Critical Care

Dating back more than 30 years, prone positioning is sometimes used to recruit alveoli to improve oxygenation and prevent complications of ventilator-induced lung injury in patients with ARDS. Recently, the use of prone positioning is now considered front-line therapy. With the mortality rate of the ARDS patient remaining at 40%, we need to implement evidence-based practices that work. This session discusses the physiological mechanisms of the prone position for reducing lung trauma and improving oxygenation. This session incorporates research to define the patient likely to respond to prone positioning, identify the appropriate time to initiate therapy and discuss time spent in the prone position. Evidence-based strategies for turning and sustaining the patient in a prone position are outlined to ensure safety for the patient and healthcare worker. As nurses, we have the potential to influence patient outcomes through a safe, noninvasive positioning technique.

Severe sepsis kills more than 700 people a day in the United States. Many programs initiated around the septic patient fall short of desired outcomes. Sepsis was deemed a core measure. Many consider septic shock and multiple organ failure to be the final common pathway to death in the ICU and the leading cause of mortality. Evidenced based practice guidelines have been established for helping to recognized and manage the septic patient but are inconsistently applied. Although they have provided compelling evidence on how to manage the severe sepsis and septic shock population there has been major gaps in the application of the evidence. Moving evidence into practice regardless of the strength is difficult especially when related to this complex patient population. Without an organized systematic approach, it is difficult to have the surviving sepsis bundles provided consistently to achieve optimal patient outcomes. This session will discuss current data to help identifies opportunities for improvement. Protocols for implementation of the bundles will be discussed and a review of new evidence regarding the science within the bundles will be presented and controversies discussed. Key implementation strategies for hard-wiring the clinical and process behaviors will be revealed. Barriers with reliable actions to reduce their impact will be described.

Many consider septic shock and multiple organ failure to be the final common pathway to death in the ICU and the leading cause of mortality. Evidenced based practice guidelines have been established for helping to recognized and manage the septic patient but are inconsistently applied. Although they have provided compelling evidence on how to manage the severe sepsis and septic shock population there has been major gaps in the application of the evidence. Moving evidence into practice regardless of the strength is difficult especially when related to this complex patient population. Without an organized systematic approach, it is difficult to have the surviving sepsis bundles provided consistently to achieve optimal patient outcomes. This session will discuss current data to help identifies opportunities for improvement. Protocols for implementation of the bundles will be discussed and a review of new evidence regarding the science within the bundles will be presented and controversies discussed. Key implementation strategies for hard-wiring the clinical and process behaviors will be revealed. Barriers with reliable actions to reduce their impact will be described.

Post Intensive care syndrome for the survivor of critical illness and their family is emerging as one of the most challenging issue in critical care today. Over the decades we have been successful at saving lives but the consequences of surviving critical illness are significant. It is imperative that we tailor our interventions to help patients not only survive but thrive. In ICU’s across the world, clinicians are working diligently to ensure the A, B, C, D, E, F’s of evidence-based practice are fully integrated into daily care to impact both short and long term patient outcomes. This bundle weaves the practices of pain and agitation management, ventilator liberation, delirium prevention and management allowing implementation of early mobility programs together with engaging the family in the journey. Without successful bundling of the interventions, the ability to integrate best practice is challenging.

In ICUs across the US, clinicians are working diligently to ensure the A, B, C, D, E, F’s of evidence-based practice are fully integrated into daily care. Over the last decade, concentrated effort has occurred to Awaken patients through use of sedation protocols, facilitating ventilator liberation through spontaneous Breathing trials, Coordination of complex interdisciplinary care, evaluating and managing Delirium in order to foster successful progressive Early mobilization with patient and Family engagement. Without successful bundling of the interventions, the ability to liberate a patient from the ventilator is significantly more challenging.

This session will provide an overview of ABCDEF bundle to help demonstrate the impact these interventions have on increasing the readiness for a critically ill patient to wean from the breathing machine. Strategies to facilitate coordination and communication of bundled care are outlined. Challenges to initiating and sustaining the ABCDEF bundle are discussed. Each clinician working with an ICU patient has a unique as well as collaborative role in helping to achieve successful patient outcomes. Through implementation of the latest evidence we can achieve that goal.