SCCM Resource Library-Atrial Fibrillation in the Critically Ill: What, When, How, and What If?

Video Transcription

Video Summary

The video transcript discusses the management of atrial fibrillation (AFib) in critically ill patients. The speakers discuss the causes of AFib in the ICU, such as inflammation, vasopressor use, electrolyte imbalances, and volume overload. They also mention different pharmacological options for managing AFib in the ICU, including calcium channel blockers, beta blockers, amiodarone, and magnesium. The effectiveness and tolerance of these agents in critically ill patients are debated. The speakers also touch on the potential role of steroids, vitamin C, and dexmedetomidine in preventing AFib in ICU patients, but note that further research is needed. The use of anticoagulation in AFib patients in the ICU is addressed, with a discussion on the challenges of maintaining therapeutic levels without increasing the risk of bleeding. Individualized approaches to managing AFib in critically ill patients are highlighted, taking into account each patient's specific risks and benefits of different pharmacological options.<br /><br />In the second summary, the video transcript covers the management of AFib in general. The speaker emphasizes the importance of identifying and treating the underlying causes of AFib and discusses the use of rate control and antiarrhythmic medications. Beta blockers, such as metoprolol and esmolol, are recommended as first-line treatment for rate control. Amiodarone is highlighted as an effective antiarrhythmic for patients with heart failure or reduced ejection fraction. Other antiarrhythmic drugs, such as ibutilide, flecainide, and sotalol, are mentioned, with the choice depending on the patient's underlying heart disease and risk factors. Cardioversion may be necessary for unstable patients or non-responders to rate control medications. The importance of anticoagulation before, during, and after cardioversion to reduce the risk of thromboembolism is stressed, with the use of the CHA2DS2-VASc score to guide long-term anticoagulation. Individualized treatment based on the patient's clinical characteristics and risk factors is emphasized to achieve rate control and/or rhythm control while minimizing complications.

Asset Subtitle

Cardiovascular, Pharmacology, 2020

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2020 Critical Care Congress held February 16-19, 2020, in Orlando, Florida, USA.

Learning Objectives

Manage atrial fibrillation with appropriate pharmacotherapy at the appropriate time in selected populations
Determine preventative measures for atrial fibrillation in the critically ill population
Discuss the benefits of interventional cardiology and other measures to treat refractory atrial fibrillation

Pharmacology: The First (and Last) Line of Defense?

Nicole M. Palm

Prevention Is Easier Than Cure!

Douglas F. Naylor Jr

Fibrillation in Critical Illness: Where Do I Go When All Else Fails?

Jacob C. Jentzer

Meta Tag

Content Type Presentation

Knowledge Area Cardiovascular

Knowledge Area Pharmacology

Knowledge Level Foundational

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Atrial Fibrillation

Tag Cardiothoracic Critical Care

Year 2020

Keywords

AFib

critically ill patients

inflammation

pharmacological options

calcium channel blockers

beta blockers

amiodarone

magnesium

anticoagulation

rhythm control

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