Critical Care Medicine: Principles of Critical Care — Comprehensive Support
Pulmonary and Critical Care Medicine · Critical Care Medicine 🎯 Practice these cards
The ____ scale is an objective tool used to titrate ____ depth in ICU patients, with guidelines favoring light rather than deep targets.
The Richmond Agitation-Sedation Scale (RASS) is an objective scale used to titrate and monitor sedation depth in ICU patients; guidelines favor light sedation targets in mechanically ventilated patients.
For continuous ICU sedation, ____ or ____ are preferred over benzodiazepines, which are associated with increased delirium.
For continuous ICU sedation, propofol or dexmedetomidine are preferred over benzodiazepines, which are associated with increased delirium.
To correct oversedation, ____ the sedative until the level is appropriate, then restart at ____ the previous dose.
An evidence-based correction of oversedation is to stop the sedative until the level of sedation is appropriate, then restart it at half the previous dose.
Daily sedation interruption decreases duration of ____, ICU length of stay, and ____ incidence, though likely without a 90-day mortality difference.
Daily protocolized interruption of sedation and analgesia decreases the duration of mechanical ventilation, ICU length of stay, and delirium incidence, though likely without a 90-day mortality difference.
A ____ monitor assesses sedation depth when scales cannot be used, for example during ____ blockade.
A bispectral index monitor is used to assess sedation depth when objective scales cannot be used, such as in patients receiving neuromuscular blockers.
ICU delirium is screened with the ____ (CAM-ICU) or the Intensive Care ____ Checklist.
ICU delirium is monitored with the Confusion Assessment Method for the ICU (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC).
Benzodiazepines for ICU delirium are reserved for treating ____ withdrawal or ____; otherwise they worsen delirium risk.
Benzodiazepines should not be used to treat ICU delirium unless they are needed to treat alcohol withdrawal or seizures; benzodiazepine exposure is itself a delirium risk factor.
In the ABCDEF bundle, B stands for performing both ____ and ____, and E stands for early mobility and exercise.
The ABCDEF bundle: A = Assess, prevent, and manage pain; B = Perform both SAT and SBT; C = Choice of sedation and analgesia; D = Delirium assessment, prevention, and management; E = Early mobility and exercise; F = Family engagement and empowerment.
Enteral nutrition should start within ____ to ____ hours of ICU admission and is associated with decreased mortality and infections.
Enteral nutrition should start within 24 to 48 hours of ICU admission; early enteral feeding is associated with decreased mortality and infections and is preferred over parenteral nutrition unless contraindicated.
Supplemental parenteral nutrition is considered only after ____ to ____ days of meeting less than ____% of energy and protein requirements enterally.
In nonmalnourished ICU patients, supplemental parenteral nutrition should be considered only after 7 to 10 days of meeting less than 60% of energy and protein requirements by the enteral route alone; earlier supplementation may cause harm.
Routine measurement of ____ residuals is not recommended because it delays feeding goals, increases access-clogging risk, and may increase ____ risk.
Routine measurement of gastric residuals is not recommended in enterally fed patients because it delays achievement of feeding goals, increases the risk of clogging the enteral access, and may increase aspiration risk.
The AID-ICU trial showed that dexmedetomidine produced no difference in ____-day mortality versus usual sedation, with more ____ and hypotension.
In the AID-ICU trial (~3,400 ventilated ICU adults), dexmedetomidine-based sedation showed no 90-day mortality difference versus usual care (mostly propofol), with more bradycardia and hypotension.
The TEAM trial found that early active ____ within 72 hours of ventilation did not improve survival or functional outcomes and caused more ____ events.
The TEAM trial (~7,000 patients) found that early active mobilization within 72 hours of ventilation did not improve survival or functional outcomes versus usual care and caused more adverse events.
In the sepsis 1-hour bundle, give ____ mL/kg crystalloid for hypotension or lactate >4 mmol/L and target a MAP above ____ mm Hg.
The sepsis 1-hour bundle: measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics, give 30 mL/kg crystalloid for hypotension or lactate >4 mmol/L, and start vasopressors to keep MAP ≥65 mm Hg if fluids fail.
The VAP bundle includes head-of-bed elevation of at least ____ degrees and changing ventilator circuits only if ____ or visibly soiled.
The ventilator-associated pneumonia bundle includes head-of-bed elevation at least 30 degrees, daily sedation interruption with extubation-readiness assessment, subglottic-suction endotracheal tubes, early mobilization, and changing ventilator circuits only if malfunctioning or visibly soiled.
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