Thread by @gretchemaben

We sometimes also under-treat patients due to racial and socioeconomic biases (THIS IS NOT OKAY!!!) #CHEST2020

Key Takeaways! #CHEST2020

The next session is "Anxiety and Agitation in the ICU: How to Treat It" with Dr. Katie Pendleton (@PendlKM)! #CHEST2020

Overview of anxiety/agitation in the ICU. #CHEST2020

Guidelines suggest the use of light sedation and minimizing benzos. #CHEST2020

Note that agitation has no clear definition in the ICU and we cannot confirm the validity of anxiety with patients. There is also no well-validated tool to screen for anxiety in the ICU. #CHEST2020

We end up having to infer ourselves whether a patient is agitated/anxious based on the patient's actions, but we may be wrong! Note that the conditions in the red circles can also be underlying causes of these behaviors. #CHEST2020

Most patients will develop anxiety at some point. We need to determine what is the acceptable level that we don't need to treat. #CHEST2020

So when is it time to intervene? When the behavior risks safety or physiologic aberrations. #CHEST2020

Consider non-pharmacologic interventions first! #CHEST2020

Restraints are frequently used in the US, but there are no major studies examining the efficacy or safety concerns. Patients have strong negative feelings about it. #CHEST2020

Pharmacologic interventions include Dexmedetomidine, which induces light sedation and analgesia with opioid sparing effects. #CHEST2020

The DAHLIA and SPICE III trials looked at Dexmedetomidine for sedation. The bottom line is that it may allow for more rapid vent weaning in agitated patients when used as an adjunct to sedation, but you should consider the side effect profile. #CHEST2020

Is Ketamine the new Propofol? It is considered generally safe and well-tolerated as an ICU sedative, but there are conflicting results on opioid sparing effect and effects on delirium. #CHEST2020

Anti-psychotics are frequently used to treat delirium in the ICU. Consider use as an adjunct if difficult to control agitation. #CHEST2020

Anti-psychotics and QTc monitoring The highest mean QTc increase is associated with Ziprasidone and lowest with Olanzapine and Haloperidol. #CHEST2020

Summary #CHEST2020

I'll have to come back to watch Dr. Greenberg's lecture on delirium later, but thanks to the awesome first two lectures! #CHEST2020