Figures
- Figure 1
Four key phases of the HERMES model.
- Figure 4
Timeline of the Delphi process.
Tables
- Table 1
CATEGORY Total n Delphi 1 Delphi 2 Delphi 3 Task Force Members 14 100% 93% N/A National Respondents 51 52% 47% 18% Respiratory Intensive Care Assembly 486 27% 22% 17% EU country representation 26 26 21 - Table 2 Syllabus modules
Module 1 Respiratory physiology and pathophysiology 2 Respiratory failure 3 Respiratory medical and surgical conditions 4 Ventilation and airway management 5 Other respiratory therapies 6 Cardiovascular disorders 7 Renal disorders 8 Central nervous system disorders 9 Metabolic and endocrine effects in critical illness 10 Infectious diseases 11 Acute haematological and oncological disorders 12 Acute gastrointestinal and abdominal disorders 13 Environmental hazards 14 Immunology and transplantation 15 Monitoring, quality control and biostatistics 16 Practical skills 17 Management 18 Communications and ethics 19 Research and evidence-based medicine - Table 3
European representation Albania Greece Romania Austria Hungary Russian Federation Belgium Iceland Serbia Bulgaria Ireland Slovakia Croatia Italy Slovenia Cyprus Lithuania Spain Czech Republic Netherlands Sweden Denmark Norway Switzerland France Poland Turkey Germany Portugal UK Syllabus # Item Level 1 Level 2 Level 3 Module 1: Respiratory physiology and pathophysiology 1 Pulmonary mechanics and gas exchange • 2 Ventilatory muscle physiology, pathophysiology, and therapy, including polyneuropathy of the critically ill and prolonged effect of neuromuscular blockers • 3 Pulmonary haemorrhage and haemoptysis • 4 Oxygen transport and utilisation • Module 2: Respiratory failure 1 Acute respiratory failure • 1.1 Hypoxaemic respiratory failure including acute respiratory distress syndrome • 1.2 Acute and chronic hypercapnic respiratory failure • Module 3: Respiratory medical and surgical conditions 1 Status asthmaticus • 2 Aspiration • 3 Chest trauma (e.g. flail chest, pulmonary contusion, rib fractures) • 4 Bronchopulmonary infections including bronchiolitis • 5 Upper airway obstruction • 6 Bronchopleural fistulas • 7 Pleural diseases in severe respiratory failure • 7.1 Empyema • 7.2 Pleural effusion • 7.3 Pneumothorax • 7.4 Haemothorax • 8 Pulmonary embolism — thrombus, air, fat, amniotic • 9 Pulmonary hypertension and cor pulmonale (including pharmacological treatment) • 10 Management of obese patient • 11 Sleep disordered breathing • 12 Near drowning (optional item) • Module 4: Ventilation and airway management 1 Oxygen therapy • 2 Hyperbaric oxygenation (optional item) • 3 Invasive mechanical ventilation • 3.1 PEEP and CPAP • 3.2 Indications for and hazards of mechanical ventilation • 3.3 Barotrauma and volutrauma, atelectrauma, biotrauma • 3.4 Extracorporeal membrane oxygenation (optional item) • 3.5 Extracorporeal CO2 removal (optional item) • 3.6 Lung-protective mechanical ventilation • 3.7 High-frequency oscillatory ventilation (optional item) • 4 Criteria for extubation and weaning techniques • 5 Airway maintenance • 5.1 Emergency airway management • 5.2 Endotracheal intubation • 5.3 Tracheostomy • 6 Noninvasive ventilation • 6.1 Choice of interfaces • 6.2 Ventilatory modes incl. CPAP • 6.3 Choice of ventilators • 6.4 Oxygen supply during NIV • 6.5 Indications and contra-indications for NIV • 6.6 Indication for withdrawing NIV • 6.7 Criteria of failure • Module 5: Other respiratory therapies 1 Positional therapy (i.e. prone position, rotational therapy) • 2 Inhalation therapies and humidification • 3 Nitric oxide (optional item) • Module 6: Cardiovascular disorders 1 Shock syndromes and hypoperfusion including management principles (obstructive shock, sepsis and sepsis shock, other distributive shock, multi-organ dysfunction syndrome, hypovolaemic shock, cardiogenic shock) • 2 Myocardial infarction and its complications • 3 Cardiac rhythm and conduction disturbances • 4 Pulmonary oedema — cardiogenic, noncardiogenic • 5 Vasoactive and inotropic therapy • 6 Haemodynamic effects caused by ventilatory assist devices • 7 Thrombolytic and anticoagulant therapy • 8 Recognition, evaluation, and management of hypertensive emergencies and urgencies• • Module 7: Renal disorders 1 Regulation of fluid balance and electrolytes • 2 Renal failure: pre-renal, renal and post-renal • 3 Acid–base disorders and their management • 4 Evaluation of oliguria • 5 Drug dosing in renal failure • Module 8: Central nervous system disorders 1 Coma: causes, assessment and prognosis • 2 Neuromuscular disease causing respiratory failure • 2.1 Guillain-Barré syndrome • 2.2 Amyotrophic lateral sclerosis • 2.3 Myasthenia gravis • 2.4 Myopathies (Duchenne's, etc.) • 2.5 Post-operative phrenic nerve dysfunction • 3 Principles of sedation • 4 Principles of pain management • 5 Neuromuscular blockade: use, monitoring, and complications • 6 Delirium and agitation • Module 9: Metabolic and endocrine effects in critical illness 1 