Critical Care Reviews meeting 2016 blog – Session 3

Paul Young (@DogICUma): Should we treat the HEAT?

WICS Bottom Line review

What is the point of fever?

Helps fight infection in animals…

  • Mice and klebsiella
  • Pigeons and pneumococcus
  • Bees and fungal infections

The higher the temperature in first 24 hours in those with an infection, the lower the mortality

In pre-defined analysis of survivors and non-survivors, paracetamol seem to prolong life of these non-survivors

Reasons that this might be:

Paracetamol blocks oxidative stress. Maybe it’s useful in delaying death and facilitate a window for recovery in ICU?


Anthony Gordon (@agordonICU): Vasopressin or Noradrenaline: should either VANISH?

VANISH isn’t published yet (its not quite through the peer review process!) but it has been presented at meetings so is fair game for a quick summary…

Untitled2UntitledThe role of vasopressin differs in health and shock/septic shock.

VASST trial

VANISH trial design

Vasopressin did point towards an increase in digital ischaema vs norad (although Confidence interval crosses zero)

As promised Anthony Gordon would:

  • 1st line Noradrenaline
  • add vasopressin earlier but no magic number
    • Especially if renal dysfunction developing or arrhythmias/tachycardias
  • Care with vasopressor combination especially in combination
  • Steroids

Pending Rob releasing this talk or the paper coming out, try this from December:

Tim Walsh (@Ed_TimWalsh): Does Rehab help ICU patients RECOVER?

Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting

Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge The RECOVER Randomized Clinical Trial

Pts refused trial as they were “too tired”.

NO benefit shown except for some pt satisfaction scores – but is this a reflection of their premorbid state? So RECOVER hasn’t shown a benefit despite all the investment and application of “seems like a good idea”

Cost of intervention is £700 per patient treated

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness

Christopher Nutt (@nuttchristopher) 2015 Critical Care Literature: The Best of the Rest

*Chris stepped up when Rob “The Machine” MacSweeney broke down.

Amongst the numerous studies discussed……. YOU HAVE TO LISTEN TO THE RECORDING. All the important 2015 trials summarised in 25 minutes! And try and beg/borrow/steal the outstanding conference book.

EUROTHERM – worse neuro outcome and mortality in intervention group

EPO-TBI

ICEREA – Endovascular versus External Targeted Temperature Management for Out-of-Hospital Cardiac Arrest Patients: A Randomized Controlled Study

Effect of Corticosteroids on Treatment Failure Among Hospitalized Patients With Severe Community-Acquired Pneumonia and High Inflammatory Response

FLORALI

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome

PERMIT Trial

TiTRE2 Trial
3 SITES Study

 

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