Critical Care: Respiratory Care, Sedation, and Quality of Death

Critical care is a dynamic and evolving field, where even small changes in practice can have a significant impact on patient outcomes. This course will emphasize the integration of the latest scientific evidence, technology, and patient-centered approaches into everyday clinical practice.

From cutting-edge imaging techniques guiding mechanical ventilation in acute respiratory distress syndrome (ARDS) to the nuanced challenges of end-of-life communication in the ICU, this course offers a timely and in-depth exploration of the most pressing topics in critical care today. Participants will gain practical, research-backed insights to enhance patient outcomes and elevate the quality of care delivered in high-acuity environments.

These topics were originally presented as part of the State of the Science Critical Care Best Practices Symposium:

  • Future of Mechanical Ventilation – Imaging to Guide Mechanical Ventilation in ARDS
  • A Call to Improve - Quality of ICU Death
  • Current State of Sedation in the Intensive Care Unit
  • Putting in EFFORT: Is High Protein Useful in Critically Ill Patients?

Target Audience

Critical Care Physicians, Cardiologists, Surgeons, Anesthesiologists, Emergency Medicine Physicians, Nephrologists, Pulmonologists, Infectious Disease Physicians, Neurologists, Gastroenterologists, Hospitalists, Physician Assistants/Physician Associates, Advanced Practice Registered Nurses, Nurses, Respiratory Therapists, Pharmacists, Pharmacy Technicians, and other interested healthcare providers.  

Learning Objectives

Future of Mechanical Ventilation – Imaging to Guide Mechanical Ventilation in ARDS

  • Review the most recent imaging techniques used in the management mechanical ventilation.
  • Discuss the evidence supporting imaging techniques to guide mechanical ventilation.

A Call to Improve - Quality of ICU Death

  • Explain the goals for improving quality at end-of-life in the ICU.
  • Evaluate barriers to effective end-of-life communication and demonstrate evidence based best practice approaches.
  • Analyze intervention targets to improve quality of death outcomes.

Current State of Sedation in the Intensive Care Unit

  • Review sedation strategies in adult intensive care unit (ICU) patients requiring invasive mechanical ventilation (MV).
  • Discuss updates in the recommendations for analgesia and sedation in adult ICU mechanically ventilated patients.
  • Evaluate the role of ketamine in the ICU for rapid sequence intubation (RSI) and continuous IV analgosedation.

Putting in EFFORT: Is High Protein Useful in Critically Ill Patients?

  • Describe current evidence and recommended guidelines for protein delivery in critically ill patients.
  • Evaluate the results of the EFFORT protein trial.
  • Demonstrate how the results of EFFORT protein trial may influence clinical practice. 
Additional information
Bibliography: 

Future of Mechanical Ventilation – Imaging to Guide Mechanical Ventilation in ARDS

  • Mousa, Amne, Peter Klompmaker, and Pieter R. Tuinman. "Setting positive end-expiratory pressure: lung and diaphragm ultrasound." Current Opinion in Critical Care 30.1 (2024): 53-60.
  • Somhorst, Peter, et al. "PEEP-FiO2 table versus EIT to titrate PEEP in mechanically ventilated patients with COVID-19-related ARDS." Critical Care 26.1 (2022): 272.
  • Ball, Lorenzo, et al. "Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia." Critical Care 25 (2021): 1-10.

A Call to Improve - Quality of ICU Death

  • Achieving Goals of Care Decisions in Chronic Critical Illness A Multi-Institutional Qualitative Study Sarah K. Andersen et al. CHEST 2024; 166(1):107-117
  • Dying with Dignity in the Intensive Care Unit;Deborah Cook, M.D.,and Graeme Rocker, D.M. N Engl J Med 2014;370:2506-2514.
  • Mortality in the ICU: Who Dies within the first 24 hours? Critical Care ICU Management and Outcomes Vol 150, Issue 4, Supplement, 292 A, October 2016.

