2020 Critical Care Psychiatry Review

This workshop is designed to bring together the information CL Psychiatrists needs to navigate the complex environment and diverse neuropsychiatric problems encountered in the intensive care units.

Jose Maldonado – Unique Challenges in the Development of Sedation and Agitation Management Protocols in Extracorporeal membrane oxygenation (ECMO) Patients: This presentation will discuss how the ECMO circuitry works and how its components may contribute pharmacodynamic changes that lead to variability in the effectiveness of commonly used psychotropic agents, making titration and optimal effect rather challenging. We will also discuss optimal psychopharmacological regimes for the management of agitation/delirium and sedation in ECMO patients. The choice of agent used is dependent on the desired physiological endpoint while balancing unwanted adverse effects.

Jeff Ha – The Use of VPA for the Management of Hyperactive Delirium in Critical Care Patients: Rationale & Pitfalls: Valproic Acid has been used as an alternate or an adjunct to anti-psychotics to manage hyperactive and mixed type delirium in ICU setting. In this talk, we will be discussing mechanism of actions of Valproic Acid, (specifically its effect on glutamate system), clinical indications, contraindications, potential side effects, including hyperammonemia, and proposed management of valproic-acid induced hyperammonemia.

Mira Zein – Sleep Management in ICU patients: Disruption of sleep-wake cycles in ICU patients is a common concern. ICU patients are known to have disrupted circadian patterns, decreased nocturnal sleep time, abnormally increased stage 1 and 2 sleep, and reduced/absent deep sleep. These changes have consequences such as increased risk of delirium and emotional distress, difficulty engaging with PT/OT, prolonged mechanical ventilation, and other physical and mental complications that can lead to prolonged ICU stays. Dr. Zein will (1) review the anatomy of normal sleep and disruptions that occur in sleep structure in the ICU; (2) discuss the main culprits implicated in ICU-related sleep disruption, and the physiologic and neuropsychiatric consequences; and (3) review current evidence for psychotropic and non-psychotropic interventions to improve sleep for ICU patients.

Yelizaveta Sher – Physiology and Management of Air Hunger in Respiratory Failure: Psychiatrists are frequently consulted for “anxiety” and/or “agitation” in ICU patients with respiratory failure, including those who are ventilated and/or supported with ECMO. In this presentation, Dr. Sher will (1) address the pathophysiology of the air hunger, including the mechanisms of breathing, involved brain regions and the triggers of shortness or breath and associated anxiety (e.g., hypoxia, hypercapnia, metabolic acidosis, low tidal volume); (2) discuss the best strategies to relieve these very distressing condition (e.g., opiates) as well as explain what does not work (e.g., benzodiazepines, paralytics); and (3) propose the role for ICU psychiatrists in multidisciplinary care of these patients to relieve short-term distress and to decrease long-term negative outcomes.