A session blog from Day 1 of State of the Art, London December 2015. See the full list.
“Fever in patients with sepsis: is it cool to be hot or is it hot to be cool?”
Rinaldo Bellomo kicks off the new look SOA ICS 2015 with the Pre-plenary Talk:
He opens by talking about Syphilis – interesting start for an ICU conference! Highlights that syphilis and gonhorrea cause fever.
Fever vs outcome in ICU population – high temperature doesn’t relate to worse outcome. Brings the question – is paracetamol beneficial or harmful?
So sets up the HEAT trial – Fever + infection – 700 ICU patients are randomised to paracetamol or placebo given every 6 hours.
He goes through the trial algorithm for daily surveillance of fever.
The 2 groups are checked for baseline characteristics which matched in both groups (treatment vs placebo).
The average drop of temperature with patients on paracetamol is between 0.6-0.7C max. (p<0.001) which proves it does reduce temperature.
Big question – did patients on paracetamol have a better outcome? Answer- maybe! But…the most striking aspect is that non-survivors spent 4-10 days longer in ICU if they had paracetamol. This was not expected and the importance of the observed difference is unclear.
Why did paracetamol behave differently according to whether a patient lived or die? RB then asks the audience, by chucking about a big soft microphone in a box to get audience participation – if they haven’t been concussed.
Questions and Suggestions include:
– Paracetamol might have an effect on inflammatory mediation? Perhaps has an anti-inflammatory effect?
– Does Paracetamol influence multi-organ failure?
– Paracetamol – drops heart rate, resp rate, fever. Perhaps it deludes doctors who think that the patient is getting better.
“Come and light my fire”
Mark starts by warming up the crowd, highlighting the need of the delegates to participate, not vegetate. He is hoping that people won’t be subjected to a slow death by PowerPoint, with some good examples of poor practice in this zone (blue screen, yellow New Roman font etc).
His list of Bad Things include:
Clip Art, Too much Text, Rubbish quality pictures, Gimmicky transitions, Video that doesn’t work and PCs that let you down.
Next is how to present your data in an innovative way. He uses the old failed intubation diagram as an example of how to confuse your stressed user.
Prezi and Haiku Deck can help present complex ideas and results if used wisely.
Presidents don’t use slides, and Steve Jobs practised his talks to the infinite degree before his big Apple keynotes.
Mark cites SMACC as a great example of snappy, well-delivered high quality content in the world of ICU/ED medicine, and John Hinds (RIP) was the consummate professional in this arena.
He finishes with the question – ‘Who is going to light your fire at the conference this year?’
Let’s hope that the speakers have taken note – I can see a few people scurrying away desperately changing their 125 slide presentations!
Question from the audience – how does body language help or hinder? Answer – don’t irritate the audience, it’s how you deliver the content of your talk! The number of slides doesn’t matter, it’s how effective the slides are to augment your talk.
“Assessing the adequacy of oxygen delivery: can’t we do better?”
Final session from John Kheir, a staff physician at Boston Children’s Hospital Heart Center.
What’s the fundamental question we are asking on our ward round every day? He says ‘ is our patient being delivered adequate oxygen to the tissues?’
Lots of ways to try and answer this question, but he quotes Einstein ; ‘Not everything that can be counted counts – not everything that counts can be counted’.
As an aside, John has clearly done his homework on presentation – beautiful graphics, clear text and slides.
As clinicians, we look at mixed venous saturation, but not O2 consumption. How can we measure the latter, and is it valuable? Perhaps more than lactate /mixed venous sats.
Go back to mitochondria – if you deprive it of o2, there’s no current down electron transport train. This causes reduction in oxidation proteins and these can be measured. His group have created a probe which can measure reductive state of mitochondria using a rodent model. He shows a pretty graph showing change in protein expression according to hypoxic or normal environment.
Difficult to hear questions as the podium is now surrounded with eager delegates but a great session.