A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study

Abstract Critical-care medicine today is practiced by anesthesiologists, internists, pediatricians, and surgeons. Outcome from today's management of critically ill patients is very good, yet associated costs are very high. Over one-half of the hospital costs of critically ill patients emanates from the intensive-care unit (ICU), although the ICU stay accounts for less than 20% of their time in the hospital. Outside of the operating room, the ICU is the most expensive location for patient care in the hospital, and laboratory tests are the most expensive single item. Plans for cost containment should incorporate the following: more effective data management, education of practitioners about appropriateness and costs of tests, conversion from laboratory measurements to appropriate in vivo and ex vivo measurements, and real-time utilization assessment. To provide high-quality, cost-effective critical care in the future, laboratorians and clinicians must work together today to meet the challenges of technology, data management, and staff education.

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The Year in Review: Critical Care Medicine

Journal of Pharmacy Practice ◽

10.1106/8y8w-9ftr-p57j-5t9x ◽

2001 ◽

Vol 14 (1) ◽

pp. 70-85

Author(s):

Maria I. Rudis ◽

David Q. Hoang

Keyword(s):

Critical Care ◽

Cardiovascular Diseases ◽

Infectious Diseases ◽

Critically Ill ◽

Critically Ill Patients ◽

Treatment Guidelines ◽

Neuromuscular Blocking ◽

Critical Care Medicine ◽

Icu Patients ◽

Adult Intensive Care Unit

Background: There have been significant recent advances in the pharmacotherapeutic management of critically ill patients. The purpose of this article is to review and discuss the most pertinent published literature in the areas of neurology, cardiovascular diseases, infectious diseases, nephrology, hematology, and gastroenterology as it pertains to critical care in order to provide an update for the critical care practitioner. Methods: We performed a Medline search from July 1999 to December 2000 utilizing terms relating to the pharmacotherapy of the specific aforementioned topics in critical care medicine. We focused on English-language clinical studies performed in adult intensive care unit (ICU) patients. From these articles we selected those that would have a practical impact on drug therapy in the ICU or the development of drug usage guidelines for critically ill patients. Review articles were generally not included. Results: The following topics were found to be either new developments or of potentially significant impact in the management of adult critically ill patients. In the area of neurology, advances were found with respect to optimization of regimens for sedative and neuromuscular blocking agents, validation of sedation scales and tools, and in the treatment of head injury patients. In the cardiovascular diseases, most studies related to the hemodynamic support of septic shock. We focus on developments in fluid resuscitation, optimization of global and regional oxygen transport variables, the repositioning of vasopressor agents, and a return to the use of steroids. Given the high mortality rate associated with the development of acute renal failure in the ICU, there has been a consistent attempt to develop preventative and treatment strategies for these patients, including optimization of antimicrobial dosing methods. Several epidemiological and longitudinal studies document changes in multi-drug antimicrobial resistance patterns. The use of treatment guidelines for antimicrobials in the critically ill improves outcomes in most patients. Significant attention has focused on the characterization of anemia in the ICU and the development of alternative pharmacological strategies in its treatment. Finally, in gastroenterology, the main focus has been the investigation of methods to optimize the delivery of enteral nutrition given its proven benefits in critically ill patients. Conclusions: Significant advances in the areas of neurological, cardiovascular, infectious diseases, renal, hematological, and gastrointestinal issues in the pharmacotherapy of critically ill patients have been published over the course of the past year. Many of these studies have yielded data that may be incorporated into the pharmacotherapeutic management of ICU patients, hence maximizing outcomes.