Current State of Sedation in the Intensive Care Unit

  • Peng J, Wu Y, Li L, Xia P, Yu P, Zhang J, Liu X. Dexmedetomidine vs. propofol on arrhythmia in cardiac surgery: a meta-analysis of randomized controlled trials. Front Cardiovasc Med. 2024 Oct 10;11:1433841.
  • Kotani Y, Piersanti G, Maiucci G, Fresilli S, Turi S, Montanaro G, Zangrillo A, Lee TC, Landoni G. Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials. J Crit Care. 2023 Oct;77:154317.
  • Amer M, Hylander Møller M, Alshahrani M, Shehabi Y, Arabi YM, Alshamsi F, Ingi Sigurðsson M, Rehn M, Chew MS, Kalliomäki ML, Lewis K, Al-Suwaidan FA, Al-Dorzi HM, Al-Fares A, Alsadoon N, Bell CM, Groth CM, Parke R, Mehta S, Wischmeyer PE, Al-Omari A, Olkkola KT, Alhazzani W. Ketamine Analgo-sedation for Mechanically Ventilated Critically Ill Adults: A Rapid Practice Guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine. Anesth Analg. 2024 Aug 29.

Putting in EFFORT: Is High Protein Useful in Critically Ill Patients?

  • Heyland DK, Jayshil P, Compher C, et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): and international, multicentre, pragmatic, registry-based randomized trial. Lancet. 2023; 401:568-576. 
  • Haines RW, Prowle JR, Day A, et al. Association between urea trajectory and protein dose in critically ill adults: a secondary exploratory analysis of the effort protein trail (RE-EFFORT). Crit Care. 2024;28:24.
  • Chapple LS, Kouw WK, Summers MJ, et al. Muscle protein synthesis after protein administration in critical illness. Am J Respir Crit Care Med. 2022;206(6):740-749.
Course Summary
Available credit: 
  • 1.50 ABS Accredited CME
  • 1.50 AMA PRA Category 1 Credit™
  • 1.50 General certificate of attendance
  • 1.50 Nurse Practitioners
  • 1.50 Florida Board of Nursing
  • 1.50 Florida Board of Pharmacy
  • 1.50 Florida Board of Respiratory Therapy
Course opens: 
06/16/2025
Course expires: 
05/31/2028

Keith Lamb, RRT, RRT-ACCS, FAARC, FCCM
Trauma, Surgical Critical Care, Neuro Service
Respiratory Therapy Services
University of Virginia Medical Center
Charlottesville, Virginia 

Eduardo Martinez DuBouchet, M.D.
Medical Director, Telehealth Center and eICU Transfer Center 
Baptist Health South Florida
Miami, Florida

Natalie Quesep, Pharm.D., BCPS, BCCCP 
ICU Clinical Pharmacy Specialist
Baptist Health South Florida
Miami, Florida

Carrie Mayo, M.S., R.D., LDN, CNSC
Clinical Nutrition Manager
Baptist Health South Florida
Miami, Florida

Keith Lamb, RRT, RRT-ACCS, FAARC, FCCM, Carrie Mayo, M.S., R.D., LDN, CNSC, and Natalie Quesep, Pharm.D., BCPS, BCCCP, faculty for this educational activity, have no relevant financial relationships with ineligible companies* to disclose, and have indicated that the presentations or discussions will not include off-label or unapproved product usage.

Donna Lee Armaignac, Ph.D., APRN, CCNS, CCRN-K, Andrew Calzadilla, M.D. and Eduardo Martinez DuBouchet, M.D., directors of this educational activity, have no relevant financial relationships with ineligible companies* to disclose, and has indicated that their presentation/s or discussion/s will not include off-label or unapproved product usage.

Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships with ineligible companies* to disclose.  

*Ineligible companies – Companies whose primary business is producing, marketing, selling, reselling or distributing healthcare products used by or on patients.

Baptist Health South Florida is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Baptist Health has been re-surveyed by the ACCME and awarded Commendation for 6 years as a provider of CME for physicians.
              
Baptist Health South Florida designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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American Board of Surgery - Maintenance of Certification (MOC) - Accredited CME - General Surgery

Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

Your participation information will be shared with specialty boards through the ACCME's PARS reporting system. Successful completion of a course examination is required. Submissions are recorded in approximately 48 hours. You will receive an email when your credits have been processed.

Available Credit

  • 1.50 ABS Accredited CME
  • 1.50 AMA PRA Category 1 Credit™
  • 1.50 General certificate of attendance
  • 1.50 Nurse Practitioners
  • 1.50 Florida Board of Nursing
  • 1.50 Florida Board of Pharmacy
  • 1.50 Florida Board of Respiratory Therapy
Please login or register for a Baptist Health CME account to take this course.

Your participation information will be shared with specialty boards through the ACCME's PARS reporting system. Successful completion of a course examination is required. Submissions are recorded in approximately 48 hours. You will receive an email when your credits have been processed.

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