Critical Care Nursing

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.