Overview
Sponsored by the American College of Chest Physicians.
Supported by an educational grant from Hospira Worldwide, Inc.
Program Description
Experts in the field will provide up-to-date information on clinical areas of patient assessment and the use of tools to evaluate sedation, agitation, pain, and delirium; the pharmacologic use of sedative and analgesic agents; and delirium. Follow-up case study questions will reiterate information provided during the lectures.
In this web-based format, participants have the opportunity to obtain the information as it was originally presented by watching the video slide presentations on line, downloading the slides for review, or downloading a written executive summary of the presentations to read. Following their review of the presentations, participants will be asked relevant test questions as part of the evaluation process to obtain CME credit.
Educational Objectives
- Identify the appropriate use of sedation in patients in critical care based on responses to case-based questions.
- Review the indications for sedative and analgesic agents and methods of administration of these agents in the ICU.
- Examine structured approaches to managing sedation and analgesia in the ICU.
Target Audience
Advanced practice nurses, cardiologists, critical care physicians, fellows-in-training, general medicine physicians, physician assistants, pulmonary physicians, registered nurses, respiratory therapists
Needs Assessment
The majority of ICU patients, particularly those suppported by mechanical ventilation, receive IV sedation and/or analgesia medications. Management of sedation and analgesia in these critically ill patients is often rather haphazard. For example, surveys indicate that only one-half of patients have sedation guided by use of a validated sedation assessment scale, and algorithms are used in only one-quarter of patients. A structured approach should include detection of pain, monitoring for sedation and agitation with a scale, proper drug selection, and structured management to optimize patient comfort and safety, yet minimize duration of critical illness. Within a structured approach to sedation and analgesia, focus on the individual patient's characteristics is critical. Each patient is unique in many regards, including underlying illness and prior use of medications (such as medications to relieve pain or anxiety or for psychiatric disorders), the presence of pain, and organ dysfunction that may include sedative and analgesic drug metabolism and optimal selection. Optimal medication selection should also consider risks for adverse drug effects and avoidance of delirium. Finally, the use of a strategy to prevent delayed recovery from sedation (and, therefore, longer ventilator time), as a result of unwanted accumulation of medication or metabolite and/or deep sedation, is supported by a growing body of literature.
Faculty
Curtis N. Sessler, MD, FCCP
Orhan Muren Professor of Medicine
Virginia Commonwealth University Health System
Medical Director of Critical Care
Medical College of Virginia Hospitals
Richmond, VA
John P. Kress, MD, FCCP
Assistant Professor of Medicine
Section of Pulmonary and Critical Care
University of Chicago
Chicago, IL
E. Wesley Ely, Jr., MD, FCCP
Professor of Medicine
Department of Allergy, Pulmonary, and Critical Care Medicine
Vanderbilt University Medical Center
Associate Director of Research
Geriatric Research Education and Clinical Center
Tennessee Valley Healthcare System
Nashville, TN
CME & Disclaimers
Release: March 2009
CME Expiration: December 31, 2009
Estimated completion time: 2 hours
This CME product is a Web-based activity. Participants will watch and listen to a Webcast slide presentation, and complete an activity evaluation to obtain CME.
Accreditation - Designation
The American College of Chest Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American College of Chest Physicians designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Anyone who attended the Evidence-Based Treatment of Pulmonary Arterial Hypertension in an Evolving Environment session at CHEST 2008 when this content was presented and already claimed CME for this presentation cannot claim CME from this enduring product.
Disclosure Statement
The ACCP remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the ACCP to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the ACCP to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair, the Education Committee, or the Conflict of Interest Review Committee to ensure that such situations are properly evaluated and, if necessary, resolved. The ACCP educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all ACCP CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available on-site during all educational activities.
The following faculty members of this educational activity have disclosed to the ACCP that a relationship does exist with the respective company/organization as it relates to their presentation of material and should be communicated to the participants of this educational activity:
Curtis N. Sessler, MD, FCCP
Consultant fee, speaker bureau, advisory committee, etc.: Advisory Board, Hospira
E. Wesley Ely, Jr., MD, FCCP
Grant monies (from sources other than industry): NIH-NIA, VA Merit
Grant monies (from industry-related sources): Lilly, Hospira, ASPECT, Pfizer
Consultant fee, speaker bureau, advisory committee, etc.: Lilly, Hospira, Pfizer, ASPECT, GlaxoSmithKline
The following faculty members of this educational activity have indicated to the ACCP that no potential conflict of interest exists with any respective company/organization:
John P. Kress, MD, FCCP
Disclaimer
The American College of Chest Physicians (“ACCP”) and its officers, regents, executive committee members, members, related entities, employees, representatives and other agents (collectively, “ACCP Parties”) are not responsible in any capacity for, do not warrant and expressly disclaim all liability for, any content whatsoever in any ACCP publication or other product (in any medium) and the use or reliance on any such content, all such responsibility being solely that of the authors or the advertisers, as the case may be. By way of example, without limiting the foregoing, this disclaimer of liability applies to the accuracy, completeness, effectiveness, quality, appearance, ideas, or products, as the case may be, of or resulting from any statements, references, articles, positions, claimed diagnosis, claimed possible treatments, services, or advertising, express or implied, contained in any ACCP publication or other product. Furthermore, the content should not be considered medical advice and is not intended to replace consultation with a qualified medical professional. Under no circumstances, including negligence, shall any of the ACCP Parties be liable for any DIRECT, INDIRECT, INCIDENTAL, SPECIAL or CONSEQUENTIAL DAMAGES, or LOST PROFITS that result from any of the foregoing, regardless of legal theory and whether or not claimant was advised of the possibility of such damages.
CME Instructions
CME for this activity is available through December 31, 2009. To receive CME credit and print your certificate, complete an online evaluation:
- Go to www.chestnet.org, and click on the “CME Certificates” icon.
- Log in using your ACCP ID number or e-mail address on file with the ACCP. Enter your ACCP ID number, and click submit, OR, if you do not have an ACCP ID number, click on the link “Create an account here.”
- To locate the product for which you want to claim CME credit, look under the “Available CME” tab on the left navigation bar.
- Click the “Claim Credit” link next to the product to begin the certificate process.
- Complete any required posttest and evaluation. Please be sure to check the box that states you are finished with the evaluation.
- Once you submit the evaluation, your CME certificate will be created and will show under the tab, “My CME History.” You can print it at any time by clicking the “Certificate” link.
If you need help, please contact the CME Administrator via e-mail at CME@chestnet.org, or leave a voice mail message at (847) 498-8376. For faster assistance, please outline the specific problem you are having, and provide your ACCP ID and contact information.
Related Materials
Download a Written Summary (pdf)
Download the Presentation Slides (pdf)
Case Study Questions and Responses
Curtis N. Sessler, MD, FCCP
Assessment of Sedation, Agitation, and Pain
Curtis N. Sessler, MD, FCCP
Pharmacologic Selection of Sedative and Analgesic Medications
E. Wesley Ely, Jr., MD, FCCP
Algorithms Useful for Sedation and Analgesia
John P. Kress, MD, FCCP
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