Playing Catch Up in the ICU: The Role of Psychiatrists in Navigating Mental Status Alteration in Critically-Ill Patients.

Abstract: Following on the tradition of previous Pre-Conference Courses by the Critical Care Psychiatry (CCP – SIG), attendees will be able to navigate an extremely complex intensive care clinical case, through the eyes of CCP specialists working along the ICU team.
Dr Ha will begin by introducing the assessment of adequate mental status and working through the differential diagnosis of mental status alteration in the Critical Care setting and the role of Critical Care Psychiatrists. This includes the management of Pain, Immobility, Anxiety, and Sleep Disruption in Adult Patients in the ICU. He will also introduce the case of a 70 y/o man with a complex past medical and psychiatric/substance use history who is admitted to the Cardiothoracic Care Unit for an emergency valve replacement. The case will be used to introduce complexities in the clinical care of this patient population and will serve as a platform for each consequent presentation.
Dr Jiang will take on the case and discuss the details of conducting state of the art bedside neuropsychiatric testing – both screening and confirmatory testing by CLP, the use of available biomarkers and the introduction of novel technologies for the assessment of altered mental status (including EEG/Ceribell, and optical imaging). His topic will include the recognition, diagnosis, and monitoring of delirium & its differential diagnoses, including non-convulsive status. Thus, following the case, Dr Jiang will demonstrate how the use of these technologies allows CCP specialist to differentiate between delirium and other potential causes of AMS.

Dr Maldonado will discuss the multiple psycho-pharmacological prevention and management of techniques that could be used in the Critical Care Units, including the issue of the unique pharmacokinetic and dynamic changes introduced by the critically ill environment and technologies, such as ECMO and hemodialysis systems. Following along with our patient’s case, Dr Maldonado will discuss the various drug-drug interactions, address how altered metabolisms both needs to be navigated to allow for life saving drugs to be administrated, but at the same time deal with the consequences of altered kinetics.

Dr Gunther will address the topic of pharmacologic neurotoxicities, & their complications (including tacrolimus, cefepime, ketamine, lidocaine toxicities and drug – drug interactions, as well as differentiating, ruling in or out, and managing potentially lethal medication side effects such as serotonin syndrome and NMS.

The intent of this course is to serve as a hand-son session, that both provides an interactive and fun educational experience, while at the same time challenges the boundaries of clinical expertise and introduces cutting edge technologies to assist in our day-to-day work with a robust discussion by all panelists and questions from the audience at the end of the presentation. At the end, we will have a Q&A session and discussion between the attendees and the audience to review the principles presented.

We intend to use an audience response system to enhance audience participation and engagement.

This course is endorsed by the Critical Care Psychiatry SIG.