Closing Plenary ICS SoA 2015

 

Blogger Adrian Wong (@avkwong)

ECCO2R/REST

James MacNamee

Summary/Key messages

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DESIST

Tim Walsh

Summary/Key messages

  • Strategies to improve sedation on ICU
  • Unnecessary deep sedation
  • Explore 3 system-wide interventions
    • webbased modular educational resource
    • Feedback of sedation quality at regular intervals
    • introduction of novel technology – RI measure
  • Sedation Quality Assessment Tool to assess the outcome
  • https://clinicaltrials.gov/ct2/show/NCT01634451 trial protocol
  • http://www.ccforum.com/content/19/1/333
  • Results
    • Typical pt – education and responsiveness technology seem to be best for optimum sedation
    • RI can improve optimum sedation
    • Sedation quality feedback alone was not effect
    • BUT no standardisation of sedation protocol

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Who to admit to ICU

Chris Bassford

Summary/Key messages

  • ICU causes harm and doesn’t always work
  • Type 1 error (false positive) – give them a go
  • Type 2 error (false negative) – let them go

 

 

Mechanisms of ARDS

Charlotte Summers

Summary/Key messages

  • NOthing seems to work with regards to treating ARDS
  • Why is nothing working?
    • Syndrome not disease
    • Don’t understand biology in humans
  • Known known
    • lots of things can cause ARDS
    • ventilate badly = do badly
  • Known unknowns
    • not everyone gets ARDS
    • one disease or many
    • how do we stop it happening
  • Unknown unknowns
    • Neutrophil biology
    • Pulmonary circulation is special
  • Flow in large pulmonary vessels is pulsatile but not at capillary level

 

References/Further reading

 

EUROTHERM

Peter Andrews

Summary/Key messages

New sepsis definition

Manu Shankar-Hari

Summary/Key messages

  • Sepsis-3 update
  • Why change?
    • SIRS/Sepsis definition messy – different ways to identify a sepsis case
    • New definiton is data-driven
  • Host responses NOT just ‘pro-inflammatory’
  • SIRS negative sepsis is common on the ward
  • Straightforward infection needs to be separated from sepsis
  • New definition is sepsis as bad infection
  • qSOFA – low BP, altered mental state, raised RR (thresholds to be specified in Feb)
  • Septic shock 3.0 – subset of sepsis where underlying circulatory and metabolic shock are likely to lead to increased risk of death
    • post-fluid resuscitation
    • need for vasopressor to support low bp
    • raised lactate

 

VANISH

Anthony Gordon

Summary/Key messages

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