I know I’d been saying that I probably wouldn’t have time to attend Wes Ely’s Grand Rounds presentation yesterday, “A New Frontier in Critical Care: Saving the Injured Brain.” But against all odds, I actually got to go, along with some medical students and a Family Medicine resident.
As I expected, Dr. Ely brought the house down. His talk was similar to the one he gave at Emory University in Atlanta, Georgia, but not identical. He described the results of the study “Haloperidol and Ziprasidone for treatment of Delirium in Critical Illness,” published last October in the New England Journal of Medicine. There’s a YouTube video of that in my March 28, 2019 post announcing his visit to Iowa City.
He also discussed in detail the ABCDEF bundle for protecting the brains of patients in the ICU.
When he outlined the history of intravenous haloperidol for the treatment of delirium in critical care units, I had to cringe because I remembered the continuous IV haloperidol infusion protocol (running at 5-10 mg an hour) developed by Riker and colleagues. I mention it for historical reasons only. I don’t recommend using it.
Riker, R. R., G. L. Fraser and P. M. Cox (1994). “Continuous infusion of haloperidol controls agitation in critically ill patients.” Critical care medicine 22(3): 433-440.
After his presentation, Dr. Ely asked for questions. I asked him what he thought the role of the psychiatrist is regarding ICU delirium. He actually recognized me; we met very briefly at a meeting of the American Delirium Society in Indianapolis several years ago.
Even better, he knew enough to mention the catatonic variant of delirium and the irony of using a benzodiazepine to treat it, which you would avoid like the plague in delirium (except for alcohol withdrawal, for example). However, benzodiazepines can reverse catatonia. See my post from April 10, 2019 (“Delirium and Catatonia: Medical Emergencies”). He thought psychiatrists would know more about that and would be important collaborators in managing catatonia.
It’s difficult not to be excited by the advances in medicine and psychiatry when an inspirational scientist, humanist, and visionary leader like Wes comes to town. It makes me wonder how I’m going to get a buzz like that out of anything I do in retirement.
On the other hand, I get a kick out of making silly videos.
Go Retire Psychiatrist 