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ICU Protocols Memphis VA Medical Center. G. Umberto Meduri, M.D. W. Andrew Bell, Pharm.D., BCPS. The ICU Team . ICU Attending Pulmonary and Critical Care Fellow Internal Medicine Resident Medicine Interns Medicine Students ICU Pharmacist Pharmacist Resident Critical Care Nurse

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icu protocols memphis va medical center

ICU Protocols Memphis VA Medical Center

G. Umberto Meduri, M.D.

W. Andrew Bell, Pharm.D., BCPS

the icu team
The ICU Team
  • ICU Attending
  • Pulmonary and Critical Care Fellow
    • Internal Medicine Resident
    • Medicine Interns
    • Medicine Students
  • ICU Pharmacist
    • Pharmacist Resident
  • Critical Care Nurse
  • Respiratory Therapist
  • Nutritionist, Physical Therapist, Palliative Care
icu protocols
ICU Protocols

Antibiotic treatment of pneumonia

Antibiotic treatment for other infections

Fluid resuscitation and ScvO2-guided therapy

Vasopressors

Mechanical ventilation

Sedation and analgesia

Glucose control

Gastrointestinal and thromboembolic prophylaxis

Weaning from mechanical ventilation

Recombinant human activated protein C (rhAPC)

Prolonged glucocorticoid treatment in patients with shock

Prolonged glucocorticoid treatment in pts with severe ARDS

guidelines
Guidelines
  • ATS / IDSA Pneumonia Guidelines
    • 2007 Community-acquired pneumonia
    • 2005 Health care associated pneumonia
  • Surviving Sepsis Campaign 2008
  • SCCM 2002 Analgesia, Sedation, & Neuromuscular Blockade Guidelines
  • ASHP 1999 Stress Ulcer Prophylaxis Guidelines
  • Chest 2008 DVT Prophylaxis Guidelines
slide14

[continued]

ScvO2 = central venous oxygen saturation

slide19

Health Care Associated Pneumonia

YES

Nursing home

Hospitalized

last 90 days

Within last 30 days

Hemo

dialysis

Home wound care

YES

IV Rx

CAP with Risks factors for

Pseudomonas aeruginosa

Bronchiectasis

Structural

lung

disease

No

Chronic

glucocorticoid

use

Repeated

antibiotics

gastrointestinal prophylaxis
Gastrointestinal Prophylaxis
  • All patients enrolled in the study should receive stress ulcer prophylaxis (SUP) with either a H2 antagonist or PPI

AJHP 1999; 56: 347-379

thromboembolic prophylaxis
Thromboembolic Prophylaxis

LMWH = Low molecular weight heparin