VANISH Trial – Gordon

closing

The New Sepsis Definition – Shankar-Hari

closing

The EUROTHERM trial – Andrews

closing

Mechanisms of ARDS – Summers

closing

 

Who to admit to ICU – Bassford

closing

 

The DESIST Trial – Walsh

closing

 

 

ECCOR2 / Rest – McNamee

closing

 

 

 

Closing Plenary ICS SoA 2015

 

Blogger Adrian Wong (@avkwong)

ECCO2R/REST

James MacNamee

Summary/Key messages

CVyeZdAWwAAPAJj.jpg-large

 

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

IMG_6560IMG_6559

 

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

IMG_6571

 

Peter Andrews

Peter AndrewsScreen Shot 2015-11-16 at 22.22.22

UK

Peter Andrews is an Honorary Professor at the University of Edinburgh, from August 1, 2007. He has an international reputation in Neurological Intensive Care and has sustained an active, externally funded research programme for more than twenty years.

Research streams include; “Direct Brain Cooling” studies attracting external funding of over £350K and public recognition of the importance of this work. This work has lead to grant funding to develop non-invasive measurement of regional brain temperature using magnetic resonance spectroscopy.

Prof. Andrews is the Chief Investigator of the EUROTHERM3235Trial investigating the use of titrated (www.eurotherm3235trial.eu) hypothermia after traumatic brain injury in patients with raised intracranial pressure. This has attracted funding of £900K from the European Society of Intensive Care Medicine for the pilot phase and the National Institute for Health, Health Technology Assessment board recently (September 2012) awarded £2.18Million for main phase of the trial.

Prof Andrews was the Chief Investigator of the “SIGNET Trial” (RCT in Scottish Intensive Care Units). This was the first UK non-commercial multicentre CT-IMP trial in critical care and had funding of over £1.5M (including £1.1M from the MRC, UK).

Prof Andrews is chairman of the VANISH and TOPSAT2 Trials DMCs and a member of another 4 DSMBs. Prof Andrews is section head for Neurological-Intensive Care (Europe) at Faculty of Medicine 1000 (http://www.facultyof1000.com) and member of the Scottish Neuroscience Council.