Critical Care Master Class - At the Edge of the Evidence-Challenging Cases

Challenging Cases - Janz

Pdf Summary

The document outlines a seminar by Dr. David Janz focusing on critical care for patients with conditions like obesity, delirium, brain injury, and ICU mobility. It includes a pre-test question about delirium treatment, emphasizing that haloperidol is less likely to lead to prolonged QT intervals than ziprasidone. A referenced study (MIND-USA) found no significant difference in delirium outcomes between haloperidol, ziprasidone, and placebo, but noted fewer issues with ziprasidone's QT prolongation.<br /><br />Ground rules for case discussions highlight that there are no clear, evidence-based solutions for many ICU conditions, and panelists will share perspectives, inviting audience interaction.<br /><br />Several specific case studies are presented:<br /><br />1. **Delirium Case:** A 45-year-old patient admitted with community-acquired pneumonia exhibited signs of delirium during intubation and sedation management. The text prompts discussions about sedation strategies and the potential addition of antipsychotics.<br /><br />2. **Brain Injury Case:** Involves a 26-year-old comatose patient post-cardiac arrest from opiate intoxication, whose EEG indicates potential brain activity. It poses questions about prognosis in such uncertain scenarios.<br /><br />3. **ICU Mobility Case:** A 75-year-old patient with heart failure faces decisions around mobilization frequency and strategies while on mechanical ventilation.<br /><br />Finally, a post-test question assesses the outcomes of daily mobility interventions in ICUs. A referenced study (TEAM Study) associates daily high-level mobility efforts with increased adverse events but not improved survival or reduced ventilation days. The study suggests that while mobility remains crucial, aggressive mobilization might pose risks.<br /><br />Overall, the seminar encourages critical thinking and dialogue on managing complex ICU cases with obesity and other challenging conditions.

Keywords

critical care

delirium

brain injury

ICU mobility

haloperidol

ziprasidone

MIND-USA study

sedation management

TEAM study

ICU conditions