill to ensure the ARDS patient not only survives but is able to return to a meaningful life as soon as possible.