As I learn, you do too
I hope these are helpful
My name is Jonathan Downham and I am an Advanced Critical Care Practitioner in Warwick, UK.
I have worked in Critical Care for over 20 years now and have learned many things whilst there. This site has some of my teaching resources, podcasts and videos for anyone else to benefit from.
If you want to follow me on Twitter then look for @ccpractitioner. I am very active on there and it is the best way to get in touch with me quickly.
You can find the rest via whichever pod catcher you choose
My contacts at the American Association of Critical Care Nurses put me in touch with Jill Guttormson, the author of Nurses’ Attitudes and Practices Related to Sedation: A National Survey. It seems we are still not great at doing the sedation hold and this is an attempt to find out why. Some interesting points raised I think.
©2019 American Association of Critical-Care Nurses doi:https://doi.org/10.4037/ccn2019530
This is a chat with the lead author of this paper Dr William McGee.
"Pre-existing pressure injuries can serve as a predictive clinical marker for longer hospitalization and increased odds of mortality, especially when other data aren’t available, according to a study published in the June issue of Critical Care Nurse.
The research team from Baystate Medical Center in Massachusetts found that pressure injuries that were present upon admission to the ICU could be used to quickly and objectively identify patients who may require additional care. The statistical analysis revealed that pressure injuries were associated with significantly longer hospital lengths of stay, regardless of mortality outcome. Among patients with pressure injuries at admission, mechanical ventilation and dialysis were more common, as was the overall severity of illness. Readmission to the ICU during the same hospitalization occurred more frequently for patients with pressure injuries."
Paul uses this A-Z checklist for every patient on the ward round. Here he takes us through it to add to our understanding of some of the issues we need to consider when assessing our patients. You can have the list for free as an aide memoir if you let me know your email below.
In this episode Bryan discusses some of the issues with pain, agitation and delirium with the pharmacist Komal Pandya.
We all try to understand how to help our patients and sometimes get it wrong, but lets continue to work hard to improve.
Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. Jama. 2012;307(11):1151-60.
Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. Jama. 2012;308(19):1985-92.
Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. Jama. 2007;298(22):2644-53.
Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. Jama. 2009;301(5):489-99.
Shehabi Y, Howe BD, Bellomo R, et al. Early Sedation with Dexmedetomidine in Critically Ill Patients. The New England journal of medicine. 2019;380(26):2506-17.
Sue Brierley Hobson is a dietitian in Wales and was part of a recent study looking into the efficacy of volume based feeding. We chat about this and the PERFECT protocol.
Safety and efficacy of volume-based feeding in critically ill, mechanically ventilated adults using the 'Protein & Energy Requirements Fed for Every Critically ill patient every Time' (PERFECT) protocol: a before-and-after study.
Having read the guidelines I made these infographics. They are FREE. Just click on the button below.