Evaluation of nutritional state • 1.1 Enteral and parenteral • 2 Glucose management • Module 10: Infectious diseases 1 Antibiotics • 1.1 Antibacterial agents • 1.2 Antifungal agents • 1.3 Antituberculosis agents • 1.4 Antiviral agents • 2 Infection control for special care units • 2.1 Development of antibiotic resistance • 2.2 Universal precautions • 2.3 Isolation and reverse isolation • 2.4 Infectious risks to healthcare workers • 3 Definition, diagnosis and treatment of sepsis syndrome • 4 Systemic inflammatory response syndrome • 5 Hospital-acquired and opportunistic infections in the critically ill • 6 ICU support of the immunosuppressed patient • 7 Evaluation of fever in the ICU patient • Module 11: Acute haematological and oncological disorders 1 Disseminated intravascular coagulation • 2 Anticoagulation; fibrinolytic therapy • 3 Principles of blood component therapy including complications • 4 Prophylaxis against thromboembolic disease • 5 ICU-acquired anaemia • Module 12: Acute gastrointestinal and abdominal disorders 1 Prevention, treatment and principles of gastrointestinal bleeding • Module 13: Environmental hazards 1 Drugs and narcotics leading to respiratory failure • 2 CO poisoning • 3 Biological and chemical terrorism (optional item) • Module 14: Immunology and transplantation 1 Principles of transplantation (organ donation, procurement, preservation, transportation, allocation, implantation, maintenance of organ donors, national organisation of transplantation activities) • 2 Immunosuppression • 3 Lung transplantation: indications, pre-operative and post-operative care • Module 15: Monitoring, quality control and biostatistics 1 Prognostic indexes, severity, and therapeutic intervention scores • 2 Principles of ECG monitoring, measurement of skin temperature and resistance, transcutaneous measurements • 3 Noninvasive haemodynamic monitoring • 4 Respiratory monitoring • 5 Telemetric systems (optional item) • Module 16: Practical skills 1 Interpretation of sputum, bronchopulmonary secretions, and pleural fluid • 2 Arterial puncture for blood gas determination and arterial catheter placement • 3 Principles, indications and limitations of pulse oximetry • 4 Physical principles, indications and limitations of end tidal and transcutaneous CO2 monitoring • 5 Pulmonary function testing to assess respiratory mechanics and gas exchange, including spirometry, flow–volume studies, lung volumes, diffusing capacity • 6 Arterial blood gas analysis • 7 Airway management including endotracheal intubation • 8 Management of the difficult airway • 9 Modes and principles of mechanical ventilation — invasive and noninvasive • 10 Modes and principles of oxygen supplementation • 11 Tracheostomy tube management and decannulation • 12 Emergent cardioversion and defibrillation • 13 Evaluation of sedation • 14 Diagnostic and therapeutic thoracentesis • 15 Chest tube insertion and maintenance of the tube and drainage systems, insertion of decompression needle for tension pneumothorax • 16 Central venous catheter placement (subclavian, femoral, jugular) with/without ultrasound guidance • 17 Set-up and operation of haemodynamic and respiratory monitoring systems • 18 Interpretation of haemodynamic and oxygen delivery and extraction data • 19 Diagnostic bronchoscopy including airway examination and bronchoalveolar lavage • 20 Therapeutic bronchoscopy (through an artificial airway) for secretion removal • 21 Insertion of nasal gastric and feeding tubes • 22 Imaging techniques commonly employed in the evaluation of patients with critical illness and/or pulmonary disorders • 23 Basic interpretation of chest radiograph • 24 Advanced cardiac life support • 25 Inhalation and humidification and secretion clearance devices • 26 Application of extracorporeal CO2 removal (optional item) • 27 Percutaneous tracheostomy (optional item) • Module 17: Management 1 Understanding and evaluation of health cost and economics • 2 Resource allocation • 3 Triage (direction of patient flow to and off critical care units) • 4 Knowledge of prevailing legal norms regarding the legally incompetent patient, euthanasia, brain death determination and organ donation • Module 18: Communications and ethics 1 Appropriate verbal and written communication • 2 Handling emotional effects of severe illness • 3 Handling of unfavourable messages and complaints • 4 Understanding medical ethics in due consideration of socioeconomic, cultural and religious differences • 5 Respect of patient autonomy • 6 Assessment of utility and futility of diagnostic and therapeutic procedures • 7 Informed consent • 8 End-of-life decision making and care • 9 Quality of end of life • Module 19: Research and evidence-based medicine 1 Application of guidelines • 2 Scientific literature appraisal • 3 Use of information technology •
Vol 8 Issue 3
Table of Contents
Respiratory critical care HERMES: a European core syllabus in respiratory critical care medicine