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Best evidence in critical care medicine: The use of recombinant human erythropoietin to reduce red cell transfusions in critically ill patients

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/bf03018406 ◽

2004 ◽

Vol 51 (6) ◽

pp. 621-622 ◽

Cited By ~ 1

Author(s):

Osama Almuslim ◽

David Leasa

Keyword(s):

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Recombinant Human Erythropoietin ◽

Critical Care Medicine ◽

Red Cell ◽

Human Erythropoietin

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Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

Yearbook of Paediatric Endocrinology ◽

10.1530/ey.15.8.10 ◽

2018 ◽

Author(s):

Annane D ◽

Pastores SM ◽

Rochwerg B ◽

Arlt W ◽

Balk RA ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Critical Illness ◽

Intensive Care Medicine ◽

Critically Ill ◽

European Society ◽

Critically Ill Patients ◽

Critical Care Medicine ◽

Diagnosis And Management ◽

Corticosteroid Insufficiency

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Retrieval Medicine

10.1093/med/9780198722168.001.0001 ◽

2016 ◽

Keyword(s):

Critical Care ◽

Resource Management ◽

Critical Care Medicine ◽

Respiratory Support ◽

Crisis Resource Management ◽

Medical Practitioners ◽

Retrieval Systems ◽

Obstetrics And Gynaecology ◽

Resource Limited ◽

Cardiac Shock

Retrieval Medicine is the practice of acute, emergency, and critical care medicine in the ‘transport’ environment. It requires medical practitioners to function independently in highly variable and resource-limited environments, in transport settings, and in the field, with acutely unwell, unstable and often clinically undifferentiated patients over long durations. This handbook covers the complex problems in the retrieval environment. It covers retrieval systems, governance, and coordination; the retrieval environment; and retrieval platforms, as well as equipment. It also involves crisis resource management. The treatment for patients with varying conditions is covered. Chapter titles include: respiratory support, cardiac, shock, sepsis, neurology and neurosurgery, obstetrics and gynaecology, behavioural disturbances, trauma, primary retrieval, bariatric, neonatal, paediatric, and specialized retrieval systems.

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Vancomycin Dosing Practices among Critical Care Pharmacists: A Survey of Society of Critical Care Medicine Pharmacists

Infectious Diseases Research and Treatment ◽

10.1177/1178633720952078 ◽

2020 ◽

Vol 13 ◽

pp. 117863372095207

Author(s):

Alexander H Flannery ◽

Drayton A Hammond ◽

Douglas R Oyler ◽

Chenghui Li ◽

Adrian Wong ◽

...

Keyword(s):

Critical Care ◽

Infectious Diseases ◽

Critically Ill ◽

Critically Ill Patients ◽

Online Survey ◽

Critical Care Medicine ◽

Guideline Recommendation ◽

Critically Ill Patient ◽

Critically Ill Adults ◽

Monitoring Protocols

Introduction: Critically ill patients and their pharmacokinetics present complexities often not considered by consensus guidelines from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Prior surveys have suggested discordance between certain guideline recommendations and reported infectious disease pharmacist practice. Vancomycin dosing practices, including institutional considerations, have not previously been well described in the critically ill patient population. Objectives: To evaluate critical care pharmacists’ self-reported vancomycin practices in comparison to the 2009 guideline recommendations and other best practices identified by the study investigators. Methods: An online survey developed by the Research and Scholarship Committee of the Clinical Pharmacy and Pharmacology (CPP) Section of the Society of Critical Care Medicine (SCCM) was sent to pharmacist members of the SCCM CPP Section practicing in adult intensive care units in the spring of 2017. This survey queried pharmacists’ self-reported practices regarding vancomycin dosing and monitoring in critically ill adults. Results: Three-hundred and sixty-four responses were received for an estimated response rate of 26%. Critical care pharmacists self-reported largely following the 2009 vancomycin dosing and monitoring guidelines. The largest deviations in guideline recommendation compliance involve consistent use of a loading dose, dosing weight in obese patients, and quality improvement efforts related to systematically monitoring vancomycin-associated nephrotoxicity. Variation exists regarding pharmacist protocols and other practices of vancomycin use in critically ill patients. Conclusion: Among critical care pharmacists, reported vancomycin practices are largely consistent with the 2009 guideline recommendations. Variations in vancomycin dosing and monitoring protocols are identified, and rationale for guideline non-adherence with loading doses elucidated.

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