Opportunities in critical care management of the ICU patient
By Deepak Sudheendra, MD, FSIR, RPVI, and Mark Reddick, MD, MS, RPVI Summer 2017
Interventional radiologists have pioneered minimally invasive procedures that obviate the need for patients to undergo high-risk surgery. As IR procedures have advanced and become more sophisticated, the medical complexity of patients presenting to the IR suite has also increased. This trend presents a clinical dilemma in that most IRs practicing today do not traditionally have the background and training to medically manage critically ill patients.
Because of the increased level of clinical acumen needed to care for critically ill patients, it is imperative that the IR team be prepared for the potential challenges that can arise in the IR suite. As a result, a new session approved for SAM credit was offered at the SIR 2017 annual meeting: “Critical care management of the ICU patient in the angio suite.” The session was spearheaded by Deepak Sudheendra, MD, RPVI, FSIR, who is also a surgical critical care attending physician, and co-moderated by Mark Reddick, MD, MS, RPVI.
The session's objective was to present IRs with various clinical scenarios involving critically ill patients in the angio suite and ask them how they would manage the medical problems of the patient in addition to the IR issue at hand in the absence of a code team. To illustrate the salient learning objectives involved with trauma and critically ill patients, two guest speakers from the Hospital of the University of Pennsylvania—Benjamin Braslow, MD, FACS, chief of emergency general surgery, and Scott Falk, MD, associate professor of anesthesiology and critical care—presented various cases to educate physicians on the importance of having a methodical plan when dealing with trauma, sepsis, bleeding, hypotension and many other issues that are faced in IR today.
Faculty discussed such management dilemmas as concomitant thoracic and pelvic trauma, respiratory arrest, massive blood loss, and sepsis. They asked attendees how they would manage the “crashing patient” in the absence of a code team and about their comfort level using iontropes, pressors, blood products and more.
Interventional radiologists have often been criticized by other specialists for not being able to manage patients. According to Dr. Reddick, “With the new IR/DR training program, future IR trainees will receive increased clinical training through ICU rotations.” In the meantime, Dr. Sudheendra hopes that this type of session will not only play a part in educating present and future IRs in how to better care for their patients but also help change the perception that IRs are merely technicians and not clinicians.
The authors have reported no disclosures pertaining to the article.