Reductionism vs Numerology: why less is best

Why less is often more in ICU

The lecture duration is 33min.

0.75 CPD Points, 0.75 CEUs, 0.75 AMA PRA Category 1 Credits.
Accredited by CPDUK, CBRN and EB Medicine.

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John Myburgh
Professor of Intensive Care Medicine, The George Institute, Australia
Lecture Summary

The optimal treatment of vulnerable, critically ill patients depends primarily on two factors: the patient's innate response to the insult (host response) and minimising secondary insults (iatrogenesis). The host response is primarily genetically determined, but the adequacy of this response is influenced by associated co-morbidities and environmental factors such as access to effective health care. In this context, the greatest impact on human survival has evolved from advances in preventive medicine, public health initiatives, universal health access, and medical technology. While Intensive Care Medicine has resulted in major improvements in the care of critically ill patients, many of the fundamental interventions have evolved through physiologically-based paradigms, often predicated on normalising short-term variables, clinical measurements, or surrogate clinical endpoints. When many of these strategies are tested in comparative effectiveness studies, evidence of adverse impacts on patient-centered outcomes has emerged that is often attributed to iatrogenic injury. While some technological advances have delivered substantial benefits, the safety and efficacy of these technologies have not been evaluated by high-quality studies. This technological imperative is associated with inexorable indication creep, overuse, and misapplication of related strategies that are applied with little consideration of adverse down-stream consequences that independently affect patient-centered outcomes. Coupled with non-validated management bundles and clinical practice guidelines, the art and science of medicine is lost, so that effective treatment directed at augmenting the innate host response over the course and trajectory of critical illness becomes obscured.

Target Audience

Critical Care Doctors
Experienced or advanced Critical Care Nurses

Learning Objectives:

Upon completion of this activity, you should be able to:

  • Understand key principles of the trajectory of human illness
  • Appreciate that physiological-based treatment strategies do not translate to improved patient-centred outcomes
  • Re-evaluate the clinical utility and safety of fundamental interventions such as fluid resuscitation and haemodynamic management
  • Understand the basic concept of a “driver diagram” and how it can be used to plan Re-evaluate temporal changes to patient-management and recognise iatrogenesis manage care

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of EB Medicine and Continulus. EB Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

EB Medicine designates this internet-enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Needs Assessment

The need for this educational activity was determined by surveys of the target audience and experts in the specialty. Further assessment was provided by examining the topics of recently published evidence-based medicine reviews, national clinical guidelines, and specialty society recommendations, as well as suggestions from evaluations of previous learning programs to determine practice gaps.

CME Faculty Disclosure

It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME accreditation requirements and policies, all faculty for this CME activity were asked to complete a full disclosure statement. The speaker did not report any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.

Earning Credit

In order to earn CME credit, the participant must take the pre-test, watch the course, take the CME post-test, and complete the post-test evaluation.

Hardware/Software Requirements

Online learners will need a computer or web-enabled device to access the podcast, additional learning materials, and CME test.

Commercial Support

This activity received no commercial support.