Education Session I: Current Controversies in Critical Care: Challenging the Dogma Enduring CME Link: https://cme.openanesthesia360.org/a/OLIJUP The session will discuss some of the current controversies in critical care which challenge conventional dogmas. Sedation strategy can avoid the use of sedative drugs, the use of opioids to achieve this may lead to acute withdrawal in the short term and persistent opioid use in the long term. Similarly, blood pressure targets amongst critically ill patients remain a matter of debate with retrospective evidence pushing for higher BP goals to avoid end-organ damage and prospective studies showing no difference. Renal replacement therapy (RRT) is often required in sepsis-related acute kidney injury (AKI), and whether the traditional thresholds for initiation of RRT are still relevant or should RRT be initiated early, is being questioned. In such a scenario, this session will discuss some of the current controversies in critical care that challenge conventional thinking and will present evidence to help answer some of these questions.
Education Session II: The Crossroads of Hematology and Intensive Care Medicine Enduring CME Link: https://cme.openanesthesia360.org/a/KHBVBZ In this session, we will address controversial and important topics at the crossroads of hematology (thrombosis and coagulopathy) and Intensive Care Medicine. Hematology can be a mystery to those in other specialties, but it is essential to be able to frame the advice from a consultant in the context of the perioperative or critically ill patient. We will describe how to incorporate this knowledge into your clinical practice in the ICU. Bleeding and coagulopathy must be addressed urgently to maintain tissue perfusion. Especially during blood product shortages, understanding the role of factor concentrates is key. Direct acting oral anticoagulants (DOACs) are continuing to dominate the market for chronic anticoagulation, we will all need to reverse these agents in an urgent or emergent situation and not all hospitals have the specific antidotes on formulary. It then becomes our problem to understand alternative strategies and their limitations. Patients on ECMO and temporary MCS cannot afford further cardiorespiratory insults. Bleeding and thrombosis threaten these vulnerable patients and knowing when to individualize anticoagulation protocols is a nuanced but essential skill. Our intensive care units provide care for multiple such patients on a daily basis and can capitalize on that experience to help troubleshoot this controversial topic.
Education Session III: The Transplant Anesthesiologist as a Perioperative Physician Enduring CME Link: https://cme.openanesthesia360.org/a/WCAKUB This session is sponsored by the Society for the Advancement of Transplant Anesthesia (SATA). We will illustrate how transplant anesthesiologists have been closely integrated in the entire peri-operative course starting from selection for transplant and assessment using novel frailty scores through the intraoperative period to involvement in critical care helping to achieve long term outcomes.Transplant anesthesiologists have long been involved in the entire perioperative care and are often considered an essential member of the transplant team. They participate in selection meetings, assess patient’s readiness for listing and preoperative testing, provide care of patients in the operating by balancing and optimizing severe derangements of all organ systems and frequently participate in the postoperative care as intensivists. Our aim is to illustrate how the functions of a transplant anesthesiologist as perioperative physician can be a model for critical care anesthesiologists who are integrated into the entire perioperative process.
Recovery following critical illness extends well beyond hospital discharge. Survivors of critical illness often experience new or worsened impairments across multiple domains most notably cognitive, physical and psychiatric termed as post intensive care syndrome (PICS). Improvement in critical care has led to a growing population of survivors who need targeted support and rehabilitation following hospital discharge. This session will highlight the burden of PICS on ICU survivors, elaborate on distinct health care needs and current state of post-discharge care of this vulnerable population. Future directions in improving quality of survivorship and the role of intensivists will be highlighted.
