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.