Last year’s conference attendees packed the educational sessions.
The conference-long critical care track returns to ATS 2011, and a sampling of topics reveals how the coverage will touch on all aspects of critical care medicine.
Intensive Care: Is More Better?
On Monday, May 16, session B4 “The Intensity of Intensive Care: Is More Better?” will help attendees learn about the consequences of ICU triage decisions, identify aspects of ICU care where some patients may benefit from less intensity of treatment, and understand the challenges of assessing the impact of staffing and technology in the ICU setting.
The session, which will take place from 8:15 to 10:45 a.m., will include six physician talks, plus a patient perspective. All are geared toward critical care practitioners, including physicians, physicians in training, nurses, respiratory therapists, pharmacists and physician assistants.
“My goal is to help people think about of the different aspects of critical care where decisions are made regarding how much and exactly when, from questions of whether or not to admit a patient to an ICU all the way through to when you should think about doing a tracheostomy,” said Hannah Wunsch, MD, MSc, assistant professor of anesthesiology and epidemiology at Columbia University Medical Center in New York.
Dr. Wunsch will co-moderate the session with Damon C. Scales, M.D., Ph.D., assistant professor in the interdepartmental Division of Critical Care at the University of Toronto.
While she said she knows that it goes against a physician’s human nature to resist the urge to “do something for someone at all times,” Dr. Wunsch said she hoped to help participants think about the facts.
“We have a lot of ICU beds and we have lot of technology. Just because we can do more sooner and faster might not always mean that we provide optimal care for patients,” said Dr. Wunsch, whose own discussion will focus on triaging patients for the ICU.
She pointed to admissions decisions: “It’s easy to conclude that a patient might get hurt by not being admitted to the ICU, but it’s sometimes harder to recognize that some patients may be better off on a ward where they can move around more easily, potentially have less exposure to patients with severe infections and be in a quieter environment,” she said.
Included in the session will be a presentation on “Rethinking Monitoring Devices,” which she said would call on physicians to focus on balancing patient risks and benefits in the use of central lines, for example.
The controversial topic of sedation is the focus of “From Light Sedation to Paralysis.” What’s appropriate in terms of how much sedation to give patients is a complex question, especially in light of recently published papers, Dr. Wunsch said.
She pointed to reports suggesting that paralysis and heavy sedation increase the length of critical illness and may contribute to polyneuropathy, while a recent paper demonstrated that early paralysis in patients with acute respiratory distress syndrome may improve outcomes.
The presentation on “Is 24-hour Intensivist Coverage Better Than Just Daytime?” will explore how such coverage influences patient care and staffing.
“There’s this sort of default idea that of course it must be better to have someone there 24 hours a day, but it’s not so clear whether the additional staffing actually makes a difference for patients. There also may be adverse consequences to increased staffing, such as physician burnout,” Dr. Wunsch said.
Use of Mechanical Ventilation
Mechanical ventilation is the pivotal therapy in patients with respiratory failure associated with hypoxemia and/or hypercarbia. In recent years, large epidemiological studies and prospective clinical trials have changed our concepts on mechanical ventilationimplementation.
A Sunday symposium, A84 “How Are We Using Mechanical Ventilation? A New Approach” from 2 to 4 p.m., will provide clinicians with up-to-date information on how to implement mechanical ventilation, assist critically-ill patients and understand its potential limitations.
The Dwindles
Tuesday’s C4 “Preventing and Treating ‘The Dwindles’ of Chronic Critical Illness,” from 8:15 to 10:45 a.m., will provide information on the current state of the art regarding the definition and epidemiology of chronic critical illness and established and novel prevention strategies and treatments.
Critical illness extends beyond initial resuscitation, yet preventive and therapeutic strategies are often lacking for patients who remain critically ill despite ongoing organ support. Physicians, nurses and allied health professionals will learn how to apply selected new nutritional and rehabilitation strategies to prevent and treat chronic critical illness, and identify new findings related to prognosis and healthcare organization for the chronically critically ill.
Neurocritical Care
Wednesday will offer D84 “Making Sense of Neurocritical Care 2011.” Neurocritical care is a relatively young subspecialty, and the topics discussed in this 2 to 4:30 p.m. symposium were selected for their extreme relevance to neurointensivists and general critical care physicians. Speakers will describe therapeutic hypothermia and traumatic brain injury, decompressive craniectomy for traumatic brain injury and stroke, neuro-prognostication in the era of therapeutic hypothermia, the need for EEG monitoring, critical organization for neurological emergencies, and clinical integration of brain oxygenation.
Participants will learn how to integrate up-to-date management strategies for brain injury, discuss appropriateness of various systems for caring for neurological patients, and critically examine and discuss modes of monitoring for neurological injury.