Thread by @brownam130

Part 3 #Illnessdoesntmeanstillness by @SapnaKmd
🔸we have created a culture of immobility
🔸"prolonged bedrest is anatomically and physiologically unsound" JAMA

#SCCM2022 #PedsICU
1/

Goal to change culture
🔸initial cost was multiprofessional investment
🔸"PICU Up" became the common name
🔸Followed AHRQ QI model

#SCCM2022 #PedsICU
2/

🔸education for every PICU team member
🔸almost every pt can at least benefit from level 1
🔸qual study of staff a few years in showed benefit for staff as well as pts
🔸created culture of mobility
🔸very low incidence of AE with early mobility
#SCCM2022 #PedsICU
3/

Only clinical factor associated with safety event was #delirium
🔸PICU UP trial underway to measure outcomes
🔸#therapeuticcuddles a goal for the youngest
🔸it's never too early
🔸interprofessional collaboration is key
#SCCM2022 #PedsICU
4/

Next Stacey Williams, CPNP-AC, talks about #familycentercare
🔸Engaging with families is imperative in this new parenting role
🔸mutual respectful partnership with all members of HC team
🔸families must be informed & active in care decisions throughout
#SCCM2022 #PedsICU
5/

How to involve families? #familycentercare
🔸Families present and engaged in rounds - teach them how it works
🔸Day 1 is different than day 4!
🔸Presence during procedures and resuscitation
🔸family conferences in privacy
🔸#COVID19 challenges for families
#SCCM2022 #PedsICU
6/

Finally @agstormorken talks about mitigating iatrogenic harm in the PICU
🔸#PICSp is an integrated framework of the sequelae of PICU stays
🔸#ABCDEbundle can help reduce the incidence and severity of #PICSp

#SCCM2022 #PedsICU
7/

Focus today on Iatrogenic Withdrawal Syndrome
🔸S&S include autonomic & CNS & GI dysfx
🔸prevalence 5-87%
🔸assessment and monitoring with validated tools critical
🔸WAT-1 and SOS most often used
🔸risk factors below

#SCCM2022 #PedsICU
8/

🔸unclear if alpha agonist use more efficacious than benzo use reduction to avoid IWS
🔸alpha agonists have their own IWS
🔸drug replacement same receptor activity mitigates S&S

#SCCM2022 #PedsICU
9/

IWS prevention is the holy grail
🔸ABCDEF bundle to reduce sedation exposure
🔸goal directed sedation protocols
🔸daily sedation interruption
🔸protocolized weaning using screening tools, incl tx for breakthrough IWS

#SCCM2022 #PedsICU
10/

Can also consider
🔸protocolized drug rotation
🔸be sure to adequately treat pain
🔸adapt to your patient population

#SCCM2022 #PedsICU
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