Back in the Knife!

So, the Critical Care Forum in Toronto is a wrap. Here are a few highlights:

1) Fluids: Liberal use of fluids in the ICU seems to decrease lung injury (more than 2 L per day over baseline). So there's some evidence for the old "fluids and rest" approach to illness. Maybe gramma's chicken soup will turn out to be the ultimate fluid!

Albumin still sucks (although people still use it).

Plasmalyte may be the best fluid as it most closely resembles our normal plasma. Ringer's is good but not in head trauma as it is hypotonic. Normal saline isn't normal after all...

2) Pain and Sedation: There really needs to be alot more attention givne to pain in the ICU setting. About half of ICU patients recall it being a terribly painful experience (maybe even to the point of PTSD). We need to pay more attention to pain. Being sedated does not mean being pain free.

3) Delirium - there is no evidence for anti psychotics in the ICU. The best approach is to treat the delirium. Try to regulate a normal sleep wake cycle. Read to the patients. Give them some stimulus that makes sense. We do not need our patients to be in a drug induced coma.

3) Traumatic head Injuries - Nimodipine prophylaxis to prevent vasospasm (60 mg q4h). Bolus 7.5% saline 250 mL for increase ICP. Mannitol is OK but not likely to do much. Hyperventillation is just plain bad! Consider MgSO4 16g per day and pravastatin 40 mg / day in all head injured patients. If you suspect vasospasm order a CTA with CT perfusion. Give norepi for MAP goal of > 120 mmHg.

The food was great. Especially at the reception on the top floor of the Sheraton.