Critical Care Psychiatry Survival Guide: Everything You Need to Know to Survive and Thrive in the ICU Setting. Sponsored by ACLP's Critical Care Psychiatry SIG

Wednesday, November 9, 2022

1:00 PM – 5:00 PM

Location: Galleria 4

CE: 3.75 CME

Lead Speaker(s)

Jose R. Maldonado, FACLP, FACFE

John & Terry Levin Family Endowed Professor of Medicine
Stanford Medicine
Menlo Park, California

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Speaker(s)

Melissa Bui, MD

Assistant Professor of Psychiatry
Virginia Commonwealth University
Richmond, Virginia

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Jordan Rosen, MD

Psychiatrist
Brigham and Women's Hospital
Boston, Massachusetts

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Yelizaveta Sher, MD, FACLP

Clinical Associate Professor of Psychiatry
Stanford University Medical Center
Stanford, California

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Abstract: Critically ill patients represent a highly specialized population given the complexity of medical comorbidities, the use of highly specialized life-sustaining treatments, the use of non-conventional pharmacotherapeutics, dramatic changes in pharmacokinetics/dynamics, and the high comorbidity of neuropsychiatric syndromes. Given the complexities of the ICU environment – the Critical Care Psychiatry (CCP) – SIG has put together a course to assist both novices starting a practice in the ICU or old-timers wanting to improve their skills. to increase the proficiency and comfort level of what we believe will become a new sub-specialty within CLP. The idea is to provide attendees with what you need to survive and feel comfortable practicing in the CCU environment, from how to start a CCP service, to a review of cardio-pulmonary and metabolic systems that can affect our practice, to the use of psychopharmacological agents in the critically ill, to the MSE assessment, and specialized diagnostic issues.

Dr Maldonado will introduce the CCP-SIG, discuss the mechanics and politics of developing a CCP-Service at your home institutions, and the management of ICU Delirium & Sleep deprivation, with special emphasis to patients on ECMO.

Dr. Bui will the proper way to conduct a comprehensive evaluation of the critically ill patient, with a focus on the mental status exam tailored toward intubated or otherwise non-communicative patients; then provide a general overview of electroencephalogram (EEG), Bispectral Index (BIS) and Intracranial Pressure (ICP) monitoring – each including a brief discussion regarding indications for use, interpretations of basic findings, and clinical applications relevant to the C-L psychiatrist.

Dr Rosen will discuss the evidence-based guidelines to sedation and analgesia in critical illness with a focus on the impact psychiatrists can make towards optimization and supplementation of these agents to improve arousal and mental status. He will also discuss specific pharmaco-dynamic/kinetic issues associated to the presence of hepatic or renal impairment given the subsequent alterations in metabolism and excretion.

Dr. Sher will discuss the basics of ventilatory support and interpretation of blood gases; the neuro-pulmonary pathways associated with the sensation of dyspnea – its recognition and management. She will also present on the incidence and etiologies of anxiety and demoralization in ICU patients as well as those of post-ICU–PTSD, along with the best treatments for these conditions.

Dr. Funk will discuss must-know cardiovascular psychiatry pearls for the ICU setting, beginning with interpretation of the electrocardiogram with special attention to QTc prolongation, variations from pacing or bundle branch block, and recognition of concerning T-wave morphology; followed by an approach to risk stratification and mitigation when using medications that may increase risk of Torsades de Pointes (i.e., monitoring, pharmacologic alternatives), and the role of implanted devices such as pacemakers, implantable cardioverter defibrillators (ICDs) and ventricular assist devices.

Agenda Overview: “Critical Care Psychiatry Survival Guide – Everything you need to know to survive and thrive the ICU setting”

Agenda:

i. Creation of a CCP Team – Creating the service / How to work with ICT teams – José Maldonado (15 mins)

ii. How to evaluate ICU patients / the Mental Status Exam – Melissa Bui (25 mins)

iii. Analgesia / Sedation Drips – Jordan Rosen (25 mins)

iv. Pulmonary Considerations – Ventilatory Settings / Assessment and Management of Dyspnea – Yelizaveta Sher (25 mins)

v. Cardiac Considerations – How to interpret the ECG and pharmacological considerations; Pacemakers/VAD/ - Margo Funk (25 mins)

vi. Hepato-Renal: pharmacological considerations due to Critical Care Changes – Jordan Rosen (25 mins)

vii. Break (15 mins)

viii. Neuro – EEG and other neuro monitoring systems – Melissa Bui (25 mins)

ix. Special Diagnostic Categories:

a. ICU Delirium – Sleep – Extra-Corporeal Membrane Oxygenator (ECMO; special consideration / pharmacodynamic changes while on ECMO) – José Maldonado (30 mins)

b. Assessment and Management of Anxiety / Demoralization / PTSD – Yelizaveta Sher (30 mins)

Learning Objectives:

Learners will review the evaluation of the mental status and become familiarized with evidence-based approaches to the management of analgesia and sedation in critically ill patients.
Learners will become acquainted with critical care monitoring and cardio-pulmonary treatment equipment, as well as the interpretation of ICU level values and their significance to care.
Learner should become acquainted with pharmacodynamic/kinetic changes taking place in critically ill patients, especially related to renal and hepatic dysfunction, as well as potential cardiac effects of psychopharmacological agents.