Prof Anthony Holley is speaking next on 'Respiratory Support in the Trauma Patient' #VTA23#critcare#FOAMcc
The 'trauma' patient is not a single disease entity, but ultimately a mechanism that is characterised by a shared multitude of pathophysiological patterns (TBI, lung contusion, etc...) and interventions (surgery, transfusion) that lead to some common disease processes. #VTA23
These common disease processes include TRALI, ARDS, TIC and many more.
Of concern, ARDS is not uncommon in trauma patients. #VTA23
An interesting new study in this space - OptiTHO - showed no benefit of HFNC and NIV in blunt thoracic trauma patients. #VTA23 doi.org/10.1186/s13054…
A difficult space is the TBI patient with ARDS or ALI. There are few well tested strategies, many of them are summarised in the paper below: #VTA23 doi.org/10.1007/s12028…
ECMO in trauma patients remains incredibly rare. In one Australian retrospective analysis which looked at 13420 major trauma patients over 10 years, only 11 patients got ECMO! This is a rare beast. #VTA23 doi.org/10.1016/j.inju…
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Why do we put tracheostomies in patients though?
The rationale for a trachy in ICU is that there are respiratory mechanical benefit (compare to a tracheal tube and a native airway). There are many patient care benefits - oral care, feeding, etc... #VTA23
There are problems, including the potential for real patient harm. Tracheostomy emergencies are a problem. Complications (Immediate, Early and Late) are encountered in 30% of patients. #VTA23
Next is Donna Hamel, speaking on 'PEEP Titration and Recruitment' #VTA23#critcare#FOAMcc
PEEP is important - it improves oxygenation, and is an essential component of lung protective strategies.
But PEEP also has some problems - it can cause hypotension and increased pulmonary vascular resistance.
So how does one get optimal PEEP? #VTA23
Optimal PEEP has no clear universal definition.
Maybe we should look for appropriate PEEP - a PEEP value that results in adequate oxygenation with the lowest risk of overdistension. #VTA23
Next up are two of the Occupational Therapists from CHBAH - Marche van der Heyden and Tiffany Fairbairn - speaking on 'Sensory Stimulation in Critical Care'. #VTA23#critcare#FOAMcc
Sensory stimulation is emerging in critical care as a modality to re-establish normal functioning. Our senses are our connection to the world. There are 8 (not 5!) senses - auditory, olfactory, gustatory, visual, tactile/touch, vestibular, proprioception and interoception. #VTA23
The lesser known of these - vestibular, proprioception and interoception - all are key in self-soothing...
Interoception is the sense how different parts of our 'deep' body are feeling. There are a few activities that include all 8 senses - for example eating. #VTA23
Midmorning #VTA23 session starting - lots of short talks so expect quick changes in topic! #critcare#FOAMcc
Michael Gentile - Is PARDIE Changing Our View of Paediatric ARDS? #VTA23#FOAMcc#critcare
PARDIE stands for Pediatric ARDS Incidence and Epidemiology study. This study is one of the results of the PALISI Conference Group. doi.org/10.1016/S2213-… #VTA23
Last up for the morning session is John Davies, who is talking about 'Mechanical Ventilation during ECMO: all, some or none'. #VTA23#FOAMcc#critcare
Essential to remember the components of lung protective ventilation - tidal volume, plateau pressure, respiratory rate, PEEP, FiO2. #VTA23
Do the rules of LPV change when the patient is on ECMO.
There is little doubt that (in appropriately selected patients) ECMO has a mortality benefit. Have a look at the CESAR and EOLIA trials: doi.org/10.1016/S0140-… doi.org/10.1056/NEJMoa… #VTA23
Next is Prof Ronel Roos, who will be speaking on 'Mobilisation Patients with Extracorporeal Circuits' #VTA23#critcare#FOAMcc
There are different types of mobilisation.
There can be passive mobilisation or active/assisted exercises. Functional exercises can include standing, sitting, walking, or even a bike (in or out of bed). #VTA23
Alot of this is about setup. Femoral vs upper body cannulisation makes a difference - femoral makes it more difficult. Securing the lines safely is essential, the tubing must be monitored and long enough. #VTA23